James Marion Sims – this “father of gynecology” doesn’t deserve any father’s day cards, let alone statues and memorials. How can an enslaved person give informed consent? They can’t. Yet that doesn’t stop people from, at worst, idolizing and, at best, being ignorant of, a man who honed his medical techniques on enslaved African American women, whom he operated on (sometimes dozens of times) without anesthesia, over and over to get things right, ignoring their screams and discounting their humanity, before he put those tools and techniques to use on anesthetized white women. (and yes, you can argue that anesthesia wasn’t widespread yet (this was the 1840s), and that the women were suffering from painful conditions, but the fact remains that he was doing this experimentation *only* on the enslaved Black women – and he was doing so not to heal them for their own good but instead to keep them fit to work and reproduce).
A couple of weeks ago I told you the story of Charles Drew, an African American doctor who is known as the “Father of the Blood Bank” because he developed methods for safely collecting & storing large volumes of blood and blood plasma, and established the first national blood blanking systems in the U.S (blood banks he was excluded from donating to because he was Black!). He’s a “father” that deserves much more attention than he gets. https://bit.ly/charlesrdrew
Today, we have the opposite story, a medical “father” who gets much more positive attention than he deserves, the “father of gynecology,” J. Marion Sims, who developed valuable gynecological tools and techniques that are still used to this day, such as the modern vaginal speculum, but did so on enslaved women without anesthesia, operating on some of them dozens of times.
I’m going to tell you a bit about Sims. I wish that, instead of telling you about him, I could tell you about the women he harmed. I wish that I could tell you about their lives – their interests, their families, their personalities. I wish that I could tell you about them as more than victims in a tragedy. But I can’t. Because their words were not recorded. Few of their names were even recorded (the 3 we know are Lucy, Anarcha, & Betsey). Instead, the abuser got to write the history books and the name we know, the name every medical student is confronted with when introduced to the speculum, is Sims. It’s the “Sims speculum” that women have inserted into their vaginal canal so that the doctor can have a look. And if that doesn’t revolt you, I guess I need to tell you more about why it should.
Sims was born in Lancaster County, South Carolina in 1813. He went to the Medical University of South Carolina (then called Charleston Medical School) for a year before transferring to Philadelphia’s Jefferson Medical College where he graduated from. In 1845 he set up a private hospital for women in the back of his house in Montgomery, Alabama. Slave owners would bring him their slaves to be treated – not out of the goodness of their hearts, but instead out of a desire to keep them working.
After experimenting on these slaves between 1846 & 1849 he moved to NYC to open a Woman’s Hospital in the 1950s (the first of its kind). There he practiced and perfected his techniques on poor Irish immigrants at the Woman’s Hospital and then use them (for a high fee) in his private practice where he treated wealthy white women. He would later also treat wealthy Europeans when he fled to Europe during the Civil War.
When he was treating White women, he used anesthesia (which was also becoming more widespread in general so there’s a lot of debate about whether he should be criticized for not using it on the slaves but that’s only part of the issue with what he was doing). https://bit.ly/2WbOsxC
Even if anesthesia were widely adopted when he was experimenting, it is doubtful whether he would have used it as he didn’t believe Black people experienced pain the same as white people. This is total myth, but it’s a myth that lives on strong, including among the medical establishment https://bit.ly/2DwpIJT and continues to negatively impact the care that Black patients receive, with Black people receiving less pain medicine and being less likely to be believed when they say they’re in pain.
Speaking of pain…the main technique Sims is known for is a way to fix a painful condition called a vesicovaginal fistula (VSF). A fistula is basically an unnatural connection between things like different organs or the inside and outside of your body. I don’t want to get too graphic here, but VSF is a complication that can occur as a result of prolonged labor if the baby’s head is in the birth canal too long. Basically, this cuts off circulation in the canal, leading to tissue death that creates a hole between the vagina and the bladder. This can lead urine to pool in the vagina which can lead to, in addition to embarrassing situations, infections and pain. Some of the slaves he experimented on also had a rectovaginal fistula, where there’s a link between the rectum & the vagina. Being able to fix these fistulas would be a big benefit to a lot of women – of all races and socioeconomic situations. But he didn’t experiment on people of all races and socioeconomic situations. He experimented on enslaved Black women, including 11 he “treated” for VSFs.
