United States

Lesson Plan 1 of 2

Purpose: This activity teaches students about the controversies surrounding public memorials in the United States.  It allows students to evaluate two sides of the controversy surrounding the 19thcentury doctor who developed the surgical technique to repair vaginal fistula while operating on enslaved African American and impoverished Irish women without anesthesia. This lesson gives students the opportunity, in some small way, to think about tradeoffs, and whether the good that results outweighs the harm that was done in developing that good. This is recommended as an activity to be included in a unit on teaching the lives and circumstances of the enslaved in the United States.
 
Objective: Students will design a memorial that will recognize the complicated contribution to medical science brought by J. Marion Sims and also honor the enslaved women whom he practiced on while developing the surgical technique to repair fistula. They will present their memorial design to the whole class.
 
California History-Social Science Content Standard:
8.7 Students analyze the divergent paths of the American people in the South from 1800 to the mid-1800s and the challenges they faced.
2. Trace the origins and development of slavery; its effects on black Americans and on the region’s political, social, religious, economic, and cultural development; and identify the strategies that were tried to both overturn and preserve it (e.g., through the writings and historical documents on Nat Turner, Denmark Vesey).
 
California Common Core State Standard:
Reading Standards for Literacy in History/Social Studies 11–12
Key Ideas and Details
3. Evaluate various explanations for actions or events and determine which explanation best accords with textual evidence, acknowledging where the text leaves matters uncertain.
Craft and Structure
6. Evaluate authors’ differing points of view on the same historical event or issue by assessing the authors’ claims, reasoning, and evidence.
Integration of Knowledge and Ideas
7. Integrate and evaluate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, as well as in words) in order to address a question or solve a problem.
8. Evaluate an author’s premises, claims, and evidence by corroborating or challenging them with other information.
9. Integrate information from diverse sources, both primary and secondary, into a coherent understanding of an idea or event, noting discrepancies among sources.
 
Speaking and Listening Standards 11–12
Comprehension and Collaboration
1. Initiate and participate effectively in a range of collaborative discussions (one-on- one, in groups, and teacher-led) with diverse partners on grades 11–12 topics, texts, and issues, building on others’ ideas and expressing their own clearly and persuasively.
a. Come to discussions prepared, having read and researched material under study; explicitly draw on that preparation by referring to evidence from texts and other research on the topic or issue to stimulate a thoughtful, well-reasoned exchange of ideas.
 
b. Work with peers to promote civil, democratic discussions and decision-making, set clear goals and deadlines, and establish individual roles as needed.
 
c. Propel conversations by posing and responding to questions that probe reasoning and evidence; ensure a hearing for a full range of positions on a topic or issue; clarify, verify, or challenge ideas and conclusions; and promote divergent and creative perspectives.
 
d. Respond thoughtfully to diverse perspectives; synthesize comments, claims, and evidence made on all sides of an issue; resolve contradictions when possible; and determine what additional information or research is required to deepen the investigation or complete the task.
 
2. Integrate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, orally) in order to make informed decisions and solve problems, evaluating the credibility and accuracy of each source and noting any discrepancies among the data
 
Presentation of Knowledge and Ideas
4. Present information, findings, and supporting evidence (e.g. reflective, historical investigation, response to literature presentations), conveying a clear and distinct perspective and a logical argument, such that listeners can follow the line of reasoning, alternative or opposing perspectives are addressed, and the organization, development, substance, and style are appropriate to purpose, audience, and a range of formal and informal tasks. Use appropriate eye contact, adequate volume, and clear pronunciation. CA
 
b. Plan and present an argument that: supports a precise claim; provides a logical sequence for claims, counterclaims, and evidence; uses rhetorical devices to support assertions (e.g., analogy, appeal to logic through reasoning, appeal to emotion or ethical belief); uses varied syntax to link major sections of the presentation to create cohesion and clarity; and provides a concluding statement that supports the argument presented. (11th or 12th grade) CA
 
5. Make strategic use of digital media (e.g., textual, graphical, audio, visual, and interactive elements) in presentations to enhance understanding of findings, reasoning, and evidence and to add interest.5.Make strategic use of digital media (e.g., textual, graphical, audio, visual, and interactive elements) in presentations to enhance understanding of findings, reasoning, and evidence and to add interest.
 
