J. Marion Sims

J. Marion Sims
Jefferson Medical College
Occupation	Surgeon
Known for	vesicovaginal surgery
Spouse	Theresa Jones
Children	9
Relatives	John Allan Wyeth (son-in-law) Marion Sims Wyeth (grandson) John Allan Wyeth (grandson)
Signature

James Marion Sims (January 25, 1813 – November 13, 1883) 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.^[3] However, he developed this technique via non-consensual and unanesthetized surgeries on enslaved Black women.^[4] He is also remembered for inventing the

He was one of the most famous and venerated physicians in the country. In 1876, he was elected President of the American Medical Association. He was one of the first American physicians to become famous in Europe.^[6] He openly boasted that he was the second-wealthiest doctor in the country.^[7]

However, as medical ethicist Barron H. Lerner states, "one would be hard pressed to find a more controversial figure in the history of medicine."^[8] A statue in his honor, the first statue in the United States in honor of a physician,^[9] was erected in 1894 in Bryant Park in New York City, but removed in 2018.

There are ethical questions raised by how he developed his surgical techniques.^[10] He operated on enslaved black women and girls (who, like prisoners, could not meaningfully consent because they could not refuse).^[10][8] In the twentieth century, this was condemned as an improper use of human experimental subjects and Sims was described as "a prime example of progress in the medical profession made at the expense of a vulnerable population".^[10][11] Sims' practices were defended as consistent with the US in the era in which he lived by physician and anthropologist L. Lewis Wall,^[12] and other medical historians. According to Sims, the enslaved black women were "willing" and had no better option.^[8]

Sims was a prolific writer and his published reports on his medical experiments, together with his own 471-page autobiography^[13] (summarized in an address just after his death^[14]), 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.

James Marion Sims, who preferred to be called "Marion", was born in Lancaster County, South Carolina,^[15] the son of John and Mahala (Mackey) 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.^[16]

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.^{[14]: 4–5}

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 (predecessor of the Medical University of South Carolina), but found it too rigorous.^[17]

He moved to

I felt no particular interest in my profession at the beginning of it apart from making a living.... I was really ready at any time and at any moment to take up anything that offered, or that held out any inducement of fortune, because I knew that I could never make a fortune out of the practice of medicine.[14]^: 8

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."^[17] After his first two patients (infants) died, Sims was despondent. He left and set up a practice in Mount Meigs, near Montgomery, Alabama.^[14]: 7 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".^[13]: 374 He was in Mount Meigs from 1835 to 1837.^[18]: 6 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.^{[13]: 177–178 [19]}

In 1837 Sims and his wife moved to Cubahatchee, Alabama, where they remained until 1840.^[18]: 6 He was a "plantation physician",^[17] who had "a partnership in a large practice among rich plantations."^[14]: 7 "Sims became known for operations on clubfeet, cleft palates and crossed eyes."^[17] 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.^[20]: 77

In 1840 the couple moved to Montgomery, Alabama,^{[14]: 7–8} where they lived until 1853.^[18]: 10 Sims later described this period as the "most memorable time" of his career.^[21] 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.^[18]: 7 "He was immensely popular, and greatly beloved."^[18]: 8 When he returned to the city for a visit in 1877, he was treated as a hero.^[22]

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.^[23]: 34 He built a hospital or "Surgical Infirmary for Negroes", for those women their owners brought him for treatment.^[14]: 9 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".^[24] It was also the first hospital specifically for Blacks in the United States.

In 1840, the field of

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,"^[26] and a common, socially destructive, and a terrible complication of childbirth that affected many women.^[12] There was no effective cure or treatment. In an era without adequate birth control and rudimentary knowledge of the processes of pregnancy and childbirth, women who gave birth frequently experienced complications afterwards.^[27] 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.^[12]

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

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.^[29][30] Moreover, Henry van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) had outlined essential repair steps for such conditions that are recognizable even today.^[31]

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.^[14]: 10 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.^[32] 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.

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.^{[33][34]: 20, 22 [35]} 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.^[14]: 9 Sims took responsibility for their care on the condition that the owners provide clothing and pay any taxes; Sims provided food.^[28] He purchased one woman specifically in order to experiment surgically when her owner refused to allow Sims to treat her otherwise.^[23]: 35

The use of enslaved people for

No place in the United States offers as great opportunities for the acquisition of anatomical knowledge, subjects being obtained from among the colored population in sufficient number for every purpose, and proper dissection carried on without offending any individual in the community. Those impediments which exist in so many other places, to the prosecution of this study, are not here thrown in the path of the Student, public feeling being rather favourable than hostile to the advancement of the Science of Anatomy.^{[37][38]: 190}

The college announced, in advertisements in the Charleston papers, that it had set up a surgery (

