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You should read Article 1 before class on Tuesday August 25.

In class we will do a jigsaw where we use the attached Graphic Organizer for Dr. J. Marion Sims Introduction to class:

1. Person 1 will read Articles 2 and 3 and summarize them.

2. Person 2 will read Article 4 and summarize it.

3. Person 3 will read Article 5 and summarize it.

4. After the jigsaw, each of you will read and respond to the two quotes in Article 6. Don’t know what to write? Some possible questions to respond to: What do you agree with? Disagree with? What do you have more questions
about? What fits with your experience? What does not fit with your experience? What is surprising, confusing, or memorable? What insights
or a-ha moments did you have? What connections do you see?

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Dorreen Gardner and Kenya Robinson

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Pioneer Works is pleased to present White Man On A Pedestal (WMOAP), a two-person exhibition by Doreen Garner and Kenya (Robinson), from November 10 - December 17, 2017. WMOAP questions a prevailing western history that uses white-male-heteronormativity as its persistent model.

Both artists approach WMOAP from an individual practice that is responsive to their experiences as black women operating in a system of white male supremacy. At a time when removing Confederate statues-literally white men on pedestals-are cultural flashpoints of whiteness and class, Garner and (Robinson) play with the size, texture, and scale of white monumentality itself, referencing both real and imagined figureheads of historical exclusion.

Garner's practice has long involved itself with medical histories. Her research on Dr. J. Marion Sims, canonized as 'The Father of Modern Gynecology,' reveals the savagery of his oft-repeated procedures on enslaved women, which were performed without anesthesia or even consent. These women have effectively been lost to history, while a statue of Sims holds court in Central Park. In WMOAP, Garner's process is two-fold: to recognize Sims' test subjects and to protest the doctor by three-dimensionally scanning his statue and rebuilding it in Pioneer Works. A silicon cast of it will be used to enact a 'dissection' of the monument in an interactive, constructed operating theatre, built as modular installation that will house sculptural work and serve as a space for live performance. Related "meat" sculptures hanging from a meat rack combine sutured skins, body parts, and surgical ephemera into organic, fleshy forms.

(Robinson) has been carrying the #WHITEMANINMYPOCKET (aka Dave Fowler) since 2013. As a 5-inch tall plastic example of an IRL emoji and an archetype of "success," the figure of a briefcase-touting, suit-wearing white professional has become a fetish object relevant to the contemporary corporate landscape and questions the privilege that is assigned to whiteness. It is a miniature representation of the absurdity of homogeneity in spaces of power. WMOAP offers a platform to lay this idea to rest by enacting a large-scale memorial service for the #WHITEMANINMYPOCKET. In addition to the procession, eulogy, and repast, (Robinson) will manufacture 10,000 'Daves' in the mode of the terracotta soldiers of ancient China, that after their display will ultimately be buried in an undisclosed location at the close of the exhibition.

Through WMOAP, Garner and (Robinson) collaboratively re-enact and hold a funeral for oppression, while revealing the difficulties of making this work within an institutional setting that too often benefits from systems of oppression. While their conversation brings together a literal and figurative cycle of meat and bone, life and death, it also foreshadows an institutional approach to exhibitions where a vested, active interest in inclusion and community engagement are at the core of the institutional mission, not just in its rhetoric or publicity apparatus.

The exhibition will serve as a catalyst for a sweeping anthology of new texts, canonical reprints, archival material, and discussions around white privilege in popular culture and art, slated for print with Pioneer Works Press in spring 2018.

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Kenya (Robinson) and Doreen Garner: White Man On A Pedestal

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Pioneer Works is pleased to present White Man On A Pedestal (WMOAP), a two-person exhibition by Doreen Garner and Kenya (Robinson), from November 10 - December 17, 2017. WMOAP questions a prevailing western history that uses white-male-heteronormativity as its persistent model. Both artists approach WMOAP from an individual practice that is responsive to their experiences [...]

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Article 1 - J. Marion Sims - Savior of Women or Medical Monster

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Article 1 - J. Marion Sims - Savior of Women or Medical Monster

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Introductory Reading from the Post and Courier

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Article 2 - The Statue of Dr. J Marion Sims in Bryant Park

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Article 2 - The Statue of Dr. J Marion Sims in Bryant Park

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Journal of the American Medical Association

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Article 3 - Unveiling of the Marion Sims Statue

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Article 3 - Unveiling of the Marion Sims Statue

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British Medical Journal

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Article 4 - Statue of Doctor Who Did Slave Experiments is Exiled. Its Ideas Are Not.

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Article 4 - Statue of Doctor Who Did Slave Experiments is Exiled. Its Ideas Are Not.

