A medical hell recounted by its victims

Harriet A. Washington weighs up a play about enslaved women subjected to experimental surgery in the nineteenth century.
Harriet A. Washington is a medical ethicist and historian based in New York City. Her books include Medical Apartheid, an account of experimentation on black Americans from the colonial era to the present; Infectious Madness; and the forthcoming A Terrible Thing to Waste.

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Two African American women hold another African American on a table

Left to right: Nia Calloway, Joel Ripka, Naomi Lorrain, Stephen James Anthony and Cristina Pitter in Behind the Sheet.Credit: Jeremy Daniel

Behind the Sheet Ensemble Studio Theatre, New York City. Until 10 March.

In the 1840s, the Alabama physician James Marion Sims conducted infamous experimental gynaecological surgery exclusively on black women, bound to the surgical table by chattel slavery, physical force and opium. The drug did not allay their pain, and some historians think that they became addicted to it. Now, playwright Charly Evon Simpson offers a fictionalized retelling of Sims’s egregious practices in Behind the Sheet.

Sims sought to repair horribly disabling complications of protracted childbirth —including vesicovaginal fistulas — that cause constant leaking of urine and faeces. The resulting pain, infection, odour and skin problems left many women of that era invalids, even pariahs. For enslaved women, the condition also meant that they could not work, and thus became ‘valueless’ in the eyes of their owners and white society. Sims is credited by some with surgical innovations that allowed him to close the fistulas. He has been called the ‘father of modern gynaecology’ (of which, more later). Yet, faced with justified accusations of surgical violence and forcible exploitation, he insisted that the women were willing. And he praised their “courage”, even though, as enslaved women whose bodies were not considered their own and who lived under constant violent compulsion, they were unable to give voluntary consent. Sims’s experiments are some of the many historical abuses detailed in my 2007 book Medical Apartheid.

The play Behind the Sheet, which I highly recommend, explores this ordeal from the point of view of three of the enslaved women, Anarcha, Betsey and Lucy (Sims may have experimented on as many as 12). This perspective alone is an important innovation, because discussions have tended to regard the women as passive beneficiaries without will, rights or identities. The play fleshes out their personalities, perspectives and motivations. History has rendered them voiceless; for the first time, this play effectively allows them to speak, and honours their personhood, obscured for nearly two centuries.

The play is greatly aided by exquisite acting under Colette Robert’s direction. Naomi Lorrain plays the fictional Philomena (whose experience parallels Anarcha’s) with sublime delicacy. When she tentatively queries surgeon George Barry (Joel Ripka) — the figure based on Sims — she precisely highlights the social limits within which she can question, complain and militate on behalf of others. A subtle hesitation, a step back, a prolonged silence communicate the deference she must be careful to show when speaking to Josephine, the physician’s jealous and quietly mercurial wife (Megan Tusing).

Sally, another enslaved woman (an ebullient Cristina Pitter) offers a pragmatic, powerful counterpoint. Stentorian tones and a confident stride broadcast her independent spirit. Yet she also makes a credible show of sympathy to Philomena when the latter experiences a fistula after a disastrous labour. Ripka’s George is pitch-perfect as he veers from self-centred zeal for technical innovations to callous dismissal of the women’s reports of pain.

Simpson was inspired to write the play some years ago. Several historical accounts — including Medical Apartheid — had questioned the accuracy and ethics of Sims’s supposed medical accomplishments. My own book inspired activists in New York City to successfully militate for a statue of Sims in Central Park to be taken down, and Simpson took note. The complexities of doing justice to such a story present the playwright with all the challenges of a drama, and of a historical work. (Given that, it is unfortunate that the play’s programme refers to just one full-length history, and Sims’s own self-serving accounts.)

I sometimes wondered how clearly the complex issues were rendered for the audience. For example, the play’s title is a heavily ironic comment on a 1952 painting by Robert Thom. This shows Sims as a medical benefactor facing an enslaved woman who kneels against a concealing sheet. The painting is reproduced in the play’s programme and mirrored in a brief opening tableau. But like Central Park’s banished colossus, Thom’s painting is a beautiful lie, which I dissected in Medical Apartheid. Anarcha, Betsey and Lucy did not kneel, fully clothed, in dignified submission. They were stripped naked and held down by young, white male assistants — immobilized and screaming in pain and humiliation — before an audience invited by Sims. The sheet is a fiction.

The script mentions, but declines to re-enact, the bloody surgical scenes. Nor is there in-depth ethical analysis. For example, despite the characters’ rumination over how women actively or passively accede to the surgery, the play never explores the real question: whether consent was even possible for an enslaved woman living under the constant threat of violence.

Several missteps also hobble the play dramatically and didactically. Worst is the introduction of a wholly fictional sexual relationship between George and Philomena; George is even presented as having fathered her baby. This invention muddies the already murky ethical waters of volition, coercion, sentiment and motivations. Moreover, it asks much of the actors, who nevertheless deliver with impressive precision and sensitivity. Philomena wordlessly conveys vulnerability, disgust and inadequate resistance in turn. George displays tenderness that is belied a moment later by his flashing eye and stony silence when Philomena dares to draw a parallel between their as-yet unborn child and George’s white heir.

A playwright cannot — as Simpson does — claim fidelity to the historical record while inventing such momentous fictions. Simpson’s solution is awkward pronouncements recited by the actors after the curtain falls, such as: “As far as we know, he did not have a relationship with one of the women.” But the portrayal of this relationship is not a bell one can so easily unring.

I worry that it informs the audience’s perception of Sims. This unnecessary layer of fiction might weaken belief in the credible moral charges levelled against him. He still has defenders, including those who protest that his actions were ‘acceptable in his time’. Acceptable to whom? Not to African Americans then or now, nor to some of Sims’s own medical peers. In fact, forcing people into experimentation without their consent was considered just as immoral in the United States during the nineteenth century as it is today — unless the subjects were legally invisible enslaved black people.

Sims’s copious sins require no embellishment. Even the monstrous have the right to an accurate historical portrayal: to be reviled for what they did, not for what they didn’t do.

doi: 10.1038/d41586-019-00340-5

Updates & Corrections

  • Correction 26 February 2019: The end date for the exhibition has been updated.

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