Students of anesthesia history are hauntingly familiar with the bone-chilling chronicle of Fanny Burney (1752 to 1840) who endured a mastectomy without anesthesia in 1811, 35 yr before the discovery of surgical anesthesia. Five months after this excruciating experience, Mrs. Burney, a well-known novelist and diarist whose writing purportedly had a strong influence on the subsequent works of Jane Austen, wrote an electrifying letter to her sister Esther describing in frighteningly vivid detail the intraoperative horrors she suffered. In contrast, the unimaginable travails of Anarcha Westcott Jackson (circa 1824 to 1869), an enslaved Black woman who underwent several experimental surgical procedures without anesthesia, have surfaced only relatively recently. Say Anarcha: A Young Woman, a Devious Surgeon, and the Harrowing Birth of Modern Women’s Health by J. C. Hallman compellingly addresses previously obscure facets of Anarcha’s horrific experiences at the hands of then-revered Dr. J. Marion Sims.
James Marion Sims (1813 to 1883). who preferred to be called “Marion,” was one of the most famous and admired surgeons in America during the 19th century. He was also a consummate showman and self-promoter who was strongly motivated by a desire for fame and fortune. Celebrated as the “father of modern gynecology,” Dr. Sims was most venerated for his claims to have devised surgical cures for vesicovaginal and rectovaginal fistulae, although Say Anarcha reveals that Sims never really cured Anarcha, and the lucrative device he invented for fistula surgery was ineffective. In addition, he became known for the Battey operation, an irrational, ill-conceived procedure that involved bilateral ovarian removal to “treat” epilepsy, insanity, hysteria, and other nervous conditions then attributed to disorders of the female reproductive system.
On a more positive note, the feted surgeon is also remembered for inventing the Sims sigmoid catheter, Sims speculum, and the Sims position, as well as for introducing silver wire sutures. The recipient of numerous professional honors, Sims was unanimously elected president of the American Medical Association in 1876.
Although the saga of Anarcha and her peers is shocking when viewed through the lens of modern sensibilities, this exploitative physician benefitted from the radically lower ethical standards extant at the time and from his own selective record-keeping. Remarkably, his clever façade of deception, evasiveness, and half-truths was generally accepted as factual history for longer than a century. It was not until the late 1960s that a more disinterested, balanced, and accurate re-evaluation of Sims’s legacy began to seep into the mainstream when scholars, historians, activists, journalists, and others chipped away at his fabricated biographical veneer.
Until recently, little was known about Anarcha other than that her name appeared in Dr. Sims’s 471-page autobiography titled The Story of My Life. She “belonged” to a Mr. Westcott who lived near Sims in Montgomery, Alabama. The best available data suggest that she was born around 1824 and died in 1869. While in her early teens, Anarcha endured a difficult labor lasting three days and eventually delivered a dead baby. After the protracted period of obstructed labor and stillbirth, Anarcha was left with vesicovaginal and rectovaginal fistulae, which led to infections, inflamed tissue, pain, and repugnant odor. The condition, although not fatal, is catastrophic. During my training and as a practicing anesthesiologist, I had not encountered a patient with a rectovaginal fistula until 1993, when I worked in Tanzania with the American Society of Anesthesiologists Overseas Teaching Program. There I met an emaciated young woman who described how she had been ostracized and abandoned for her tragic condition not only by her husband and his family, but also by her own family. She lived in misery.
Sims named three enslaved Black women in his autobiography: Anarcha, Betsey, and Lucy. Each of these young women were frequent subjects of his surgical experiments to repair fistulae. He operated on Anarcha at least 30 times without her meaningful consent and without anesthesia. (Apparently, the practice of using enslaved people for research typically was not considered controversial in the antebellum South.) Moreover, to be fair, Sims’s failure to anesthetize his patients might conceivably be explained by factors other than cruelty, racial bigotry, or misogyny. Sims began his experimental surgery in 1845, one year before the first successful public demonstration of surgical anesthesia with ether on October 16, 1846, in Boston. His series of fistula operations was completed by 1849. It is, therefore, possible (although unlikely) that Sims was unaware of the availability of surgical anesthesia from late 1846 onward. If he eventually was cognizant of the existence of general anesthesia, perhaps he did not consider the fistula procedure to be sufficiently painful to justify the risks of administering anesthesia, because a common belief at the time was that Black people did not experience as much pain as White people. (Sadly, I can remember, as a medical student, watching a skilled and compassionate pediatric surgeon using adhesive tape to immobilize a neonate on the operating room table before he infiltrated local anesthetic into the operative site. As late as the early 1970s, the well-meaning surgeon subscribed to the concept that neonates and young infants did not experience pain to the same degree that older patients did.) Interestingly, Sims’s records, suspect as they may be, indicated that he also performed fistula surgery on white women without anesthesia. Both the Black and the white women were allegedly given opium to mitigate postoperative pain.
Eventually, physicians in Montgomery became concerned about the propriety of Sims’s experiments and refused to even observe his procedures, much less assist him. Who else was available to advance the cause of fistula surgery? Without Sims either intending or furthering it, a patient-centered model of care developed as Anarcha, Betsey, and Lucy, who lived communally, learned to assist Dr. Sims as he operated and to restrain and gently comfort one another as needed during their respective surgeries. They became a corps of skilled attendants, holding the patient’s hand and speaking soothingly to her as Sims worked. These vulnerable fistula sufferers also learned to provide one another with empathetic postoperative care. Eventually, Anarcha went on to become a midwife, nurse, and “doctor woman.”
With the passage of time, the disinfectant of sunlight exposed the celebrated surgeon’s clay feet. It became apparent that the putative success of Sim’s fistula surgery had not been independently corroborated; the “father of modern gynecology” had been falsifying his results. Decades later, in 2018, after a public protest and investigation, an august statue of Dr. J. Marion Sims was removed from its pedestal in Central Park opposite the New York Academy of Medicine and relocated to the Green-Wood Cemetery in Brooklyn where Sims is buried. Fittingly, Anarcha, Betsey, and Lucy were memorialized in a sculpture, the Mothers of Gynecology monument, by artist Michelle Browder, that was ceremoniously unveiled in 2021 in Montgomery, near Dr. Sims’s former “Surgical Infirmary for Negroes.”
Since 2015, J. C. Hallman has been on a mission to ensure that Anarcha is not relegated to an historical footnote. He writes with a sharp eye and a distinctive voice as his painstaking research reveals a shameful time in our nation’s history. This extraordinary book restores dignity to Anarcha and other Black women who endured and survived a series of harrowing ordeals to advance medicine both in our nation and abroad. “Anarcha” is a name we should not merely say. We should reflect on her courageous legacy as we strive to remedy ongoing racial and gender disparities in healthcare. One hopes J. C. Hallman’s exhaustive historical study will advance the conversation and stir the collective conscience as we reckon with a dark past and move toward a brighter future that will better empower disenfranchised voices.