In order to fix these fistulas, he needed to be able to see them. An idea for how to get a better look struck him when he was treating a white woman who had been thrown from a horse. Instead of testing it out on a white woman, he went to a slave and stuck his primitive invention – the bent handle of a silver gravy spoon – up her her vagina. https://bit.ly/2WaURJc
He would go on to improve this bent spoon design into the modern vaginal speculum (the modern version is barely any different from Sims’ – in 1870 Thomas Graves updated it slightly https://bit.ly/2WaURJc
Speculum in hand, Sims could go on to experiment. and experiment. and experiment – on enslaved Black women over a period of 4 years (1845-1849), which Sims describes in his own words in his autobiography, which was only 1/2 finished when he died. You can read it here: https://bit.ly/2CtH7lS but be warned that there’s some very offensive language including many instances of the N word.
Sims describes how the experiments came about – “I made this proposition to the owners of the negroes: If you will give me Anarcha and Betsey for experiment, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them.” Doctors happily consented at first, but when the situation dragged on for 4 years! the owners became unwilling to pay, so Sims took on the full cost, which he loved to boast as if he were the victim in the situation, writing “I kept all these negroes at my own expense all the time. As a matter of course this was an enormous tax for a young doctor in country practice.”
He also brags in his autobiography that “My patients are all perfectly satisfied with what I am doing for them.” I seriously doubt that. But we don’t know what they thought or said. He experimented on at least 10 enslaved women, but we only known the names of 3 of them – and not much more about them – these 3 women, the initial cases, are Betsey, Lucy, and Anarcha and here’s what we know.
Anarcha was the first case of VSF Sims saw (and she also had a rectovesticular fistula). She was about 17 years old when Sims was called in to assist with her labor – she had been in labor for 3 days! and the baby’s head was stuck. Sims helped deliver the baby with forceps but Sims was later called back and discovered the fistulas. Sims initially said he couldn’t do anything for her but, after he invented his speculum he called her back. He would operate on her 30 agonizing times.
Lucy was the first he operated on. She was about 18 at the time. Sims describes excitingly going into it as “commenc[ing] the the season of philosophical experiment,” Lucy on her knees surrounded by about a dozen doctors there to watch. Lucy almost died from sepsis (blood infection) after that first infection, but that didn’t stop Sims from operating on her – and other women – over and over and over.
The third of those other women we have a little information about was Betsey, a 17 or 18 year old who, after giving birth to a baby, was unable to control her bladder and was thus sent to Sims by her owner for examination and experimentation.
And there were others. As he writes in his autobiography, “there was never a time that I could not, at any day, have had a subject for operation.” Problem was, his operations weren’t working and, although he would eventually figure things out, it would take him four years, and lots of failed operations which he considered “unfortunate experiments” and which the women likely considered torture. “Lucy’s agony was extreme. She was much prostrated, and I thought that she was going to die. … After she had recovered entirely from the effects of this unfortunate experiment, I put her on a table, to examine.” https://bit.ly/2CtH7lS
Ultimately, he was able to develop a successful technique and it is this technique that serves the basis for much of his fame. A fame which he likely believed he very well deserved. Never one for modesty, after fixing the fistulas of Anarcha, Betsey, & Lucy, he wrote “I realized the fact that, at last, my efforts had been blessed with success, and that I had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity.“ And, if that weren’t disgusting enough, that sentence follows right after he writes “In the course of two weeks more, Lucy and Betsey were both cured by the same means, without any sort of disturbance or discomfort.” No discomfort? BS!
