Essay — From the November 2017 issue

Monumental Error

Will New York City finally tear down a statue?

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Since the 1990s, one of the most prominent figures in the Sims controversy has been L. Lewis Wall. Wall’s résumé makes you feel like you’ve wasted your life. He holds two doctorates, is a professor of medicine, social anthropology, and bioethics, and founded the Worldwide Fistula Fund, which has launched clinical programs to combat the scourge in Niger, Ethiopia, and Uganda. Wall has performed hundreds of fistula surgeries in Africa, and has seen firsthand the struggles of aid efforts — including local corruption and political exploitation. Just as onerous, in his view, was “fistula tourism”: non-African doctors making blitzkrieg trips to Africa to rack up “good cases.” Wall responded with two articles, “A Bill of Rights for Patients with Obstetric Fistula” and “A Code of Ethics for the Fistula Surgeon.”

The latter manifesto stands in stark contrast to Sims’s lifelong hostility toward medical ethics. He always hated rules, and a petulant inability to follow even those he had agreed to has been viewed by his champions as an element of his puckish persona. Yet Sims did sometimes pay for his rule-flouting tendencies. In 1870 — thirteen years before assisting with the Sims Memorial Fund Committee — the New York Academy of Medicine put him on trial for ethics violations. Sims had written publicly about the condition of the theater star Charlotte Cushman, whom he had once seen in private practice. In doing so, he violated his patient’s confidence and ignored an ethical prohibition against doctors seeking publicity — hardly a first for Sims, who had a ringmaster’s flair for self-promotion and had once socialized with P. T. Barnum.5 Sims was found guilty. He was given a formal reprimand, which would subsequently be characterized by his detractors as a draconian penalty and by his supporters as a slap on the wrist.

5 There is no evidence yet to suggest that pomposity and narcissism are hereditary conditions. Let’s recall, however, that our current president’s tasteless retreat at Mar-a-Lago was designed by the grandson of J. Marion Sims.

Judging from this, one might suspect that Wall would have pitched his tent in the camp of Sims’s critics. Instead, as the debate turned rabid, Wall kicked back against Sims’s detractors. No, he argued, Sims did not deliberately addict his experimental subjects to opium. As to anesthesia, Wall calmly noted, the exterior of human genitals is indeed sensitive, but that the inner lining of the vagina is not nearly as innervated as one might expect.

Wall is not above reproach. For example, he decided on the basis of the little information available that Sims’s experiments were “performed explicitly for therapeutic purposes.” This conclusion overlooks the social and economic realities of the South, and the less than altruistic reasons that a plantation owner might send a woman suffering from a fistula in search of a cure: the sexual exploitation of slaves, and the financial benefits to be reaped from breeding additional human chattel. In any event, in the zero-sum game of journalism, Wall found himself positioned as Sims’s highest-profile defender, even though he had been the first to suggest that there should be a monument to Anarcha, Betsey, and Lucy.

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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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