J. Marion Sims

James Marion Sims, who preferred to be called "Marion", was born in Lancaster County, South Carolina, 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. 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 (infants) 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".{{citation 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.{{cite book ==Practice in Montgomery==

In 1840 the couple moved to Montgomery, Alabama, 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." 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. 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.{{cite journal|last1=Ojunga|first1=Durrenda|title=The medical ethics of the 'Father of Gynaecology', Dr J Marion Sims ==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. 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. 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. 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. 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: {{blockquote|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. 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, 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. • Delia, 23, "Dr. Sims' own servant [slave]", who between 1850 and 1853 underwent ten or more operations for fistula repair. 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. and in 1874 on using chloroform. 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). He proceeded to repair fistulas in several other enslaved black women. 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.{{cite journal |last=Ojanuga |first=Durrenda |title=The medical ethics of the 'father of gynaecology', Dr J Marion Sims |journal=Journal of Medical Ethics |date=March 1, 1993 |volume=19 |issue=1 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. Nevertheless, the fact that white women were afforded the possibility to opt out of the procedure if they could not endure the pain, in comparison to the enslaved women used to develop the procedure, reinforces the prevalence of the aforementioned racist belief that black people do not feel as much pain as white people. ==Trismus nascentium==

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." 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. ==New York: the Woman's Hospital==

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. In 1860 a Charleston, South Carolina, newspaper described his success as "splendid," and called him "the happiest man in New York." In 1855 he founded the Woman's Hospital, which, not counting his own backyard infirmary, was the first hospital for women in the United States. At its inception, Woman's Hospital's primary purpose was to repair vesico-vaginal fistulas using Sims' technique, His project met with "universal opposition" from the New York medical community; 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. 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." ==Sims and the Confederacy==

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. 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 Dublin and performed one in front of Dr. Fleetwood Churchill and other colleagues. He then proceeded to Edinburgh to see Sir James Young Simpson operate on dysmenorrhea, but evidently "did not think it well done." From there, he went to London, and performed a second fistula repair with several colleagues on hand to observe, including Dr. Thomas Spencer Wells (soon to be appointed Queen Victoria's household surgeon). The patient, however, died within six days because, as the autopsy showed, Sims had inadvertently closed the patient's ureter. Undaunted, he went to Paris in September 1861, where he performed fistula repairs at the Beaujon, the Hôpital St. Louis, the Hôtel Dieu, and La Charité. Afterwards, Sims was called to Brussels to operate there, before returning to Paris. These surgeries greatly enhanced Sims's reputation, and he planned on traveling to Vienna to demonstrate the procedure there, when another case from a colleague arrived in the French capital and eventually caused him to cancel his trip to Austria. However, according to J.C. Hallman, Sims was actually in Europe as one of several government agents of the Confederacy, who were seeking money (loans), diplomatic recognition of their new government (which never came to pass), along with supplies and ships. An intercepted letter informed Lincoln's Secretary of State William H. Seward that Sims was "secessionist in sentiment," and that his "purpose in going abroad at this time is believed to be hostile to the government," as Seward reported to U.S. diplomats in Europe.{{cite news In 1863 Sims was reportedly summoned to treat Empress Eugénie for a fistula. This publicly helped Sims to solidify his global surgical reputation. 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. 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. 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. 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." 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." 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. ==Later career==

in New York's Central Park, removed in April 2018. 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."{{cite book |title=The Story of My Life |first=J. Marion |last=Sims Sims received honors and medals for his successful operations in many countries. Many of these surgeries were unnecessary and would be unacceptable in modern medical practice. He frequently performed surgery for what were considered gynecological issues: such as clitoridectomies, then believed to control hysteria or improper behavior related to sexuality. These were done at the requests of the women's husbands or fathers, who were permitted under the law to commit the women to surgery involuntarily. Under the patronage of Napoleon III, in 1870 Sims organized the American-Anglo Ambulance Corps, which treated wounded soldiers from both sides at the Battle of Sedan. ==The first cancer hospital==