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.^[8] 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.^[25] Anarcha suffered from both vesicovaginal and rectovaginal fistulas, which Sims struggled to repair.^[12] "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."^[14]: 10 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.^[39] Anarcha, Lucy, and Betsy are memorialized in the statue Mothers of Gynecology, unveiled in Montgomery, Alabama, on September 24, 2021.^[40]

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.^{[41]: 2 [34]: 19–21}
• Lavinia Boudurant, 13, had a bladder calculus removed by Sims in 1850.^[34]: 23
• Delia, 23, "Dr. Sims' own servant [slave]", who between 1850 and 1853 underwent ten or more operations for fistula repair.^[34]: 24
• 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.^{[34]: 25–27, 42–45}

Although anesthesia had very recently been used experimentally, Sims did not use any anesthetic during his procedures on these three women.^[8] Ether anesthesia was first publicly demonstrated in Boston in 1846, a year after Sims began his experimental surgery. Sims himself indicated that he was unaware at the time of the use of diethyl ether.^[42][12][28] As late as 1853, when Sims's fistula experiments were concluded and reports on them were being published, many physicians still doubted chloroform's safety, and guidelines for its proper administration during surgery had yet to be devised and published.^[43]

In addition, a common racist belief at the time was that black people did not feel as much pain as white people.^[44] Given this, Sims did not anesthetize the women he operated on while developing his fistula repair technique. Anesthesia was itself still experimental; early anesthetic agents were much more dangerous than the replacements developed in the twentieth century. Dosing was also imprecise: underdosing did not kill the pain; overdosing could and sometimes did kill the patient. Chloroform could be obtained from a druggist, but nitrous oxide and the highly flammable ether had to be manufactured by the surgeon on the spot. In Sims' day, surgeons were trained to operate quickly on unanesthetized patients. Anesthesia was first used in dentistry, and was just being announced as an exciting novelty in privately published pamphlets, some claiming credit for the anesthetic's first use, at the same time as Sims' fistula repair surgeries.^{[45][46][improper synthesis?]}

Sims published a paper In 1868 on his work on using nitrous oxide as an anesthetic,^[47] and in 1874 on using chloroform.^[48] In 1874 Sims addressed the New York State Medical Society on "The Discovery of Anaesthesia," in which he claimed that Americans had discovered the practice before the British,^[49][50] and in 1880 he delivered a paper (published soon afterwards) at the New York Academy of Medicine about a death from anesthesia.^{[14]: 22 [51]}

Sims also committed other errors due to the primitive knowledge about sanitation and infection in surgical theaters at the time. One patient, named Lucy, nearly died from sepsis after Sims operated on her in the presence of twelve doctors, experimentally using a sponge during the procedure to wipe urine from her bladder.^[27] Sims negligently left the sponge in her urethra and bladder.^[35] Although Sims eschewed using anesthesia during surgery, he did frequently administer opium to the women afterwards, which was an accepted therapeutic practice of the day.^[52]

Sims eventually perfected his technique. One of his key developments was the introduction in 1849 of silver wire as a suture, thus avoiding the infections associated with silk sutures, or the potential poisoning from using lead sutures (as Mettauer had done in 1838).^{[6][14]: 10} Sims published an account of his successful repair of Anarcha's suture using the silver wire in his surgical reports of 1852.^[10][53] He proceeded to repair fistulas in several other enslaved black women.^[54]

According to Durrenda Ojanuga, after Sims' successful treatment of Anarcha, he was asked by many white women to repair vesicovaginal fistulas, but most of them were apparently unable to endure the pain of the operation.^[55] The Journal of Medical Ethics reports a case study of one white woman whose fistula was repaired by Sims without the use of anesthesia during a series of three operations in 1849.^[12]

Sims later moved to New York to found a Woman's Hospital, where he performed the operation on white women. There are some discrepancies regarding whether he used anesthesia there. Ojanuga has claimed he did not, and L. L. Wall suggests that as of 1857 Sims did not use anesthesia to perform fistula surgery on white women, citing Sims' lecture to the New York Academy of Medicine of November 18 that year, wherein Sims asserted that he never used anesthesia for fistula surgery because the procedure was not painful enough to justify the risks of administering it. Wall notes that, while Sims' refusal to use anesthetic may seem shocking, he believes that this is a reflection of the contemporary sensibilities of the mid-1800s, particularly among surgeons who began their practice in the pre-anesthetic era.^[27][44][12]

During his early medical years, Sims also became interested in trismus nascentium, also known as neonatal tetanus, that occurs in newborns. A nineteenth-century doctor described it as "a disease that has been almost constantly fatal, commonly in the course of a few days; the women are so persuaded of its inevitable fatality that they seldom or ever call for the assistance of our art."^[56]