I don’t know about those final surgeries, but the surgeries in general were so agonizing that the doctors who had initially helped hold down the writhing patients could no longer stand to watch and listen to the screams, especially when such little progress was being made. So, instead, Sims made the other slaves do that job – taking turns restraining one another, having to watch the torture they knew they’d soon be receiving. https://bit.ly/3gPk0kM
It gets a lot less attention, but Sims also experimented on enslaved Black children, using a shoemaker’s tool to pry the bones of their skulls apart to try to cure a condition called Trismus nascentium (aka neonatal tetanus). When the babies inevitably died, Sims blamed the mothers and black midwives. https://bit.ly/3gPk0kM
Another thing that doesn’t get much attention (and which I only learned while doing this research) – Sims is glorified for doing so much to benefit women – but, in addition to all the good he did, such as with inventing the modern vaginal speculum and figuring out how to fix VSFs – even putting aside (just for a second!) the slave exploitation used to achieve that, he also did a lot of harm to women – even the rich white ones. Like many doctors of his time, he prescribed to the belief that mental illnesses like “hysteria” and “disorders of the nerves” were caused by problems with the female reproductive system. So, at the request of women’s husbands and/or fathers, he would perform operations to remove their ovaries. This operation, which Sims popularized, was called the Battey surgery and it theoretically served to cure the mentally ill; literally, it served to sterilize them. At the other end of the spectrum, he would take whom he diagnosed with “frigidity” which basically meant their vaginas didn’t want to open for their husbands, anesthetize them, and allow their husbands to have intercourse with, and hopefully impregnate, her. https://bit.ly/2WbOsxC
Sims resigned from the Woman’s Hospital in 1875 because they wouldn’t let a big enough crowd watch (they limited it to 15 observers). A few months later he was elected president of the American Medical Association (AMA) – and argued that its code of ethics was too strict… https://bit.ly/2WbOsxC
Now back to the stories of Anarcha, Betsey, Lucy, and the unnamed others slave women experimented on. For many years, Sims’ story went uncriticized – at least publicly – according to a 1950 biography by Seal Harris, “All kinds of whispers were beginning to circulate around town… dark rumors that it was a terrible thing for Sims to be allowed to keep on using human beings as experimental animals for his unproven surgical theories.” https://bit.ly/2CtqZ3O
But then, in 1976, a historian named G.J. Barker-Benfield wrote a scathing critique of Sims in his book “The Horrors of the Half-Known.” And, of course, the backlash & excusivizing came soon after from the medical gynecological community. At the American Gynecological Society’s 1978 meeting, doctors took turns defending Sims against Barker-Benfield’s accusations. A doctor named Lawrence I. Hester Jr. from the Medical University of South Carolina (the same school Sims had gone to) rose “not to reappraise J. Marion Sims, but to praise him.” In addition to rising, he announced that his school was raising $750,000 for an endowed chair (important faculty position) to be named after Sims. https://bit.ly/2CtqZ3O
Some doctors offered an excuse that you still hear a lot today – that Sims was *helping* the enslaved women. A doctor named Irwin Kaiser is on the record as saying “Women with fistulas became social outcasts…In the long run, they had reasons to be grateful that Sims had cured them of urinary leakage.” https://bit.ly/2CtqZ3O
I don’t know about you, but I’d say having a doctor operate on you dozens of times, poking around your private parts, is a hell of a lot more embarrassing than not being able to control your bladder… (though it is important to point out that problems from these fistulas can be much more serious than bladder leakage).
Other doctors took an approach that is the one you hear more often these days – that, yes, Sims did some ethically dubious things, but look at how much good he did! (sounds familiar…)
To emphasize how much good he did, statues and monuments have been erected in his honor. Fellowships, awards, and endowed positions have been dis-graced with his name. But, starting in 2006, the tide started to slowly turn. Before people start getting all hot & angry over statue removal, which is getting a lot of attention these days because of the removal of Confederate Statues, take a minute to take a deep breath, relax, and recognize that there’s a huge difference between remembering/educating and glorifying. Statues with praiseful plaques and triumphant poses literally placed on pedestals in positions of power = glorifying. Museum exhibits with nuanced explanations and accurate portrayals = education. Named professorships, fellowships, awards, etc. = glorifying. Names mentioned in full context, warts & all, in history books = educating. More on this later but first, some of the changes that started in 2006.
That year, the University of Alabama at Birmingham removed a painting which glorified Sims as one of the “Medical Giants of Alabama.” In November 2017, the American UroGynecological Society (AUGS), unable to reach a consensus, retired their “J. Mariom Sims lectureship” saying:
“The J. Marion Sims lecture served this society well for many years, we were no longer unified in our views, and it now serves primarily as a source of polarization, pain, and disenfranchisement. Since AUGS could no longer speak with one voice about this topic, the Board of Directors of AUGS has determined that it was the right time for the J. Marion Sims lectureship to be retired.” https://bit.ly/2AQazlI
A couple of other big reckonings took place in 2018 – that February, the Medical University of South Carolina renamed that endowed chair that Lawrence I. Hester Jr. had announced. https://bit.ly/2CtqZ3O
Then, in April 2018, in what is probably the most visible and publicized change, a group of Black activists got a statue of him removed from New York’s Central Park and transferred to the Brooklyn cemetery where Sims is buried, with informational plaques added to the now empty pedestal in Central Park and the statues’ new location, and newly commissioned artwork to “reflect issues raised by Sims’ legacy.” That’s according to a 2018 NPR story, so I don’t know if there are updates and if that new artwork is up yet. https://n.pr/3fhag2l I did find an article from January 2019 complaining it was moving too slowly… https://bit.ly/2ZmkLM9
As for how it came to be – the statue was built in the 1890s and placed in its Central Park location, across from the New York Academy of Medicine (position of power) in 1934 with a plaque praising him. In January 2018, after years of urging from local residents and multiple groups of activists, East Harlem Preservation, El Museo Del Barrio, the New York Academy of Medicine, and Black Youth Project 100 (BYP100), a mayoral commission examining controversial NYC monuments recommended it be relocated, Mayor Bill de Blasio agreed, the Public Design Commission approved the decision unanimously and Sims literally came off (this) pedestal the next day. But there are still memorials to him – including in South Carolina and Pennsylvania.
In addition to a few scattered statues, idolization of him lives on in examination rooms around the world in the “Sims speculum” and “Sim’s position” (the lateral recumbent position) which is used for rectal examinations, enemas, and other sensitive procedures that shouldn’t have their name associated with a sexual abuser. Because, make all the excuses you want for him. At the end of the day, even if he was doing it to “help” them, he was poking around the privates of women who, as slaves, were in no position to dissent and thus cannot be considered to have willingly consented.
I’m not saying we should erase Sims’ name from history books. I’m saying we should accurately portray him. The abusers shouldn’t be able to control the narrative, yet, so often that’s what our history books are. They’re the stories of the victors, the conquerors, the abusers. They’re not some objective, harmless, factual records. They’re the records the recorders want us to hear. So, when we talk about wanting to change the history books, that doesn’t mean erasing history – it means filling in the gaps and providing a richer, more accurate history.
They say that those who don’t know history are doomed to repeat it. They say that knowing history is important – and I agree. But, do we really know the full history of things? A 2011 study found that medical textbooks & inventors treated Sims solely as a “surgical innovator,” not mentioning any of the controversy. I don’t have access to the whole article, but their conclusion:
“While historians, ethicists and the popular press have debated Dr. Sims’ legacy, medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.” https://bit.ly/2CrZ5p7
So, the problem is not that we tell Sims’ story, and the stories of other morally flawed humans who also did some good things and/or made some huge contributions to medicine, science, society. The problem is *how* we tell those stories. It’s what gets included and what doesn’t. And it’s who gets included and who gets excluded from these stories. So, Anarcha, Betsey, Lucy, and all the other women Sims experimented on – this post is dedicated to you.
If you want to learn more, Hidden Brain did a great podcast episode named “Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology” which I think was where I first heard the story (definitely wasn’t covered in school…) https://n.pr/2Ws3wrd