This post is about a presentation that I did in my anatomy course during the Fall 2020 semester. This presentation is about James Marion Sims and the unethical experiments that he performed in the early 1800s. This information was derived from The Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, written by Harriet A. Washington which was a required reading for this course.
ABSTRACT The Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, written by Harriet A. Washington, is a historical account of medical experimentation on individuals of African descent. This mini-review aims to illustrate one such case of unethical medical experimentation described in Washington’s writing. James Marion Sims performed several unethical experiments on a group of enslaved women of African-descent under the guise of curing Vesicovaginal Fistula. Sims negatively impacted the integumentary, nervous, and urinary systems of his subjects, while violating ethical principles of the medical research protocol. It is an unfortunate observation that unethical experimentation on women which began as early as the 1800s persists today. Similar to the work of Sims, events of unethical surgeries have arisen in Georgia. In Georgia, Immigration and Customs Enforcement detention centers are under scrutiny for performing hysterectomies on detainees without their consent or knowledge.
KEYWORDS African-descent, Ethical Violations, Experimentation, Harriet A. Washington, James Marion Sims, Medical Experimentation, Systems of A&P, Vesicovaginal Fistula (VVF)
INTRODUCTION Harriet A. Washington’s book, The Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, focuses on the numerous unethical experiments performed on subjects of African descent (1). James Marion Sims is referenced within the book as a medical professional known for unethical experimentation. James Marion Sims was an American physician in the 1800s and developed surgeries and techniques that gave rise to the field of gynecology. He was the original gynecologist and is better known today as the “father of modern gynecology”. While his work has informed modern gynecological practices, his techniques and studies are now seen as controversial and raise many questions of ethics. Sims’ greatest accomplishments in the field of medicine are the inventions of the vaginal speculum, a medical tool used for dilation; and the development of a treatment for Vesicovaginal Fistula (VVF) (2). VVF is an abnormal tract from the bladder and exiting the vagina that causes continuous urinary discharge into the vaginal vault (3). This was widely observed in women who had undergone hardships in childbirth. Malnutrition and Vitamin D deficiency causes bone deformities, resulting in small pelvises, which regularly caused such hardships in childbirth (4). Sims’ research further suggested that Vesicovaginal Fistula was more common in women who experienced vaginal birth via forceps, specifically enslaved women of African-descent.
SYSTEM OF A&P FOCUS Sims’ discovery led to the unethical treatment of enslaved women to serve as a tool to further his search to successfully treat VVF. He performed surgeries without localized anesthesia due to his racist notion in assuming women of African descent were unable to feel pain. This severely impacted each woman’s integumentary, urinary, and nervous systems.
CURRENT EXAMPLES Sims performed vaginal operations on women without consent in the 1800s. Recently in the 21st century, there has been news of unwanted hysterectomies being performed on ICE women detainees. In mid-September, there was a whistle-blower complaint made by a nurse at a private detention center in Georgia. Although some of this information was not verified, the nurse claimed that several women at the detention center complained of having their uteruses removed without their consent or any formal notice. Similar to Anarcha and Sim’s other subjects, these women claim feeling shaken and confused by the procedures taking place on them (9). It is unfortunate to see that several years after Sims’ procedures, there are still unwanted procedures taking place on people today. This is only one example of the absence of consent in the medical procedures of minority groups. There are often cases that display the violation of the ethic of consent, some cases are highlighted and some are not. Several public figures today claim that James Marion Sims’ actions were justified under the umbrella of slavery. Whether or not Sims was righteous in his deeds seems like an uncomplicated question, but it remains a topic of controversy today. Furthermore, It is upsetting to see that events that were executed centuries ago and were documented in the Medical Apartheid more than 10 years ago are still taking place in parts of America today. However, reading the literature of this sort and understanding the moral dilemma behind this, opens doors for change and instills hope for a light at the end of the tunnel.
CONCLUSION Sims’ experimentation on women of African descent heavily influenced current practices in gynecology. His research brought about medical innovation however this was at the cost of psychological and unethical practices that were forced upon these women (4). Centuries later, non-white individuals are faced with the consequences of such unethical research and malpractice in communities of color. Injustice influenced by events of the past has resulted in health challenges in communities once subjected to unethical practices (7). In many communities there is mistrust of medicine and biomedical research, resulting in low adherence to medical treatments and public health guidelines, thus some communities have poor health outcomes and are predisposed to certain ailments (8). To address the inequities in healthcare, there has been a reevaluation of the medical education curriculum to focus on the treatment of vulnerable populations. One such example is The National Center on Medical Education, Development, and Research (NCMEDR) at Meharry Medical College. The NCMEDR is one of six academic units defined as national centers. These units were created to transform primary medical education and clinical practice through the Academic Units for Primary Care Training and Enhancement program (8). The NCMEDR uses Communities of Practice (CoP) to reform the medical curriculum with the input from organizations, academicians, researchers, stakeholders, but most importantly people who are considered to be vulnerable populations, and populations of interest. The Center works with their CoP to conduct research, identify gaps in medical education training, and disseminate research findings to improve the training of medical students so that they are trained to meet the needs of vulnerable populations (8). The goal of new training is to address the healthcare challenges of vulnerable populations; representing many needed voices to reduce the likelihood of unethical practices within biomedicine.