Trismus nascentium is a form of generalised tetanus. Infants who have not acquired passive immunity from the mother having been immunised are at risk for this disease. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. In the twenty-first century, neonatal tetanus mostly occurs in developing countries, particularly those with the least-developed healthcare infrastructure. It is rare in developed countries.^[57]

Trismus nascentium is now recognized to be the result of unsanitary practices and nutritional deficiencies, but in the nineteenth century its cause was unknown, and many enslaved African children contracted this disease. Medical historians believe that the conditions of the quarters of enslaved people were the cause. Sims alluded to the idea that sanitation and living conditions played a role in its contraction, writing that

[w]henever there are poverty, and filth, and laziness, or where the intellectual capacity is cramped, the moral and social feelings blunted, there it will be oftener found. Wealth, a cultivated intellect, a refined mind, an affectionate heart, are comparatively exempt from the ravages of this unmercifully fatal malady. But expose this class to the same physical causes, and they become equal sufferers with the first.^[17]

Sims also thought trismus nascentium developed from skull bone movement during protracted births. To test this, Sims used a shoemaker's

Sims reluctantly moved to New York City in 1853 because of his health. He decided to focus on diseases of women. He had an office at 267 Madison Avenue.^[60] In 1860 a Charleston, South Carolina, newspaper described his success as "splendid," and called him "the happiest man in New York."^[61]

In 1855 he founded the

In the Woman's Hospital, Sims usually performed his operations on indigent women in an operating theatre so that medical students and other doctors could view it, as was considered fundamental to medical education at the time. Some patients remained in the hospital indefinitely and underwent repeated procedures.[23]^[why?]

When Sims addressed the American Medical Association in 1858 on the topic "Treatment of the results of obstructed labor", the "charts" which illustrated it "caused the lady auditors to vacate the gallery."^[66]

Sims' Southern sympathies were no secret—he was no abolitionist—and even in New York, many of his patients were Southern ladies. As the American Civil War drew near, this practice fell away, and he did not feel comfortable remaining in New York.^{[62]: 27–28}

In 1861 Sims, who considered himself "a loyal Southerner," moved to Europe. There, he toured hospitals at first primarily for the purpose of researching hospital architecture for the new premises of his Woman's Hospital in New York, then still in the planning stages, but his renown soon permitted him to demonstrate his vesicovaginal repair surgery multiple times. First, he arrived in

Sims returned to the US in January 1862 aboard the Great Eastern, and back in New York he favorably reported on the pavilion plan and convinced the board of the Woman's Hospital to adopt it. He then returned to Europe in July 1862, intending to return to New York for six months out of the year to earn enough to allow his family to stay in Europe. However, Sims discovered that a remunerative practice to support his family working on fistula patients in Paris was possible, and so he decided to remain in Europe until the cessation of hostilities in the USA.^{[23]: 46 [17][14]} He simultaneously ran consulting rooms in Paris, Berlin, and London.^[67][65] However, according to

In 1863 Sims was reportedly summoned to treat Empress Eugénie for a fistula. This publicly helped Sims to solidify his global surgical reputation.^[17] According to Hallman, no source confirms that Eugénie had any documented medical problem at all. Sims' visits to the palace were semi-diplomatic Confederate visits, and the illness an element of subterfuge to escape the eyes of U.S. Federal diplomats, who had their eyes on Sims. Eugénie became an "ardent disciple" of the Confederacy.^[68]

In 1864 Sims moved to London from his previous base in Paris for the education of his children. He published Clinical Notes on Uterine Surgery simultaneously in English, French, and German (London, Paris, and Berlin) in 1865; this work described novel methods of treatment which were not readily adopted by the profession, but which in a few years would revolutionize the practice of gynecology.^[65] Sims remained in Europe until after the end of Civil War, in September 1868, opening an office upon his return to New York at 13 East 28th Street in Manhattan.^[14]

After the Fifteenth Amendment to the United States Constitution was passed in 1868, Sims said that it was a "dreadful mistake...to give the negro the franchise."^[68] Two years later, offering a toast on board the steamer Atlantic, returning to Europe, he said that in the aftermath of the war, the South had been degraded "beyond the level of the meanest slave that ever wore a shackle."^[68] Sims also argued that it was puerile for the South to sulk in its loss. He called for an acceptance of the outcome of the war, including the Fifteenth Amendment. "It is folly to talk of the lost cause," he said.^[68]

Having treated royalty, after his return to the United States, Sims raised his fees in his private practice. He thus effectively limited it to wealthy women, although "he always had a long roll of charity patients."^[69]: 25 He became known for the Battey surgery, which contributed to his "honorable reputation".^{[clarification needed]} This involved the removal of both ovaries. It became a popular treatment to relieve insanity, epilepsy, hysteria (diseased uterus), and other "disorders of the nerves" (as mental illness was called at the time). At the time, these were believed to be caused by disorders of the female reproductive system.^[23]