Essay — From the November 2017 issue

Monumental Error

Will New York City finally tear down a statue?

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In 1845, Marion Sims was a thirty-two-year-old doctor with ten years of experience in the South’s Black Belt. He served Alabama’s free black population; he contracted to care for the slaves of local plantation owners; and his office and home in downtown Montgomery included a small backyard facility he called the Negro Hospital. Tending to the medical needs of current and former slaves was an economic necessity in an area where two thirds of the population was black. Indeed, Sims was a slaveholder himself: he had accepted an enslaved couple as a wedding present from his in-laws, and he came to own as many as seventeen slaves before he moved to New York City in 1853. Letters to his wife (“Negroes and children always expect liberal presents on Christmas”) betray a rank paternalism typical of antebellum Southerners.

Medicine had been a default vocation rather than a calling. Sims’s mother steered him toward the cloth, his father toward the law, and the latter complained, when his son settled on medicine, that there was no “honor” or “science” in it. Sims attended medical schools in South Carolina and Philadelphia, and soon settled on surgical innovation as the best path to a lucrative practice and a permanent legacy. At the time, this involved learning new procedures from medical journals, and Sims made a name for himself by treating clubfoot and crossed eyes.

Source photographs: bust of Confederate general Stonewall Jackson © Drew Angerer/Getty Images; statue of Chief Justice Roger Brooke Taney © Dennis MacDonald/Alamy Stock Photo; statue of a horse in the Confederate Army © Jerry Jackson/Baltimore Sun/TNS via Getty Images

More grandiosely, he announced that he had devised a better method for dislodging foreign objects from the ear, and that he had discovered the cure for infant lockjaw. He would later apologize for the first claim, acknowledging that others had preceded him in syringing the ear. But he went to his grave insisting that his cure for lockjaw was his “first great discovery in medicine.” He couldn’t have been more wrong. Zealous in his belief that most maladies were by nature mechanical, Sims had attempted to cure a number of suffering slave babies by prying up their skull plates with an awl. Shortly after Sims died, in 1883, scientists identified lockjaw as a bacterial infection, also known as tetanus.

By Sims’s account — as related in The Story of My Life (1885), published posthumously and excerpted in this magazine — his next great discovery came just two months after the first. In the summer of 1845, he was asked to treat three young female slaves with holes inside their vaginas. A few days after delivery, fistula sufferers experience a sloughing away of dead tissue, most often leaving an opening between the vaginal canal and the bladder. Once afflicted, women are cursed with a perpetual leak of urine from their vaginas, frequently resulting in severe ulceration of the vulva and upper thighs.

These were the first cases of VVF that Sims had encountered. It’s not surprising, given his later confession that he had initially “hated investigating the organs of the female pelvis.” A little research revealed that doctors throughout history had been stymied by the affliction. The basic problem, surgically speaking, was that you had little room to see the wound you were attempting to close, let alone to stitch sutures in the secreting tissue. Sims concluded that all three of the women were untreatable, but the last, having traveled from Macon County, was permitted to spend the night in his Negro Hospital, the idea being that she would leave by train the following afternoon.

There the story might have ended — except that the next morning, Sims was called to attend to an emergency. A white seamstress had dislocated her uterus in a fall from her horse. Sims grudgingly made his way to her home and placed her facedown with her buttocks awkwardly elevated in what doctors called the knee-chest position. The idea was to vigorously push her uterus back into place. Sims was first surprised when the woman’s entire womb seemed to vanish, leaving his fingers flailing about in an apparent void — yet somehow this worked, her pain was immediately relieved. He was surprised again when the woman, lowering herself onto her side, produced a blast of air from her vagina.

The seamstress was mortified, but Sims rejoiced. The accident explained what had happened — and offered great promise besides. The position of her body and the action of his fingers against her perineum and the rear of the vaginal wall caused an inrush of air that inflated her vagina. Sims immediately thought of the young woman still waiting for a train in his backyard clinic. Might not the ballooning action of the vagina enable a doctor to clearly observe a fistula, and thereby cure a condition that had baffled the world’s leading medical minds for centuries?

Sims rushed home, stopping on the way to purchase a large pewter spoon that he believed would function more efficiently than his fingers. Two medical students assisted him with the woman — her name was either Lucy or Betsey, depending on how you read Sims’s account — and as soon as they put her in the knee-chest position and pulled open her buttocks, her vagina began to dilate with a puffing sound. Sims sat down behind her, bent the spoon, and turned it around to insert it handle first. He elevated her perineum and looked inside. He could see the fistula as plainly as a hole in a sheet of paper. Years later, Sims described the moment as if he had summited a mountain or landed on the surface of the moon.

“I saw everything,” he wrote, “as no man had ever seen before.”

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is the author of six books. His article “Getting to the End” appeared in the December 2015 issue of Harper’s Magazine.

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