6. Adapt speech to a variety of contexts and tasks, demonstrating a command of formal English when indicated or appropriate. (See grades 11–12 Language standards 1 and 3 for specific expectations.
 
Suggested Time: 1-3 class days (at least one hour of class time)
 
Background Information:
Teachers may want to update their own background knowledge about J.Marion Sims by reading the article on him at History.com
Brynn Holland, "The 'Father of Modern Gynecology' Performed Shocking Experiments on Slaves," HISTORY, last modified August 29, 2017: https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves.
 
Procedure: 
  •  Teachers may or may not want to spend 5-10 minutes explaining to students what a fistula is.  In women, fistulas most often form between the rectum and the vagina (Rectovaginal fistula) or between the bladder and the vagina (vesico-vaginal fistula), as a result of a difficult childbirth or of gang rape. It may be difficult for students to grasp the importance of this surgery if students do not understand what it is or it’s import.  If the teacher does explain to students what a fistula is, they may want to also mention that one half of the 2018 Nobel Peace Prize went to Denis Mukwege, who performs this surgery on Congolese women who were gang-raped in the Congolese civil war.
   
  • You should also show your students a photo of the statue in question, which sits on the grounds of the state capitol in Montgomery, AL. 
 
 A photo by Mickey Walsh of the newspaper the Montgomery Advertiser can be found here: https://www.montgomeryadvertiser.com/story/news/local/alabama/2018/05/10/sims-statue-state-capitol-has-go-senator-says/597564002/ 

  • Once students have read the background information on Sims and examined the image of the statue they should answer the following questions:
 
  1. Who was James Marion Sims and what was he known for?
  2. Based on what you know so far, what are your thoughts regarding commemorating Sims with a statue?
 
  • Next, have your students read a 2018 article published in The Guardian newspaper by Nadja Sayej entitled: "J Marion Sims: controversial statue taken down but debate still rages,"
You may want to select excerpts for you students to read, based on their reading level or time constraints.

  • After your students have read the article have them answer the following questions:
 
  1. What happened to the statue of J. Marion Sims in New York City?
 
  1. What are some of the objections people have to the statue remaining up?
 
  1. Why do some people think that the statue should not be taken down?
 
  1. Are any alternatives to removal mentioned?
 
  1. Based on what you know so far, what are your thoughts regarding how Sims should be remembered?
   
  • Then students should answer the following questions:
  1. What are the author’s thoughts about J. Marion Sims?
  2. In what ways were Sims’ medical practices normal for his time? In what ways were they different?
  3. Based on what you know so far, what are your thoughts regarding how Sims should be remembered?
 
  • After students have read the articles and answered the questions they should design a memorial (the design can be on paper or with clay/play-dough) that puts J. Marion Sims in the full context of his work and honors the women he practiced  his surgical techniques on. You may want to assign students to small groups of 2-3 for the memorial design activity. After they design the memorial they should write a paragraph explaining the design of their memorial and what the different aspects of it refers to.  Depending on the class setup students can do a gallery walk of each other’s memorials or present their memorial to the class
 
Materials/Handouts:     You may want to select excerpts for you students to read, based on their reading level or time constraints.

(again, you may want to provide excerpts instead of the entire article)
  • Drawing paper and colored pencils OR play-dough
  • Sample rubric for assignment 

Lesson Plan 2 of 2​

Purpose: This activity teaches students about the Tuskegee Syphilis Experiment and the role that Nurse Rivers played in continuing the experiment for 40 years.  They will employ a variety of lens and themes to examine both the larger context and specific and purposeful role that Nurse Rivers occupied in the study.  Some of themes to consider are: race, sex, socio-economic class, medical ethics, and power dynamics.
 
Objective: Students will read various excerpts about Nurse Rivers and decide for themselves whether she was a victim, perpetrator, upstander, or bystander in the Tuskegee Syphilis Experiment and defend their argument with specific examples and facts.
 