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New York Times

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Big City

As the statue of J. Marion Sims was taken from its perch on Fifth Avenue, a small crowd gathered and cheered. Credit... Mark Lennihan/Associated Press

Eight years ago, late one afternoon, Richard J. Moylan, the president of Green-Wood Cemetery, was watching the local news and caught Anthony Weiner, then a congressman, calling for a controversial statue, "Civic Virtue,'' to be removed from the front of a courthouse in Queens and sold on Craigslist. Referencing Classical allegory, the sculpture depicts virtuous good government in the form of a muscular 11-foot-tall man crushing writhing, feminized aquatic creatures meant to represent all that is inimical to it.

Women had complained about the statue for decades, but Mr. Moylan, outraged at the thought that it might simply be destroyed, gave it a home at Green-Wood, the cemetery that spreads over 478 acres of western Brooklyn, where a plaque now explains its history.

This week he took in another exiled sculpture, the bronze rendering of J. Marion Sims, which stood at the edge of Central Park on Fifth Avenue at 103rd Street for more than a century. On Tuesday, the statue was removed a day after an arts commission assembled by Mayor Bill de Blasio unanimously determined, that Sims, a doctor who performed experimental gynecological surgeries on slave women at his home in Alabama, should not be lionized, despite the medical achievements that provided the occasion for the statue's creation.

As it was being dismantled, a small crowd gathered and cheered. Commenters celebrated the city's decision as if officials had sent the statue to be destroyed, or otherwise shielded from public view, rather than merely relocated. "A monument to recognize a serial torturer of enslaved black women has no place in our city & today action is being taken to finally remove it," Letitia James, the city's public advocate, wrote on Twitter, a statement seemingly blind to the reality that the statue was moving from one highly trafficked quarter of the urban landscape to another.

Green-Wood, a national historic landmark, functions as few other American cemeteries do. Founded in 1838, it had become one of the most popular tourist attractions in the country, second only to Niagara Falls, by the 1860s. Over the past several years, as Brooklyn has grown and gentrified, Green-Wood has received more and more visitors - last year it took in 280,000. It essentially serves as a park and in that spirit, in recent years, it has offered trolley tours, birding walks, wreath-making classes, scavenger hunts and whiskey tastings.

As the conversations around dubious public sculpture have intensified in the wake of a fatal white supremacist uprising in Charlottesville, Va., over the removal of Confederate statues, we have come to imagine that eliminating a statue from the place where it has spent its long life, so unjustly, is the consummate expression of moral authority when really, in many cases, it is just a photo opportunity and a first step.

What happens next? In July, the city of Gainesville, Fla., decided to get rid of a statue of a confederate soldier in front of a municipal building; a local chapter of the United Daughters of the Confederacy (which still refers to "The War Between the States") wanted to claim it. Last year, after the University of Louisville took down a monument to Confederate soldiers, the small city of Brandenburg, Ky., welcomed it.

In February, the city of Pittsburgh decided to remove a statue of the composer Stephen Foster, whose music supplied the canon of American minstrelsy during the 1840s, from its prominent place at the entrance to Schenley Park. Commissioned in 1900 by Andrew Mellon and other wealthy industrialists, the sculpture depicts Foster sitting high above a black man who is positioned sycophantically playing the banjo at his feet. A local graveyard considered taking it.

At Green-Wood, Mr. Moylan had alerted New York City's parks department that he would provide a home for the Sims statue long before the commission had come to a decision, he told me. Sims is buried at Green-Wood and, as Mr. Moylan put it, "you go to the grave site now and you think, 'What a great guy!' I thought this would give us an opportunity to tell the story, good and bad."

The notion that certain kinds of public art are valuable in their own sake, whatever their subject's moral merits or deficiencies, whatever their aesthetic value, that they can still teach when their days of glorifying are long gone, is one shared, of course, by many preservationists.

There is a naïve optimism attached to it - the belief that we would find ourselves at risk of forgetting the darker aspects of our past if we did not have all of that Carrara and bronze to remind us; we would stand at too safe a distance from the ugliness.

Implicit in that belief is the fantasia that we are living at some other point in our history, when terrible things aren't happening to black men who walk into Starbucks.

Last week an investigation into the crisis of black infant mortality in the United States, that appeared in The New York Times Magazine, revealed that black women are three to four times as likely to die during pregnancy as white women. The racial disparity in infant death is wider today than it was in 1850, when Sims was practicing.

Is the problem really that we have overlooked the sins of our forebears? Or that we have held on to them, all too closely?

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Statue of Doctor Who Did Slave Experiments Is Exiled. Its Ideas Are Not.

