The exploitation of bodies, whether living or dead, of those viewed as subhuman in the eyes of their contemporary society, whether murderers offered up for dissection or minorities relegated to subordinate status, undeniably forms the bedrock upon which the edifice of modern medicine was built. In the early days of American medicine, this role was filled by black bodies, both enslaved and free, who alongside poor, transient whites such seamen, immigrants, and indigents found their way to charity hospitals, dissecting tables, and operating amphitheaters. Once within such facilities, the indigent patient was at the mercy of his doctors and faced unregulated experimentation of often of dubious value either to the patient himself or the wider community. Even death posed no real hindrance in the face of laws which explicitly condoned the utilization of corpses of minority groups for the benefit of medical advancement for the majority population.
What most grips me, however, is not the ease with which one can cast condemnation upon the valueless experimentation that constituted so much of the investigatory paradigm raised above, but rather those rarer, but no less horrific acts that legitimately advanced the medical field. The work of J. Marion Sims, a 19th century OB/GYN, epitomizes this struggle. A hero in his own time and still a revered figure across much of the USA with schools named for him and, until recently, a statue in New York, Sims’ patients included Empress Eugenie of France, wife of Napoleon III, Scotland’s Duchess of Hamilton, and the Empress of Austria. Additionally, patients in his own time and thousands of women since were saved from the horrors of rectal and urinary incontinence, and subsequently from both isolation and consequent death through his pioneering work on the repair of vesicovaginal fistulas. Marring this august legacy, however, is the fact it was built upon the mutilation and death of dozens of slaves. Sims’ first patient (or subject), for example, was operated on at least thirty times without anesthetic before she ultimately passed away.
This approach to medical innovation is unimaginable without a system like chattel slavery, where one human life could be so utterly subordinated to the desires of another. His other patients fared little better. with even those that survived left addicted to the early anesthetic compounds Sims’ eventually began to utilize. It is a telling sign of the complexity of the issues we confront as medical historians that even experiments undoubtedly as horrific as these are not without their defenders. Scholars, for example, present the argument that Sims’, unlike Mengele to whom he is often compared, was addressing an actual problem in a wholly socially acceptable way. Intimately tied to this is the argument that Sims’ enslaved subjects were afflicted by and would likely have died of their fistulas in any case and so should be viewed not as experimental subjects, but rather as desperate patients attempting a novel therapy. Finally, we are confronted with the nearly impossible task of attempting to balance the thousands of women and immeasurable pain spared by Sims’ work with the cost of 34 lives.
Medicine is undoubtedly a wonderful enterprise; that is why many of those reading this and I, myself, have chosen to devote our lives to it. However, like any long-lived entity, it has both its darkness and its light. By reflecting on the former, we are able to better work towards the latter and take greater care in not recapitulating the mistakes made in getting us to this point, while taking the profession still further and striving to practice in such a way as to offer restitution to the groups upon whom progress was built.