J. Marion Sims

James Marion Sims was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth. However, he developed this technique via non-consensual and unanesthetized surgeries on enslaved black women Anarcha Westcott, Lucy and Betsey and impoverished Irish women.
He is also remembered for inventing the Sims speculum, the Sims sigmoid catheter, and the Sims position. Against significant opposition, he established, in New York, the first hospital in the United States specifically for women. He was forced out of the hospital he founded because he insisted on treating cancer patients; he played a small role in the creation of the nation's first cancer hospital, which opened after his death.
Sims was one of the most famous and venerated American physicians of his era. He was elected President of the American Medical Association in 1876, and he was one of the first American physicians to become famous in Europe. He openly boasted that he was the second-wealthiest doctor in the country. However, as medical ethicist Barron H. Lerner states, "one would be hard pressed to find a more controversial figure in the history of medicine." A statue in his honor was erected in 1894 in New York City's Bryant Park, the first statue in the United States in honor of a physician. It stood for 124 years before being removed in 2018.
Today, many medical ethicists criticize how Sims developed his surgical techniques. He operated on some enslaved black women and girls who, like prisoners, could not meaningfully consent because they could not refuse. During the 20th century, his experiments began to be condemned as an improper use of human experimental subjects. Sims has been described as "a prime example of progress in the medical profession made at the expense of a vulnerable population". Some medical historians have defended Sims' practices as consistent with the accepted standards of his time. According to Sims, the enslaved black women upon whom he experimented were "willing" patients who had no better options for treatment.
Sims was a prolific writer and his published reports on his medical experiments, together with his own 471-page autobiography, are the main sources of knowledge about him and his career. His positive self-presentation has, in the late twentieth and early twenty-first centuries, been subject to revision.

Childhood, education, and early career

James Marion Sims, who preferred to be called "Marion", was born in Lancaster County, South Carolina, the son of John and Mahala Sims. His father, Colonel John Sims participated in the War of 1812, being stationed at Charleston. His paternal grandfather was one of Marion's men; his great-grandfather was with Washington at Braddock's defeat. His maternal grandfather, Charles Mackey, was taken prisoner by Banastre Tarleton, and would have been hanged, but for the intervention of his wife.
For the first twelve years of his life, Sims and his family lived in Lancaster Village, north of Hanging Rock Creek, where his father owned a store. Sims later wrote of his early school days there.
After his father was elected sheriff of Lancaster County, he sent Sims in 1825 to the newly established Franklin Academy, in Lancaster. In 1832, after two years of study at the predecessor of the University of South Carolina, South Carolina College, where he was a member of the Euphradian Society, Sims worked with Dr. Churchill Jones in Lancaster, South Carolina. He took a three-month course at the Medical College of Charleston, but found it too rigorous.
He moved to Philadelphia, Pennsylvania, in 1834 and enrolled at the Jefferson Medical College, from which he graduated in 1835 as "a lackluster student who showed little ambition after receiving his medical degree". As he put it:
He returned to Lancaster to practice. As of that date "he had had no clinical experience, logged no actual hospital time, and had no experience diagnosing illnesses." After his first two patients died, Sims was despondent. He left and set up a practice in Mount Meigs, near Montgomery, Alabama. He described the settlement in a letter to his future wife Theresa Jones as "nothing but a pile of gin-houses, stables, blacksmith-shops, grog-shops, taverns and stores, thrown together in one promiscuous huddle". He was in Mount Meigs from 1835 to 1837. Sims visited Lancaster in 1836 to marry Theresa, whom he had met many years earlier, when a student in Lancaster. She was the daughter of B.C. Jones, and the niece of Churchill Jones, and had studied at the South Carolina Female Collegiate Institute.
In 1837 Sims and his wife moved to Cubahatchee, Alabama, where they remained until 1840. He was a "plantation physician", who had "a partnership in a large practice among rich plantations." "Sims became known for operations on clubfeet, cleft palates and crossed eyes." This was his first experience treating enslaved black women, whose owners summoned Sims to treat them. Being a "plantation physician" was not as lucrative as Sims hoped a life as a doctor would be.

Practice in Montgomery

In 1840 the couple moved to Montgomery, Alabama, where they lived until 1853. Sims later described this period as the "most memorable time" of his career. Within a few years he "had the largest surgical practice in the State", and the largest practice of any doctor in Montgomery up to that time. "He was immensely popular, and greatly beloved." When he returned to the city for a visit in 1877, he was treated as a hero.
In Montgomery, Sims continued essentially his practice as a plantation physician: treating the enslaved, who then made up two thirds of the city's population. He built a hospital or "Surgical Infirmary for Negroes", for those women their owners brought him for treatment. It began with four beds, but it was so successful he added a second floor, doubling capacity to eight beds. One source says it expanded to twelve beds. It has been called "the first woman's hospital in history". It was also the first hospital specifically for Black people in the United States.
In 1840, the field of gynecology did not exist; there was no training on the subject, for Sims or anyone else. The only books were on midwifery. Medical students did not study pregnancy, childbirth, or gynecological diseases. Student doctors were often trained on dummies to deliver babies. They did not see their first clinical cases of women until beginning their practices. "The practice of examining the female organs was considered repugnant by doctors." Sims shared this view, remarking in his autobiography that "if there was anything I hated, it was investigating the organs of the female pelvis".