California Social Studies Content Standard: 11.10 Students analyze the development of federal civil rights and voting rights. 2. Examine and analyze the key events, policies, and court cases in the evolution of civil rights… Examine and analyze the key events, policies, and court cases in the evolution of civil rights…
 
Suggested Time: 1-2 class days (at least one hour of class time)
 
Procedure:
  • Spend 5-10 minutes teaching students about the history, causes, purpose, consequences, and significance about Tuskegee Syphilis Experiment.  Teachers should also provide definitions of victim, perpetrator, upstander, and bystander.
 
  • Distribute copies of the excerpts about Nurse Rivers to every student.  Teachers can have students read the excerpts independently, in small groups, or as a whole class.
 
  • Student will read and take notes on each passage.  They will decide if each passage portrays Nurse Rivers as a victim, perpetrator, upstander, and/or bystander.  After reading all the passages, they will write a formal paragraph that asserts and defends their claim as to what role she played in the experiment.
 
  • Teachers should lead a whole class discussion that allows students to share their claims, ideas, and evidence.  Consider starting the discussion by starting with the “four corners” strategy.  Encourage debate amongst the students. Try to ensure that themes of race, sex, socio-economic class, medical ethics, and power dynamics are discussed.  Prepare students to expect differences in opinions and accept a lack of consensus.
 
Materials/Handouts:
  • Worksheet (included on next page)
  • Suggested reading: Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones
 
 
Nurse River’s Role in the Tuskegee Syphilis Experiment
 
Directions: Read and annotate each passage.  Under each passage, jot down notes about the major ideas in the reading and if you believe Nurse Rivers was a victim, perpetrator, upstander, and/or bystander.  You will use these notes to write a paragraph afterwards.
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 152-155
“During the first twenty years of the experiment, she approached 145 families [for permission to perform autopsies on the men in the experiment who died] and all but one granted permission.
…
Beginning in 1935 her work became easier because the Public Health Service (PHS) began offering burial stipends in exchange for permission to perform the autopsies…Nurse Rivers saw the burial stipends as a godsend for people who could not afford decent funerals… she observed, ‘because in those early days, fifty dollars was a whole heap of money for a funeral.’… Most of the families accepted the offer without hesitation, considering themselves fortunate to receive burial aid.”

 
 
 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 155-6
“Nurse Rivers’s interest in the families did not end once they had granted permission for the autopsies.  She attended every funeral service and often sat with the relatives of the deceased.  ‘I was expected to be there,’ she said.  ‘They were part of my family.’
 
Home visits became an important part of her follow-up activities.  Through them, she came to know the men and their families well.  ‘Miss Rivers would come by and check on us between times we see the doctors,’ recalled one of the men.  ‘Yes, sir, she sure would.  Come in and visit with us and talk to us and ask us how we are doing,’ the man continued.  ‘Sometime she’d feel our pulse, see how our pressure was doing…It was very nice,’ he added gratefully.”

 
 
 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 156-158
“‘Annual roundups’ was what the health officers called their excursions back to Alabama.  A different team of doctors conduced the roundups most years…Standing between the physicians and the subjects was Nurse Rivers… ‘Some people rub other people wrong,’ she observed, ‘there’s got to be somebody who can serve as a cushion.’
…
Several of the physicians were harsh and condescending, projecting airs of authority and superiority that threatened to inject overt racial tensions into the experiment…Nurse Rivers recalled one young doctor… ‘I said [to the doctor]: ‘You don’t have to pet them; you don’t have to beg them.  Just talk to them man to man.  Just talk to them, they understand.  You don’t have to get on your knees to them, but just be polite to them.  Just talk to them like they’re people.’
…
If Nurse Rivers served as ‘cushion,’ she also served as a ‘bridge’ between the doctors and the men.  The health officers occasionally complained that the men were uncooperative or responded to instructions too slowly.  She handled these situations by paraphrasing what the doctors had said so the men would understand exactly what the doctors wanted.”

