The Hidden Atrocities Behind Medical Progress


A number of years ago, I attended a lecture at Columbia Law School. I no longer recall the name of the lecturer, but the lecture was about a man known as the father of modern gynecology, James Marion Sims. Sims practiced medicine in the nineteenth century, at a time when slavery was still legal in the United States, and Sims performed surgeries on slaves. It was through experiments on slaves that he successfully developed a technique to repair obstetric fistulas, a complication of childbirth that often leaves women leaking urine and/or feces and can render them outcasts in their families and communities. In this column, I explore how we might think about this man today and the connection between the answer to that question and how we ought to handle the link between evil deeds and positive outcomes in other contexts.

Three Slaves: Anarcha, Betsey, and Lucy

In Dr. Sims’s records, he identifies by name three slaves on whom he performed surgeries in his efforts both to repair their fistulas and to figure out a surgical procedure for repairing fistulas more generally. The women’s names were Anarcha, Betsey, and Lucy. Though anesthesia had become available by the time he performed surgeries on these women in the 1840’s, he did not use it, and he recorded how one of the patients would scream in pain during the numerous surgeries to which he subjected her.

Though people offer excuses for Sims’s failure to use anesthesia (including its relative newness), it seems likely that myths of the time (that African Americans did not suffer pain in the same way as whites did) as well as an obvious devaluation of an enslaved person’s suffering also played a dominant role. In the spirit of “all’s well that ends well,” however, J. Marion Sims is largely honored without ambivalence today, has a bronze statute of him erected in New York City’s Central Park North, and is praised for “his service to suffering women. Empress and slave alike.”

Prior to the lecture that I attended at Columbia, I had never heard about any of this. I am not sure I even knew there was a “father” of modern gynecology, but it never occurred to me, if there were such a paternal figure, that enslaved women had been involved in his developing fistula surgeries. I had learned about childbirth-associated fistulas from Nicholas Kristof’s regular discussions of the topic in his column in the New York Times, where he explained the “child birth injury, often suffered by a teenager in Africa or Asia whose pelvis is not fully grown. She suffers obstructed labor … and endures internal injuries that leave her incontinent—steadily trickling urine and sometimes feces through her vagina.” Whoever had figured out how to repair these injuries, I imagined, would have to have been a hero.

Reality, however, can prove more complicated. The reality in this case was that a white man with power over African American women in pain used his power to inflict what amounted to torture on them, despite the availability of anesthesia (something that he did use on his white patients, after perfecting the procedure,). He was somehow able to ignore the women’s screams and treat the women themselves not as valued and honored patients but as experimental instruments whose lives were not rightly theirs to control or direct.

A Utilitarian Calculus

If one is a utilitarian, one calculates the morality of an action by asking whether, on net, it generates more good than ill (with good and ill measured in pleasure and pain, preference satisfaction and frustration, or some other metric of utility). One could, as a utilitarian, argue that Dr. Sims did the right thing in performing surgeries on enslaved persons to find a way to repair fistulas. Because of the great suffering of the relatively small number of women in his “care,” countless women after them (including women in developing countries today) have benefited from the surgery. A utilitarian would acknowledge that Sims should have used anesthesia, but beyond that feature of the surgeries he performed, the sum of the good that he gave to other and future women was arguably great enough to justify what he did, from a utilitarian point of view.

My view about this calculus of net gain is that the very fact that this argument has such plausibility within the utilitarian framework illustrates a problem with utilitarianism: it does not endow individuals with rights and therefore cannot protect the marginalized individual from becoming a commodified instrument to be utilized for others’ gain. I would suggest, moreover, that the failure to use anesthesia on the enslaved women on whom Sims operated was not just a coincidental moral error but for which the experiments would have been easier to justify. It was instead a predictable behavior and a feature of the mindset that one must adopt in order to be able successfully to downgrade a fellow being to the status of a “thing.”

How do I mean this? Consider the mental work that it takes, at least initially, to look at another and think, “despite all of the qualities that we share, I am supreme over this other to such a degree that I may choose to perform experimental surgeries on her without consent (for the enslaved necessarily cannot give consent in these circumstances). One must take whatever fellow feelings one might have and largely suppress them or else one might easily be overwhelmed with the horror of the deed that one is contemplating. One must, in other words, resist one’s natural empathy.

