AUGS Breaks with the Father of Gynecology

‍MESH MEDICAL DEVICE NEWS DESK, July 4, 2018 ~ Twelve years after a portrait was removed from the University of Alabama of a controversial figure in modern gynecology, the medical society has decided to part ways with Dr. J. Marion Sims.

AUGS.  The American Urogynecologic Society is the lead medical society responsible for the promotion of polypropylene mesh (PP) implants.

Most recently, in response to a recent 60 Minutes segment on some rather questionable behavior by Boston Scientific, AUGS issued a reasonable sounding statement on its website that it is neither “Pro – Mesh nor Anti – Mesh. AUGS is Pro-Science!”

Good to know.

It was science, ethics and pressure among the 1,900 members that caused AUGS, in November 2017, to make a radical departure from past behavior.

The medical society decided to retire its annual keynote speech, the J. Marion Sims Lectureship at Pelvic Floors Disorder Week, after a presentation the month before by Dr. Lewis Wall.

J MARION SIMS, MD

Dr. Sims is known as the father of modern gynecology because in the mid 1800's, he perfected the treatment of fistulas and creation of the modern tools used in gynecologic procedures.

The problem is that Dr. Sims perfected his surgical techniques by operating on enslaved black women.  He didn’t use anesthesia, it was believed they did not experience the same level of pain as white women.

Anesthesia was just coming into its own between 1846 and 1849, when Dr. Sims performed multiple surgeries on at least ten slave women. There was no informed consent.  The slave women often carried babies that were the result of rape, and those babies could be taken from them. Their bodies were not their own to be able to direct. They were powerless.

The women, undergoing the experimental surgery, were naked, as one portrait shows. They would be held down, either by other doctors in attendance or by other slave women.

The women reportedly wanted to be rid of fistulas, the result of a difficult birth where an infant becomes lodged during the birth process.

Dr. Sims' first three fistula patients were Lucy, Anarcha, and Betsey.

Lucy was 18 when she underwent an operation at the hands of Dr. Sims. She had given birth a few months prior and now had incontinence.

Lucy was on her hands and knees with her head rested on her hands. She screams in pain, and Sims wrote “Lucy’s agony was extreme.”  She also contracted blood poisoning from his use of a sponge to drain the urine. It took her months to recover.

Anarcha, 17, a slave, had a traumatic labor and delivery and underwent 30 operations, without anesthesia. Dr. Sims perfected his method on Anarcha, then later in 1855 he moved to New York and opened Women’s Hospital, the first of its kind, where he performed surgery on white patients.

The medical society decided to retire its lectureship in the name of Dr. Sims because the members were “no longer unified in our views, and it now serves primarily as a source of polarization, pain, and disenfranchisement.”

Then AUGS President, Halina M. Zyczynski, MD, wrote, “We are sensitive to the perspective that the named lecture implies honor to a man whose treatment of vulnerable women has been determined to be strongly suspect.”

The Controversy is Not New

Twelve years earlier, a portrait of  Dr. Sims had been removed from the University of Alabama’s Center for Advanced Medical Studies.

After medical training in 1813, which involved interning with a physician, taking a three-month course, and then studying for a year at Jefferson Medical College, Dr. Sims practiced in Lancaster Co. SC, but his first two patients died and he moved to Montgomery, Alabama.

Meanwhile a statute of Sims still stands in Alabama. Removing it is not possible under the Alabama Memorial Preservation Act of 2017. A monument to Sims near the South Carolina Statehouse near Columbia, S.C. remains in place.

On April 17, 2018, a statute of Dr. Sims in New York City was removed from its Central Park location and relocated to Greenwood Cemetery in Brooklyn. The move came after years of protests by community activists who had gathered more than 26,000 signatures, which were brought to the attention of city officials. Mayor Bill de Blasio agreed to the relocation.

While medical scholars and bioethicists argue over Dr. Sims, another option has been proposed.

In a 1941 paper titled “The Negro’s Contribution to Surgery,” published in the Journal of the National Medical Association, Dr. John A. Kenney of the Tuskegee Institute, considered the dean of black dermatology, wrote,

“I suggest that a monument be raised and dedicated to the nameless Negroes who have contributed so much to surgery by the ‘guinea pig’ route.”

Kenney was referring to Lucy, Anarcha and Betsey, whose stories have been erased from history.

LEWIS WALL MD

The Keynote speech that caused the change in direction for AUGS, Vesico-Vaginal Fistula: Historical Understanding, Medical Ethics, and Modern Sensibilities, was delivered by Dr. Lewis Wall, an obstetrician and gynecologist with a doctoral degree in social anthropology and masters in biotethics.

He founded the Worldwide Fistula Fund and has a fistula center in Niger, consults to the International Fistula Alliance and has written, Tears for my Sisters: The Tragedy of Obstetric Fistula."

He works with a Ugandan NGO, Terrewolde, as well as Danja Fistula Center in Niger.

In an interview (here) with PFD Week, Dr. Wall said he has long been interested in medical ethics and in fistulas. He has traveled extensively throughout Africa to treat women with fistulas.

An estimated 4 million African women have a vesico-vaginal fistula, a result of a difficult childbirth in areas of the world where cesarean section is not available. In those cases, labor may last for days and in the process, the tissues that separate the bladder from the vagina can be destroyed.

Women who suffer this injury may become totally incontinent. In some societies that means they are outcasts.

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LEARN MORE:

Post & Courier, Investigation,  J. Marion Sims, Savior of Women or Medical Monster
https://data.postandcourier.com/saga/jmarionsims/page/1

YouTube on J. Marion Sims MD
https://www.youtube.com/watch?v=YTCXZ9HhyZQ

J. Marion Sims, The Story of My Life
https://archive.org/details/storyofmylif00sims