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Big City Eight years ago, late one afternoon, Richard J. Moylan, the president of Green-Wood Cemetery, was watching the local news and caught Anthony Weiner, then a congressman, calling for a controversial statue, "Civic Virtue,'' to be removed from the front of a courthouse in Queens and sold on Craigslist.

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Article 5 - Students Memorialize a Past Tragedy to Create a More Hopeful Future

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Article 5 - Students Memorialize a Past Tragedy to Create a More Hopeful Future

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"Facing Today" Blog Post

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For students at Overton High School in Memphis, Tennessee, discovering the case of Ell Persons became a call to action. Angered by the brutality of his murder and the high number of lynchings that took place in their own backyard, they decided to channel their energy into something positive. They have been hard at work to create a memorial for Persons and to bring light to an often forgotten part of U.S. history so that others, too, will learn from the past.

They first learned about him when Zoey Parker, a junior, discovered his case while doing a research assignment for Dr. Marilyn Taylor's yearlong Facing History elective course. Persons was an African American woodcutter who was burned alive after being accused of murder. An estimated 5,000 people from the community came to watch. When Dr. Taylor informed her students the lynching occurred near the present day drive-in movie theater that was close by, "They were stunned," she said.

"They have all been to this drive-in. They had a multitude of questions the following day so we put our scheduled lesson aside and they began their investigation."

The students felt the need to do more so Dr. Taylor asked them, "What are we going to do about it?"

What they did was rally together, turning research into action, and formed the nonprofit, Students Uniting Memphis. Their goal is to create a memorial garden at the site of Ell Persons' lynching, which is now an abandoned bridge abutment surrounded by river overflow and dense foliage.

Image by Andrea Morales, from "Memphis Burning," an article by Martha Park about Ell Persons' lynching and local efforts to memorialize victims of lynching. Published in the Memphis Flyer. (Andrea Morales /All rights reserved.)

A simple research assignment has blossomed into a full-fledged community effort to reconcile with Memphis' past. Overton students will meet with their peers at Central High School for the first time next week at the Facing History office to discuss how they might work together to make the memorial garden a reality. And it's showing students the importance of being an upstander.

"Young people today have to take action in order for history not to repeat itself," said Zoey Parker, the student who first researched Persons' case for Dr. Taylor's class. "We have to be mindful enough to understand we cannot continue to make the same mistakes as those before us."

For Central High School teachers like Mary McInstosh, it's a way to help her students confront the past and find meaningful ways to engage in dialogue about difficult topics like race. She was shocked to learn that Central High School students were let out of school early to attend the lynching 99 years ago.

"To find something real that's happening in the moment, and to be able to take leadership in organizing within the school and connecting with other students and community members will be very powerful," she said.

Overton's students also garnered support from The Lynching Sites Project of Memphis. Spearheaded by a local interfaith group of ministers, historians, and activists, the project formed after two of its members, Sharon Pavelda and Tom Carlson, heard Bryan Stevenson of the Equal Justice Initiative speak at a Facing History benefit in November 2015. As a defense attorney fighting for fairer sentencing and justice for the wrongly incarcerated, Stevenson makes the link between our history, including the narrative of African Americans as racially inferior, and the inequities we still struggle with today. He champions the idea that we can find a path toward healing and reconciliation once we face our past. The Lynching Sites Project aims to do just this and is committed to helping empower Students Uniting Memphis.

Students tell the story of Ell Persons at an interfaith prayer service in Memphis.

On Sunday, the 99th anniversary of Persons' death, nearly 100 people gathered at the site of Ell Person's lynching for an interfaith prayer service. Students Uniting Memphis hopes to draw 5,000 people to next year's memorial service to mark the 100th anniversary.

Although Ell Persons' murder represents a divisive and violent part of U.S. history, the students at Overton High School have given it a more hopeful and inspiring legacy. They are personifying what it means to face history so they can build a better future.

Watch students Zoey Parker and Khari Bowman present about Ell Persons to their class.

How have your students taken action to face the past? Share your stories of students mobilizing into action with us.
Want resources that can help you facilitate productive and meaningful conversations about race, membership, and difficult moments in U.S. history? Check out some of these recommendations:

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Students Memorialize a Past Tragedy to Create a More Hopeful Future

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For students at Overton High School in Memphis, Tennessee, discovering the case of Ell Persons became a call to action. Angered by the brutality of his murder and the high number of lynchings that took place in their own backyard, they decided to channel their energy into something positive.

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Article 6 - Two Quotes About Statues in New York City

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Article 6 - Two Quotes About Statues in New York City

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1b. J. Marion Sims Two Quotes About Statues in New York City

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Graphic Organizer for Dr. J. Marion Sims Introduction to class

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Graphic Organizer for Dr. J. Marion Sims Introduction to class

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1. J. Marion Sims Introductory Activity Graphic Organizer

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News Alert Statement from CEO Kate Grant on Current Events Read Now

Skip to Content

How Fistula Occurs

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but doesn't have access to emergency medical care, such as a C-section. She often labors in excruciating pain for days. Tragically, her baby usually dies.

During her prolonged labor, the mother's contractions continually push the baby's head against her pelvis. Soft tissues caught between the baby's head and her pelvic bone become compressed, restricting the normal flow of blood.

Without adequate blood supply, sections of tissue soon die, leaving holes-known as "fistulae" -between the mother's vagina and her bladder or rectum. It is these holes that cause incontinence. If untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.

Learn more about our approach to treatment

Today, at least one million women in Africa and Asia needlessly suffer from untreated fistula.

How Fistula Impacts a Woman's Life

Obstetric fistula most commonly occurs in poor, rural areas of Africa and Asia where the women affected live in dirt-floor dwellings and lack access to running water and incontinence pads.

Under these circumstances, a woman with fistula faces devastating physical and psychological consequences. Unable to control the leaking of her body's waste, she suffers with chronic infections and pain. Too often, her smell drives away her husband, family and friends.

With little community understanding of fistula and its causes, a woman is frequently blamed for her condition. She too often lives in isolation, unaware that others share her injury and that it is treatable. Because fistula usually occurs during a woman's first pregnancy-when she is in her teens or early twenties-she will likely suffer for decades, if it is not repaired.

Can obstetric fistula be cured?

Yes. An obstetric fistula can be closed with corrective surgery. If the operation is performed by a skilled surgeon, a woman with fistula can very often return to a normal life, with her continence and hope restored.

Fistula most commonly occurs to women in their early twenties, in countries where the average life span is approximately 65 years - meaning a one-time surgical intervention can restore 40+ years of health.

Does obstetric fistula occur in wealthy countries?

Even though obstructed labor occurs in approximately 5% of all child births worldwide, obstetric fistula has largely been eradicated in wealthy countries, thanks to the advent of the Cesarean section in the early 1900s.

Today, fistula persists in low-income countries where women have limited access to emergency obstetric care. It continues to destroy women's lives at an alarming rate in poor, rural regions of Africa and Asia, where fewer than 6 out of 10 women give birth with a medical professional present.

Learn more about where we work

What are the root causes of obstetric fistula?

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but cannot access to emergency medical care, such as a C-section. It is a symptom of deep, intractable poverty and the low status of women and girls.

In poor countries, many children are malnourished, which can stunt their growth. If a young mother's pelvis is not fully mature, she is at an increased risk of experiencing an obstructed labor-and with it, devastating childbirth injuries like obstetric fistula. T he practice of early marriage and young pregnancy can additionally compound this risk.

Another cause of fistula is a critical lack of doctors and medical facilities. In poor, rural regions of Africa and Asia, fewer than 6 out of 10 women give birth with a medical professional present.

Why Are Women Still Suffering?

Women in Africa and Asia are needlessly suffering today for want of a single surgery that can completely transform their lives.

Fistula repair surgery was a common practice in wealthy, western nations in the late 1800s.

Fistula Foundation exists to remove all barriers to treatment, so that every woman can have access to high-quality fistula care.

Learn about barriers to treatment

Taking action means saying 'no' to indifference...It is a choice: whether or not to support a woman, whether or not to protect her, whether or not to defend her rights.

Dr. Denis Mukwege

Fistula Foundation works to end the suffering caused by obstetric fistula, because we believe no woman should endure a life of misery simply for trying to bring a child into the world.

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News Alert Statement from CEO Kate Grant on Current Events Read Now Skip to Content An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but doesn't have access to emergency medical care, such as a C-section. She often labors in excruciating pain for days. Tragically, her baby usually dies.

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Obstetric fistula is one of the most serious and tragic childbirth injuries. A hole between the birth canal and bladder and/or rectum, it is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women and girls leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Half a million women and girls in sub-Saharan Africa, Asia, the Arab States region and Latin America and the Caribbean are estimated to be living with fistula, with new cases developing every year. Yet fistula is almost entirely preventable. Its persistence is a reminder of gross inequities, a sign of global inequality and an indication that health and social systems are failing to protect the health and human rights of the poorest and most vulnerable women and girls. As the leader of the global Campaign to End Fistula, UNFPA provides strategic vision, technical guidance and support, medical supplies, training and capacity building, as well as funds for fistula prevention, treatment and social reintegration and advocacy programmes. UNFPA also strengthens sexual and reproductive health care including timely and quality emergency obstetric services to prevent obstetric fistula from occurring in the first place.

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Obstetric fistula is one of the most serious and tragic childbirth injuries. A hole between the birth canal and bladder and/or rectum, it is caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It

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2. J. Marion Sims Background_Scientific Lens Describe Fistula in 10 Words or Fewer

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I am not yet dead. Do not call this miracle or raise your hands in praise. First,
you should know how long I prayed, and how I came to know the silence of the Lord.

He does not arrive in a ball of light blinding on the road to Damascus.
He comes in silence. Lie there night after night and you will come to know

He speaks in the tongue of suffering. I have survived; do not call it brave.
I rattled this body from the inside. I could not find its latch. I would have escaped it

if I could. Reader-a body can be rummaged through like a medicine cabinet.
The flesh can be unfurled. Stitched, unbound, mended and stitched again.

Nothing is lost; nothing can be unmade.

Do not underestimate how hard it is to die and do not think the dead will save you.
The dead have forgotten suffering. Remember what I told you.

Remember how hard I prayed. Remember: whole days and nights
I wandered outside myself. My body opened to wind and latched again

like a door against it. There was pain in the opening and pain in the parts that healed.
Remember what I said of prayer: to house the soul in a body is a way of it.

Sometimes we suffer for one another as I have suffered for you. If you like,
we can call it holy.

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Anarcha: J Marion Sims Opens My Body for the Thirty-Fourth Time

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I am not yet dead. Do not call this miracle or raise your hands in praise. First, you should know how long I prayed, and how I came to know the silence of the Lord. He does not arrive in a ball of light blinding on the road to Damascus.He comes in silence.

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J Marion Sims (1813-1883) was arguably the most famous American surgeon of the 19th century and today he is generally acknowledged as the founder of modern surgical gynaecology. His rise to prominence began with his development of the first consistently successful operation for the cure of vesicovaginal fistula, a catastrophic complication of childbirth in which a hole develops between a woman's bladder and her vagina and leads to constant, unremitting, and uncontrollable urinary incontinence. Attempts to cure this condition had eluded many previous generations of surgeons who had tried to repair these devastating injuries time and again, but without significant success.

Lauded as a conquering surgical hero in his own time and generally admired by succeeding surgeons in the decades following his death, Sims's reputation diminished considerably in the mid‐twentieth century as it was assaulted by a series of strident critics who condemned him for his reputedly unethical behaviour. The primary reason for these attacks on Sims is that his initial attempts to cure vesicovaginal fistulas were carried out on a group of enslaved African American women whom he quartered in a small hospital behind his house in Montgomery, Alabama. Between late 1845 and the summer of 1849, he carried out repeated operations on these women in a dogged effort to repair their injuries. One young woman, a slave named Anarcha with a particularly difficult combination vesicovaginal and rectovaginal fistula, underwent 30 operations before Sims was able to close the holes in her bladder and rectum.

In interpreting these historical events, some modern writers have denounced Sims with the kind of righteous indignation that is usually heard only from pulpits. Durrenda Ojanuga-for example, writing in the Journal of Medical Ethics -has castigated Sims for achieving fame and fortune as "a result of unethical experimentation with powerless Black women" and refers to his attempts to cure vesicovaginal fistulas as "a classic example of the evils of slavery and the misuse of human subjects for medical research". Ojanuga and like minded critics present a picture of Sims as a cold, brutal, calculating misogynist who carried out a series of unwarranted surgical experiments on unwilling but helpless slaves in pursuit of his own self advancement. This paper will demonstrate that the attacks launched against Sims by these modern writers are actually not substantiated by the primary historical sources relating to the case, nor are their charges consistent with any deep clinical understanding of the predicament faced by women who have developed a vesicovaginal fistula from obstructed labour; rather, their analysis of Sims's early surgical operations on vesicovaginal fistulas can be seen as a striking example of Herbert Butterfield's observation that "for the compilation of trenchant history there is nothing like being content with half the truth".

Distilled to their essential points, Sims's modern critics make three major claims about Sims and his early operations for vesicovaginal fistula. The first assertion is that it was unethical "by any standard" to perform experimental surgical operations on slaves because slaves, by definition, could not have given voluntary informed consent for surgery. Underlying this assertion is the hidden presupposition that enslaved women with fistulas did not want surgical care for their condition (vesicovaginal fistula) and that they were therefore coerced into having unwanted (and perhaps, unnecessary, surgery). The second assertion is that Sims's failure to use ether anaesthesia during these operations was racist: that he did not use anaesthesia when performing fistula surgery on black women, but later, after he had developed his operation and moved to New York to found the Woman's Hospital there, he routinely used anaesthetics when operating on white women who, it is alleged, unlike blacks, were unable to stand the pain involved. The third assertion is that the use of slaves for medical experimentation was unnecessary because substantial advances in medical care were made in the 19th century by Southern physicians who experimented in an ethical manner using white women from whom they obtained "informed consent", a circumstance that modern critics assert did not exist with regard to Sims's operations on these early slave women. Close examination of primary source material demonstrates that each of these claims about Sims is either unsubstantiated or demonstrably false. The inevitable conclusion seems to be that the accusations levied against Sims by modern authors are largely the result of the unquestioned presuppositions that these authors have made regarding the clinical problem Sims and his first patients faced; shoddy historical research, and an abysmal lack of understanding of the future life prospects faced by a woman who had a vesicovaginal fistula in 1845.