If we are in the process of suppressing empathy, it is to be expected that we will tell ourselves that the one to whom we deny our empathy cannot possibly feel pain the way that we feel pain, because if she could, then we would not presume to inflict undeserved harm on her at all. Once we do what it takes to diminish her enough to use her in a painful experiment, however, (and the experiment would be painful even with the help of anesthesia and palliative care, as people who undergo normal surgeries know), it becomes that much easier to deny that she truly needs or would benefit very much from anesthesia. The more we think of her as an unfeeling object, the less we are inclined to look for ways to protect her from harm.

Analogies to Animal Experimentation

As I have elsewhere acknowledged, drawing analogies between atrocities is in general a very risky proposition. People feel protective over their own history and their own or their group’s experience of trauma and persecution, and comparing what they endured with what another group endured can be triggering for them. I understand this, and I generally avoid drawing analogies between atrocities.

I am especially careful about analogizing atrocities when the comparison is to the experience of animals, because people are often deeply offended by comparisons between harm inflicted on (any) humans and harm inflicted on nonhuman animals, for a variety of reasons. One reason is that people tend to think of most animals in purely instrumental terms to begin with, so that an analogy can seem to imply (without intending to do so) that the group to which animals are compared should somehow also be thought about in purely instrumental terms. Another reason is that to use “group A” (whether Holocaust victims, enslaved peoples, or another persecuted group) as a way to talk about animals is in a sense to take group A and literally turn its history into an instrument for talking about another group—and that other group is not even human!

With these acknowledgments, though, I do feel it is important to think about animal experimentation when we talk about the evil of human experimentation, whether it be what J. Marion Sims did to enslaved women, acts that continue to be implicitly celebrated with monuments, or what Dr. Josef Mengele did to the inmates of Auschwitz, the latter of which acts have been unambiguously condemned.

Why draw the analogy? Because when people consider the wrongfulness of experimenting on humans, they regularly invoke—by way of contrast—the presumed rightfulness of experimenting on animals. Indeed, in the years since I attended the Columbia lecture, in stories that I have heard told about Dr. Sims’s cruel and immoral behavior, the common trope is that Dr. Sims treated enslaved women as though they were animals and that Dr. Mengele made guinea pigs (or other animals frequently subjected to experimentation) of his human victims. The deeply embedded assumption is that someone does belong on the other end of the scalpel, and that someone is a nonhuman animal.


One thing that makes it difficult to talk about animal experimentation as an unadulterated evil is that people can more credibly claim that animal experiments are “necessary” than that the other ways in which we commodify and instrumentalize nonhuman animals are necessary. We can live a healthy and joyous life without consuming animal products as food or clothing (or entertainment), but it is difficult to say with certainty that an experiment on an animal will not yield a life-saving treatment for humans that would have otherwise gone undiscovered. And it is true as well that perhaps if Dr. Sims had not harmed Anarcha, Betsey, and Lucy in the ways that he did, there would never have been a fistula surgery for the many women who have desperately needed it.

To condemn what Dr. Sims did, then, is to say that something can be an absolute evil worthy of condemnation even if it is simultaneously potentially “necessary” for reaching some positive outcome. It is like a hypothetical case in which we torture not a terrorist but a completely innocent child to prevent a bomb from exploding and killing hundreds or thousands of people. It is tempting and it has an upside, but it is nonetheless evil, from a deontological point of view. And so we understand that to condemn animal experimentation, just as we condemn human experimentation, is to say what Mark Twain once said of the former practice:

“I believe I am not interested to know whether Vivisection [experimentation on live animals] produces results that are profitable to the human race or doesn’t. To know that the results are profitable to the race would not remove my hostility to it. The pains which it inflicts upon unconsenting animals is the basis of my enmity towards it, and it is to me sufficient justification of the enmity without looking further.”

This is, I think, the right attitude to have toward what Dr. Sims did to the enslaved women in his care and toward what Dr. Mengele did to the inmates he tortured. Any sentient being at the other end of the experimenter’s scalpel is there wrongfully, whether man, woman, child, or other sentient animal and regardless of what good may come of it. In saying this, I challenge the implicit or explicit phrase “they were treated like animals” that so often goes along with (rightly critical) narratives of human experimentation. (For more on the subject of Dr. Sims’s checkered legacy, listen to the Hidden Brain podcast here).

  • George Lowrey

    I recommend the following article for a more balanced perspective on the ethics and achievements of Dr. J Marion Sims:

    The medical ethics of Dr J Marion Sims: a fresh look at the historical record, LL Wall, J Med Ethics. 2006 Jun; 32(6): 346–350.


    Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims’s medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims’s modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.

    LL Wall is a member of the Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; Department of Obstetrics and Gynecology, School of Medicine, and Department of Anthropology, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: