J. Marion Sims is a controversial figure in both the history of Alabama and early modern medicine. His experiments on enslaved women in Alabama and poor women in New York occurred without their ability to consent, dispute treatment options, or seek a different doctor.
In writing about him I have also committed a deep mistake in relying too heavily on his accounting of his life without consulting additional monographs on the topic or making mention of his intense ambition and desire for fame and fortune. Below are some links for further reading on the central issues of his medical ethics.
Part 4: “If there was anything I hated…”
In mid-June of 1845, a hog lay along the roadside in Montgomery, “in the corner of the fence.” Mrs. Merrill rode her horse down the same path. She lived at the top of what locals simply called “the hill” and took in washing to make a living.*
The hog charged the horse.
The horse startled and threw Mrs. Merrill. She broke no bones nor suffered much abrasion. Instead all her injuries were internal. The trauma of the fall resulted in a “retroversion of the uterus,” that caused her great pain. Locals summoned the doctor that they sought for strange conditions, J. Marion Sims, and he came in haste. He beheld Mrs. Merrill and felt an instant pang of regret. “If there was anything I hated,” he later wrote, “it was investigating the organs of the female pelvis.”
Sims hated examining vaginas. Yet he billed himself as a doctor and doctors did unpleasant things, so “by a digital examination,” he soon concluded that he would need to manipulate her uterus back into its proper alignment.
Contemporary medical knowledge claimed that the only way to solve this crisis involved placing the patient “in a genu-pectoral position,” or on their hands and elbows, followed by an insertion of fingers into both the rectum and vagina, accompanied with some serious wiggling. Sims already found his fingers inside Mrs. Merrill’s vagina and proved hesitant about the insertion of a thumb into her rectum, “because only a few days before I had had occasion to examine the rectum of a nervous gentleman.”
As Mrs. Merrill positioned herself onto her elbows and knees, Sims paused to take stock of the situation – he’d already put his finger into one rectum this week, he dared not make it two. With the rectal finger foregone, he simply tried to turn Mrs. Merrill’s uterus towards its correct position.
Sims contorted his hands into all manners of shape. With three fingers fully engulfed he attempted to relieve his patient of her pain by twisting upwards and then downwards, by pulling the uterus towards him or pushing it away with all of his strength. Sims struggled with the organ and Mrs. Merrill struggled through the pain.
Eventually, after much exertion and groans of agony, “[it] was as if I had put my two fingers into a hat, and worked them around, without touching the substance of it.” Mrs. Merrill sighed, her had pain subsided and the uterus returned to its original position. She turned to Sims and said, “[why] doctor, I am relieved.”
Both Sims and Mrs. Merrill found themselves exhausted and perspiring. The ersatz procedure required momentous effort and fortitude from both participants. Mrs. Merrill collapsed onto her side.
Then something marvelous happened.
As Sims probably looked around for a rag, “there was an explosion,” of air from Mrs. Merrill. Although she looked on in horror, the doctor thought of other things. “That is not from the bowel,” he thought, “but from the vagina,” suddenly a lot of things made sense. By dilating Mrs. Merrill’s labia, in a genu-pectoral position, it allowed the organ to expand to its natural capacity, which Sims estimated to be “fifty-five pounds to the square inch.”
This episode taught him an important lesson; that if one might use air to dilate the vagina, then one might manipulate and perform procedures upon it more easily. On that hot June day, Mrs. Merrill gave forth the most important case of vaginal flatulence in medical history.
Sims intended to use this knowledge on what he considered previously hopeless patients. (230-234)
*one can only hope that it was Goat Hill, the eventual site of the Alabama state capitol.
Sims, J. Marion. The Story of My Life. New York: D. Appleton and Company, 1884