The abuse of power by doctors and medical institutions has a long and storied history. The work of J. Marion Sims and Henry Cotton are representative of the systematic violence visited upon marginalized populations in pursuit of medical knowledge. They were placed in positions of undisputed power over their subjects, and subsequently proceeded with actions otherwise deemed unconscionable, leadership was absent or actively complicit in enabling their activities, their subjects were largely dehumanized by nature of their mental or physical states, and the sheer volume of persons they interacted with heightened the risk of deindividuation. Yet, they both believed they were serving the greater good.
J. Marion Sims was a physician in the American South whose practice was inextricable from the systematic violence of slavery. While he is credited for the development of a surgical procedure to treat vesicovaginal fistulas, he practiced and perfected his technique on the bodies of enslaved black women purchased for this express purpose.
There are few incidents in history that are as emblematic of large-scale dehumanization as American slavery. The slaves were seen as little more than objects. This perception was reinforced through practices such as slave markets, branding, and the three-fifths compromise, which legally deemed them less than human. The dehumanization of these bodies is evidenced by the fact that he denied them any form of anesthesia, despite it being available at that time — a practice with chilling echoes in today's medical practice, where black people are often given less pain medicine than their white counterparts.
More locally, there is the case of what is now Trenton Psychiatric Hospital. At the dawn of the twentieth century, Dr. Henry Cotton became the director of the institution. While he started out by banning restraints and introducing occupational therapies, he was obsessed with the idea that mental illness was rooted in pathological infections. Cotton then began a series of brutal extraction experiments, removing teeth and internal organs from patients entrusted to his care.
He rarely obtained consent from either the patients or their families, often proceeding with his surgeries despite patients pleading with him not to. The persons left in these asylum facilities were easy to deindividuate, as new ones kept coming in with similar diagnosis and physical attributes. After performing the sheer volume of surgical removals he did, it is also likely that Cotton lost the ability to differentiate between different victims.
In terms of control over their subjects, Sims and Cotton were abetted by different institutional supports. In the case of Sims, there is little dispute that his subjects' identity as slaves gave him a great deal of socially-sanctioned control over their bodies. In fact, the practice of using slaves for anatomical research was entrenched in the medical practice of the time. Sims' actions were both condoned and widely practiced, with academic institutions further rewarding such violence by publishing the resultant papers.
In the case of Cotton, his patients were susceptible to the prevailing social attitudes of the time, where persons institutionalized in insane asylums were seen as helpless and heavily infantilized. Directors, nurses, and wardens were given patrician levels of control over the day-to-day existences of their wards. Though he abolished physical restraints, this level of control made it possible for him to force surgical procedures on them with little outside intervention. He was further supported at an institutional level. His mentor, Adolf Meyer, intentionally suppressed reports that detailed the horrors at work in Trenton, allowing Cotton to continue unfettered for years.
In conclusion, the use and abuse of underserved patients is not a recent intrusion into America's medical history. It is up to us as informed individuals to make sure our healthcare providers are held accountable for their practices.
Next week, I'll be looking at two more recent cases: opioid over-prescription and the rise of anti-vaccination ideologies.