Medical journals are filled with untold stories. We may be able to imagine a moment — the pain of a biopsy, the devastation of a cancer recurrence. But in a research paper, these experiences are necessarily reduced, by the scientific method and privacy concerns, to numbers. Responders and non-responders. Recurrence and no recurrence. Mortality and survival. Rarely, one name leaps at us from the medical literature and demands a personal reckoning. And one such name is Anarcha.
Anarcha was an enslaved African American woman who suffered greatly from an obstetric fistula. Typically this is the result of a prolonged labor — sometimes days long — in which pressure from the fetus’s head reduces blood flow, causing the surrounding tissue to die off, thereby leaving a connection between the bladder and the rectum or vagina. When untreated, this can cause incontinence, tremendous pain and infections as well as professional consequences. To call these injuries catastrophic is an understatement, and they were considered untreatable at the time.
But the medical travails of Anarcha, and several other enslaved women, were not limited to the devastation of their injuries: They also suffered greatly at the hands of Dr. J. Marion Sims. In his repeated attempts to find a surgical cure for fistulas, primarily for fame and profit (his own as well as the enslavers’), Sims subjected Anarcha to dozens of surgeries without anesthesia in his backyard hospital in Alabama. As a result of this “research,” and his aggressive self-promotion, Sims eventually became known as the father of American gynecology, immortalized by three statues across the country and in the annals of medical literature.
In recent years, Anarcha has been reassessed and celebrated. She has been memorialized in art, film and song. A statue of Anarcha was placed on the grounds of the Alabama State Capitol, next to that of Sims; in 2021, the Mothers of Gynecology Monument was erected in Montgomery. The author and essayist J.C. Hallman, for his part, has since 2015 worked to disseminate the story of Anarcha and restore her name to the public record.
“Say Anarcha” is the result of that work, and presents a compelling and well-researched dual biography of Anarcha and the man who caused her so much suffering. But their stories are more intertwined than those unimaginable years under Sims’s dubious care might imply; indeed, parts of this truly astounding tale are best left for the reader to discover, then reread in disbelief. At times, this can be horrifying, but it feels vital that we bear witness — and Hallman handles these moments of intimate suffering in a way that never comes across as exploitative.
In the case of Sims, an author has ample material: His own writings, and those of his contemporaries, provide a detailed record of his life. Ambitious and self-confident, Sims raised himself from a small-time “plantation physician” to the head of the American Medical Association and founder of a women’s hospital, and ultimately his medical advice was sought by the wealthy (whose custom he pursued). But much of what is known about Anarcha is from Sims’s own studies and memoirs — and he is a most unreliable narrator.
What facts are known about Anarcha are extremely limited, but without question we know more thanks to Hallman’s research; he worked tirelessly to find her grave and discover records beyond Sims’s. To help give Anarcha a voice, Hallman draws on first-person accounts of formerly enslaved people. This is an effective device; while we know that we are not reading Anarcha’s actual words or thoughts, she comes alive. Along the way, we are shown reproductions of signatures and documents that act like markers, reminding us that we are reading about the real life of a woman who lived and loved and suffered.
As a physician who sees patients with severe skin problems related to untreated incontinence, I know from experience how much pain even the lightest touch can cause. I also know that each operation would have made the next one more agonizing. And the fact that Anarcha almost certainly held still and silent for her many unanesthetized surgeries is almost unimaginable.
Sims’s rise to gynecological legend is fascinating not merely when one considers his brutality, which was not limited to the repair of fistulas, but also given his frequent failures and the scorn of many contemporaries. His misdiagnoses and botched surgeries left a trail of suffering and death in his wake, and his victims numbered not just enslaved women and children but also those with money and position. When he began experimenting on Anarcha and others, his white male assistants soon quit; his unwilling subjects were forced to hold one another during surgeries and provide nursing care. His initial fame arose directly from these experiments and it is the suffering of his victims that allowed him to claw his way up both in the medical profession and in society at large.
But even at the heights of his career, he lived in constant fear that the truth would be revealed: Despite so many surgeries, Sims had never cured Anarcha — and the device he developed for fistula surgeries (from which he had made a fortune) did not, in fact, work.
The book is packed with detail and the subject matter is treated with due seriousness; the stories of Anarcha and Sims flow. That said, it is not perfect: Comets and falling stars are a pat recurring trope that repeatedly emphasizes the interconnection of the stories and grows to feel heavy-handed. But this is a small quibble.
“Say Anarcha” is an important book and deserves to be widely read, especially by those in medicine. I challenge any Sims supporters to read it and continue to defend his ethics. At a certain point, Hallman reveals that Sims was inspired partly by his contemporary P.T. Barnum, the greatest showman on earth. This makes perfect sense, because in many ways Sims was the original American medical huckster.
In the introduction Hallman tells us that his goal is “to subvert every aspect of the fraudulent narrative” connected to Anarcha and to “excavate the life story of a young, enslaved woman who changed history, only to be forgotten by it.” He has accomplished that and more.
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