Medical experimentation on enslaved women and girls

Repair of vesicovaginal fistulas

In 1845 Sims was brought a woman with a condition he had not seen before: vesicovaginal fistula. Although not fatal, in the nineteenth century, vesicovaginal fistulas were "one of the most loathsome and disagreeable maladies to which females are subject," and a common, socially destructive, and a terrible complication of childbirth that affected many women. There was no effective cure or treatment. In an era without normalized contraception and rudimentary knowledge of the processes of pregnancy and childbirth, women who gave birth frequently experienced complications afterwards. Vesicovaginal fistulas occur when the woman's bladder, cervix, and vagina become trapped between the fetal skull and the woman's pelvis, cutting off blood flow and leading to tissue death. The necrotic tissue later sloughs off, leaving a hole. Following this injury, as urine forms, it leaks from the vagina, leading to a form of incontinence. Because a continuous stream of urine leaks from the vagina, it is difficult to keep the area clean. Such personal hygiene issues often lead to marginalization from society as well as vaginal irritation, scarring, and loss of vaginal function. Sims also worked to repair rectovaginal fistulas, a similar condition in which flatulence and feces escape from the rectum through a tear in the tissue separating it from the vagina, thus leading to fecal incontinence.
When Sims went to see a patient with an injured pelvis from a fall from a horse, he placed her in a knee-chest position and inserted his finger into the vagina. This allowed Sims to see the vagina clearly, and spurred him to investigate fistula treatment. In order to facilitate the examination of patients, he soon developed a precursor to the modern speculum, using a pewter spoon and strategically placed mirrors. As a result, he has generally been credited with the instrument's invention.
Sims, however, was not the first to successfully treat a vesicovaginal fistula, not even in the United States; Dr. John Peter Mettauer had successfully surgically repaired one in Virginia in 1838; and Dr. George Hayward in Boston the following year. Moreover, Henry van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations had outlined essential repair steps for such conditions that are recognizable even today.
Between 1845 and 1849, Sims performed experimental surgery on enslaved black women and girls to treat vaginal problems. He added a second story to his four-bed hospital, doubling its capacity. He developed techniques that have since formed the basis of modern vaginal surgery; one key component was silver wire, which he had a jeweler prepare. Sims' vaginal speculum, described above, aided in vaginal examination and surgery. The rectal examination position, in which the patient is on the left side with the right knee flexed against the abdomen and the left knee slightly flexed, is also named for him.

Experimental subjects

Occasionally, Sims conducted experimental surgery on white women, but his main subjects were twelve enslaved black women and girls with fistulas, whom he treated at his own expense in his backyard hospital. They were brought to him by their owners. Sims searched for patients with this fistula, and succeeded in finding six or seven women and girls. Sims took responsibility for their care on the condition that the owners provide clothing and pay any taxes; Sims provided food. He purchased one woman specifically in order to experiment surgically when her owner refused to allow Sims to treat her otherwise.
The use of enslaved people for medical research was not considered controversial in the Antebellum South. A prospectus from the 1830s of the South Carolina Medical College, then the South's leading medical school, pointed out to prospective students that it had an advantage of a peculiar character:
The college announced, in advertisements in the Charleston papers, that it had set up a surgery for negroes, and offered to treat without charge, while it was in session, any "interesting cases" sent by their owners, "for the benefit and instruction of their pupils". They extended the offer to free "persons of color". The advertisement ends by pointing out that their sole objective was "to promote the interest of Medical Education."
Sims named three enslaved black women and girls in his autobiography: Anarcha, Betsy, and Lucy. Each of them suffered from fistula, and all were subjects of his surgical experimentation. Sims conducted experimental surgery on each of them several times, including operating on Anarcha thirty times before the repair of her fistulas was declared a success. Anarcha suffered from both vesicovaginal and rectovaginal fistulas, which Sims struggled to repair. "Notwithstanding repeated failures during four years' time, he kept his six patients and operated until he tired out his doctor assistants, and finally had to rely upon his patients to assist him to operate." In some cases, like Anarcha's, who is estimated to have been 13 years of age when first treated by Sims, some of the enslaved women were girls, who in having been victims of childhood sexual assault by their enslavers, were physically immature for the act of giving birth, likely contributing to the severity and extent of their childbirth complications. Unlike his previous essays, which included at least a brief description of his patients, the article issued in The American Journal of the Medical Sciences omits any identifying characteristics of Anarcha, Betsy, or Lucy. Anarcha, Lucy, and Betsy are memorialized in the statue Mothers of Gynecology, unveiled in Montgomery, Alabama, on September 24, 2021.
Sims' former collaborator, Nathan Bozeman, later supplied the names of at least four other African-American women treated by Sims during this period:

Ann McRee, 16, treated by Sims for fistula in 1849.
Lavinia Boudurant, 13, had a bladder calculus removed by Sims in 1850.
Delia, 23, "Dr. Sims' own servant ", who between 1850 and 1853 underwent ten or more operations for fistula repair.
Julia McDuffie, 20, operated on by Sims for fistula closure in March 1853, and again in June 1853 by Bozeman after Sims' departure for New York.