What is a vesicovaginal fistula and how does it originate? Obstetric vesicovaginal fistulas do not arise, as many authors commonly state, as the result of "tears" to the bladder during labour; rather, they are the result of a massive crush injury to the soft tissues of the pelvis. Obstetric vesicovaginal fistulas develop during prolonged obstructed labour when the fetus will not fit through its mother's birth canal. In the presence of absolute cephalopelvic disproportion, the contracting uterus tries to force the fetus through the birth canal but only succeeds in gradually wedging the fetus more and more tightly into the maternal pelvis until eventually it can no longer be moved at all. At this point, the soft tissues of the woman's bladder, cervix, and vagina are trapped progressively more and more tightly between two immovable bony plates-the fetal skull and the mother's pelvic bones-and the blood supply to the entrapped tissues is shut off. In such cases the fetus almost invariably dies from asphyxiation, and if the mother lives through her ordeal and does not herself die from uterine rupture, sepsis, haemorrhage, or the sheer exhaustion of labouring in this fashion for days on end, a day or two later the fetus decays, macerates, and finally softens enough to slide out of its mother's vagina. Some time thereafter, a slough of necrotic tissue comes away from the injured woman's vesicovaginal septum, and a fistula forms. To the agony of days of unrelieved labour and the sorrow of delivering a dead child is now added the physical and social calamity of complete loss of urinary (and often faecal) control.

The injuries that women receive from prolonged obstructed labour are not limited to vesicovaginal and rectovaginal fistulas. These injuries form only a small part of a broader spectrum of injuries known as the "obstructed labour injury complex". In addition to the continuous stream of urine (and sometimes faeces) to which they are subjected, these victims of prolonged obstructed labour also often suffer from secondary infertility; loss of vaginal function due to extensive scarring of the birth canal; damage to the pubic bones; contractures of the lower extremities from neuromuscular damage; recurring pelvic and urinary tract infections; horribly diminished self esteem, damaged body image, and, not infrequently, severe depression, even suicide. The cumulative devastation wrought by this process can be appalling. It is hardly the "relatively minor condition" referred to by historian Deborah Kuhn McGregor.

In alleging that it is unethical for slaves to participate in any form of medical experimentation, Ojanuga and other writers seem to imply that it would never have been appropriate for slaves to undergo innovative surgical operations, no matter what their problems might have been. Critics of this stripe conveniently ignore the differences between non‐therapeutic and therapeutic medical experimentation. In the former case, participants can have no reasonable expectation of obtaining direct personal benefit from whatever is done, but in the case of therapeutic experimentation research participants may gain direct-and sometimes substantial-medical relief as a result of their participation in a clinical trial. At the time Sims began his attempts to repair the fistulas afflicting his African American slave patients, there was no effective therapy for a vesicovaginal fistula. Many surgeons in different countries had made repeated but unsuccessful attempts to close vesicovaginal fistulas and put an end to the tormenting loss of urine that these suffering women experienced. With rare exceptions, all such attempts failed. The French surgeon Alfred Velpeau, writing in 1847, maintained that the medical community had not accepted a single reported case of successful cure of a vesicovaginal fistula without dispute. The common experience of surgeons who undertook the care of women with vesicovaginal fistulas was a repeated series of failures, with the desperate patients returning again and again, begging that another attempt be made to give them some relief.

Because Sims's patients had a condition that was generally acknowledged to be incurable, they had only two therapeutic choices: they could continue as they were, with whatever palliative treatment might be provided, or they could agree to undergo experimental surgical operations that might offer them some relief, perhaps even a total cure, for their condition. What would the first alternative have been like? What "palliative treatments" were available to fistula sufferers at this time? Is it true, as Diane Axelson has charged, that both Sims and his subsequent biographer, Seale Harris, portrayed the physical condition of women with fistulas with "unjustified exaggeration"? Is it reasonable to suppose, as Patricia King has speculated, that "given the other aspects of slave life, it is not clear that these women would have ranked this problem high on their list of medical problems that needed attention"? Consider the following description of what it was like to be a woman with a vesicovaginal fistula in the mid‐19th century, given by Dr P M Kollock at the annual meeting of the Georgia State Medical Society in April, 1857:

The poor woman [with a vesicovaginal fistula] is now reduced to a condition of the most piteous description, compared with which, most of the other physical evils of life sink into utter insignificance. The urine passing into the vagina as soon as it is secreted, inflames and excoriates its mucous lining, covering it with calcareous depositions, and causing great suffering. It trickles constantly down her thighs, irritates the integument with its acrid qualities, keeps her clothing constantly soaked, and exhales without cessation its peculiar odour, insupportable to herself and those all around her. In cases where the sloughing has been extensive, and the loss of substance of the tissues great, and where neither palliative nor curable means have availed for the relief of the sufferer, she has been compelled to sit constantly on a chair, or stool, with a hole in the seat, through which the urine descends into a vessel beneath.

Given the choice between living the rest of their lives in this manner or of taking a chance-however remote-that Sims might be able to cure them, it is not surprising that these patients, even though they were enslaved, would have jumped at the opportunity to have surgery. That patients with a vesicovaginal fistula are desperate for a cure and will willingly submit to almost any therapy that is proposed to them is the universal experience of surgeons who have worked with this condition, both in the 19th century and today.

In her article, which is critical of Sims, Durrenda Ojanuga states that: "The enslaved women were not asked if they would agree to such an operation as they were totally without any claims to decision making about their bodies or any other aspect of their lives". This statement is untrue. Sims gave numerous accounts of these early fistula operations during the course of his career, and, although they differ in some details, they all state quite plainly that he discussed what he proposed to do and obtained consent from the patients themselves before undertaking any operations. Writing in the New York Medical Gazette and Journal of Health in January, 1855-for example, Sims declared:

For this purpose [therapeutic surgical experimentation] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs-the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not.

It is true that under Southern law, slaves were the property of others and Sims could not have legally operated on them without the consent on their owners; however, this cannot be taken as a priori proof that these slaves were unwilling patients. As a matter of surgical practicality, considering the delicate and tedious requirements of performing surgery inside the vagina and the exceedingly difficult circumstances of exposure and inadequate lighting under which he was forced to operate, Sims could not have carried out these operations successfully without the cooperation of the women involved. Even the slightest movement, much less the active resistance of these patients, would have rendered it impossible for him to have completed his operative procedures. Indeed, when his regular medical assistants tired of working with him, Sims trained the patients themselves to act as his surgical assistants and they thereafter helped him operate on one another in turn! In fact, in a passage in his autobiography that his modern critics have apparently not understood, Sims wrote that at a time when he had stopped attempting surgery on these women due to his repeated failures and was wondering how best to proceed, they "clamoured" for operations, insisting that he keep trying to cure their injuries. No wonder he owed these women a debt of gratitude for their persistence and their cooperation-a debt that he readily acknowledged publicly on numerous occasions.

Why did Sims not use anaesthesia when carrying out these operations? Was he an "anaesthetic racist," as has some authors allege? Vanessa Northington Gamble-for example, maintains that, in contrast to the way he treated slaves, Sims only operated on white women using anaesthesia. The chronology of events is extremely important here. Sims grew up as a surgeon in the days before anaesthetics and was accustomed, as were all of his contemporaries, to the pitfalls and requirements of preanaesthetic surgery. Durrenda Ojanuga writes: "He performed his first operation on a slave woman named Lucy. Lucy was operated on without anaesthetics as Sims was unaware of the advances which had been made in this area of medicine." This statement is not true. Sims began his fistula operations on his enslaved patients in late 1845, before the anaesthetic properties of ether were known. Ether anaesthesia was not discovered and publicly demonstrated in Boston until October 16, 1846, nearly one year later. Although the use of anaesthesia spread rapidly, its acceptance was not universal, and there was considerable opposition to its introduction from many different quarters, for many different reasons. As historian Martin Pernick has written:

Our twentieth century sensibilities recoil at the thought that sane, responsible physicians could ever have opposed the use of anaesthetics. Today, the concept of operating on a fully sentient patient conjures up only hellish images of concentration camp doctors. Yet in mid‐nineteenth century America, humane, conscientious, highly reputable practitioners and ordinary lay people held many misgivings about the new discovery. Neither sadists nor fools, these critics alleged a variety of rational drawbacks to the use of anaesthesia.

Many 19th century surgeons felt that attempts at repairing vesicovaginal fistulas were neither serious nor painful enough operations to warrant the risks of general anaesthesia. Sir James Young Simpson, the discoverer of chloroform and probably the most vigorous advocate of the use of anaesthesia on women during the 19th century, was one of these people. Writing about the use of anaesthesia during fistula surgery in 1859, a full decade after Sims's initial surgical experiments had been completed, this champion of anaesthesia could declare that chloroform was not absolutely necessary in the performance of fistula operations, since "The mere amount of pain endured by the patient is perhaps less than in most surgical operations, as the walls of the vesicovaginal septum are far less sensitive than you would a priori imagine".

Ojanuga further states that: "Many white women came to Sims for treatment of vesicovaginal fistula after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation." This allegation, often repeated, is also false. For example, Sims published a detailed case study of a white woman who came to him with a fistula in 1849, which he was eventually able to repair after three operations, none of which involved the use of anaesthesia. Terri Kapsalis, writing with reference to Sims's later career in New York, declares that "the widespread use of anesthetics finally allowed Sims to bring his surgeries to white women and allowed for the establishment of places such as the Woman's Hospital". Sims himself, however, in a public lecture to the New York Academy of Medicine given on November 18, 1857, at a time when he was actively engaged in the practice of surgery at the Woman's Hospital in New York (whose clientele were almost exclusively white and many of whom were of middle or upper middle class origin), noted that he never resorted to the use of anaesthetics in fistula operations "because they are not painful enough to justify the trouble, and risk attending their administration". In retrospect this was certainly an unfortunate error in clinical judgment-a mistaken "calculus of suffering"-but it was not anaesthetic racism. It is also worth pointing out that if Sims had used anaesthesia in operating on his first fistula patients before the safety and efficacy of ether and chloroform had been sufficiently established for routine clinical use, this, too, would have constituted another therapeutic experiment on slaves.

In her final assault against Sims, Durrenda Ojanuga maintains that significant medical breakthroughs were achieved in the antebellum South without using slaves in therapeutic experiments. To buttress her argument, she compares Sims unfavourably with Dr Ephraim McDowell (1771-1830) of Danville, Kentucky, and with Dr Crawford W Long (1815-1878) of Georgia. McDowell was the first surgeon to successfully open the peritoneal cavity and carry out a major intra‐abdominal operation. With her consent, McDowell removed a 22 pound benign ovarian tumour from Jane Todd Crawford, a white woman, on December 13, 1809, without anaesthesia, carrying out the operation on a kitchen table. She recovered completely and survived to a ripe old age. Crawford Long was a Georgia dentist who noticed the intoxicating effects of sulfuric ether that the youth of his community were using as a recreational drug during periodic "ether frolics". He decided to try ether as an anaesthetic agent during surgical operations. In 1842 he successfully removed a small tumour from the neck of James Venable, a white man, who had given his consent to the procedure.

These examples are true as far as they go, but both accounts given by Ojanuga selectively omit major pieces of information that, once known, completely deflate the case she is attempting to make against Sims. Although it is true that McDowell performed his first ovariotomy on Jane Todd Crawford, a white woman, Ojanuga neglects to inform her readers that McDowell performed this operation at least seven more times during his lifetime and that four of these patients were black slave women, one of who died from complications. With respect to Crawford Long, Ojanuga omits to mention the fact that he also used ether anaesthesia in a number of other surgical experiments in addition to the initial operation he performed on James Venable. For example, Long wrote the following in his article on the anaesthetic use of ether in the Southern Medical and Surgical Journal of December, 1849:

Surgical operations are not of frequent occurrence in a country practice, and especially in the practice of a young physician; yet I was fortunate enough to meet with two cases in which I could satisfactorily test the anaesthetic power of ether. From one of these patients I removed three tumours the same day: the inhalation of ether was used only in the second operation, and was effectual in preventing pain, while the patient suffered severely from the extirpation of the other tumours. In the other case, I amputated two fingers of a negro boy: the boy was etherized during one amputation, and not during the other; he suffered from one operation, and was insensible during the other.

Both free whites and enslaved blacks were involved in all of these experimental surgical operations. McDowell's operations were clearly performed with therapeutic intent, although it is unclear to what extent some of these black patients consented to surgery. If one assumes that the amputations performed by Long were clinically indicated, then he was performing necessary surgery while conducting a rather brutal (and probably unnecessary) comparative trial of the effects of ether on surgical pain.

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The medical ethics of Dr J Marion Sims: a fresh look at the historical record

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J Marion Sims (1813-1883) was arguably the most famous American surgeon of the 19th century and today he is generally acknowledged as the founder of modern surgical gynaecology.

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Curriculum Vitae for Durrenda Ojanuga (now Durrenda Onolemhemhen)

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Curriculum Vitae for Durrenda Ojanuga (now Durrenda Onolemhemhen)

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Word Version

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3a. Ojanuga Line of Reasoning Graphic Organizer

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Owens Text

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PDF Version