 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 159-160
“Most of the men never raised questions about the experiment, at least not outside their own circle.  To them, Nurse Rivers offered no explanations; one of her characteristics was knowing then to remain silent.  ‘She never did tell us nothing about what they [the doctors] was doing,’ complained one subject bitterly.  But when the men did raise questions, they asked them of Nurse Rivers…
 
Often her replies merely echoed what the men had been told at the beginning. ‘The answer she would give me was: ‘You just got bad blood and we is trying to help you,’ a subject recalled.’  While generally vague and elusive, Nurse Rivers also knew how to trade upon the men’s ignorance and need for medical care to fashion explanations for the experiment that they would find compelling…
 
The relationship that evolved between Nurse Rivers and the men played an important role in keeping them in the experiment.  More than any other person, she made them believe that they were receiving medical care that was helping them.”

 
 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 161-162
“Nurse Rivers’s ability to recognize the men on sight helped the PHS prevent them from obtaining treatment.  During the first few years of the experiment there was no real danger that the men would receive medical care.  But in 1937 the Rosenwald Fund decided to renew its support of syphilis control programs and sent a black physician, Dr. William B. Perry of the Harvard School of Public Health, to Macon County.  Fearing that the resumption of treatment activities might endanger the experiment and aware that Dr. Perry needed help badly, Dr. Vonderlehr shrewdly arranged to have Nurse Rivers assigned as his assistant….Her presence at the treatment clinics no doubt guaranteed that the men in the experiment were not treated.
 
Nurse Rivers was called upon the perform the same task a year or so later when another treatment program threated to make health care available to the men…‘When we found one of the men from the Tuskegee Study,’ recalled Dr. Reginald G. James, ‘she would say: ‘He’s under study and not to be treated.’’
 
Men in the experiment told similar stories.  Because of Nurse Rivers, they were prevented from receiving medical care at the rapid-schedule treatment clinics that were introduced by the PHS in the late 1930s and early 1940s.”

 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 166
“She had been trained to follow the doctors’ orders and to take good care of her patients.  Nothing in her nurse’s training had prepared her to recognize that there could ever be a tension between doing what the doctors instructed and looking after the best interests of her patients.  Her former teachers at Tuskegee, the private doctors in the area, and the PHS officers who served as her supervisors were all involved in the experiment.  It never occurred to her to question their judgment.
 
Another professional hierarchy impinged upon Nurse Rivers: the division between medical practitioners and medical scientists.  The stature of scientists in American society was high when the Tuskegee Study began, and her career paralleled advances in medical research that further increased their prestige.  Nurse Rivers never pretended to be able to judge the scientific merits of the study…Nurse Rivers accepted the expertise of her supervisors.”

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 166-167
“Sex roles reinforced her ethical passivity.  Most physicians were male, most nurses were female, and, within medicine as within American society, the men dominated.  Deference to male authority figures formed a pattern in Nurse Rivers’s life.  Her father was the principal influence in her early years; Dr. Dibble molded her professionally and hand-picked her for the experiment; and all the supervisors under whom she worked were male.  While she would not hesitate to argue with a physician in defense of the subjects, in most instances she did as she was told.”

 
 
 
 
 
 
 
 
 
 
 
 
 
Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, pg. 167
“Race was the final authority symbol in Nurse Rivers’s world. She was black and the physicians who controlled the experiment were white…
 
And yet if Nurse Rivers was subject to the authority of race, she never realized that the men were its victims.  She knew that only black men were selected as subjects, that they were chosen because they were ill, that they were systemically deceived and lied to, that they were denied treatment, and that syphilis killed many of them.  But she could still say: ‘It didn’t affect me as a civil rights issue’ and could declare: ‘I don’t think it was a racist experiment.’
 
The Oslo Study was the key.  Nurse Rivers was aware that the Tuskegee experiment was designed to provide a black contrast to Oslo Study and she understood its overall purpose was to prove that whites and blacks responded differently to syphilis.  This suggested that the races were being treated equally.  She completely ignored the distinctions between the studies.  To her, all that mattered was that physicals had once studied untreated syphilis in whites.”

 
 
 
 
 
 
“First, Do No Harm: a Nurse and the Deceived Subjects of the Tuskegee Study” by Michel Marriott in The New York Times, February 16, 1997
“I think she was as much a victim as the men themselves were victims,” Mr. Grey said of Nurse Rivers.  “Nobody could expect one black woman in Alabama in 1932, when the Federal Government is employing her, to do something.  How could she resist and say, “I’m not going to do it.”

 
 
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