' The Agnew Clinic (1889) illustrates a typical scene inside a medical amphitheater in an American teaching hospital, in this case at the University of Pennsylvania. Sims operated frequently in such a setting at the Woman's Hospital. In 1871, Sims returned to New York and resumed working at the Woman's Hospital, where he provided surgical treatment for women with cancer. At the time, cancer was considered to be a disease specific to the lower socioeconomic classes, and feared by some to be contagious or even sexually transmitted. In response to Sims' efforts, the highly influential Ladies' Board of the Woman's Hospital strongly argued against the treatment of cancer patients, which resulted in the hospital prohibiting the admission of cancer patients. At a meeting of the hospital's Board of Governors in 1874, Sims gave a speech rebuking the Board for refusing to treat cases of cancer even in their earliest stages. In addition, he criticized the restriction imposed by the Ladies' Board limiting the number of spectators to fifteen on operating days. Previously, as many as sixty could observe any given operation, but this had been changed because the Ladies' Board considered it an affront to a woman's modesty to have more than fifteen male surgeons observe a woman's sexual organs under treatment. Sims argued that this restriction impaired the distribution of knowledge to the many surgeons who came to New York to study gynecological diseases.{{cite book |first1=E.R. |last1=Peaslee |first2=T.A. |last2=Emmet |first3=T.G. |last3=Thomas |title=Reply to Dr. J. Marion Sims' Pamphlet, entitled 'The Woman's Hospital in 1874' After quarreling with the board of the Woman's Hospital over the admission of cancer patients, Sims became instrumental in establishing America's first cancer institute, New York Cancer Hospital.{{cite web In reply to the treatment he received from the Woman's Hospital, Sims was unanimously elected president of the American Medical Association, an office he held from 1876 to 1877. ==Death==

Sims suffered two angina attacks in 1877, and in 1880, contracted a severe case of typhoid fever. W. Gill Wylie, one of Sims' early twentieth-century biographers, said that although Sims suffered delirium, he was "constantly contriving instruments and conducting operations". After several months and a move to Charleston to aid his convalescence, Sims recovered in June 1881. He traveled to France. After his return to the United States in September 1881, he began to complain of an increase in heart problems. In 1881, Sims was one of four physicians asked for an opinion about whether medical errors had contributed to the recent death of President Garfield.{{cite journal According to Wylie, Sims consulted with doctors for his unknown cardiac condition both in the United States and in Europe. He was "positive that he had a serious disease of the heart and it caused deep mental depression". He was halfway through writing his autobiography and planning a return visit to Europe when he died of a heart attack on November 13, 1883, in New York City (Manhattan). He had just visited a patient with his son, H. Marion Sims. He is buried at Green-Wood Cemetery in Brooklyn, New York. ==Criticism of Sims==

Sims' experimental surgeries on enslaved women, who could not consent, have been described since the late twentieth century as an example of systemic racism in the medical profession. This is more generally understood as part of the historical oppression of people of color and vulnerable populations in the United States. She further notes that "the slave masters who sent the women to Sims for treatment were less concerned about their suffering than their ability to produce more slaves", a fact that may have further impacted the ability of these women to consent. Drawing on Sims' published autobiography, case-histories, and correspondence, historian Stephen C. Kenny highlights how Sims' surgical treatment of enslaved infants suffering from neonatal tetanus was a typical, but tragically distinctive, feature in the career of an ambitious medical professional in the slaveowning South. Individual doctors like Sims and the profession were incentivized in multiple ways through the system of chattel slavery. Many physicians not only employed enslaved people in their practice, but also traded in enslaved people, while at the same time their medical research was advanced directly and significantly through the exploitation of the enslaved population. Others, such as Harriet A. Washington and Rebekah Barber, have emphasized how "[e]ach naked, unanesthetized slave woman had to be forcibly restrained by other physicians through her shrieks of agony as Sims determinedly sliced, then sutured her genitalia" and argued that slaves were forced to hold each other down during these surgeries. ==Defense of Sims==

In his autobiography, Sims said he was indebted to the enslaved black women on whom he experimented. He suggests that surviving documentation indicates that the women were trained to assist in their own surgical procedures and that (despite some being as young as 13) She suggests that these opposing views are overly reductionist and that Sims' history is more nuanced. Indeed, Sims lived in a slave-holding society and expressed the racism and sexism that were considered normal during his time. According to the Australian gynecologist and author Caroline M. de Costa, According to L. Lewis Wall, "Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims." Wall, who has himself performed fistula surgery, portrays Sims as an ethical, caring, and successful clinician. ==Legacy and honors==

grounds, Columbia, South Carolina. • On the title page of the reprint of an article, "History of the Discovery of Anesthesia", first published in the May 1877 number of the Virginia Medical Monthly, Sims listed his honors as: • A bronze statue by Ferdinand Freiherr von Miller (the younger), depicting Sims in surgical wear, was erected in Bryant Park, in midtown Manhattan, New York, in 1894, then taken down in the 1920s amid subway construction, and in 1934 was moved to the northeastern corner of Central Park, at 103rd Street, opposite the New York Academy of Medicine. The address delivered at its rededication was published in the Bulletin of the New York Academy of Medicine. This was the first statue erected in the United States in honor of any physician. The statue became the center of protests in 2017 due to Sims' operations on enslaved black women. • In November 2017, author J.C. Hallman's article about Sims' Central Park statue, "Monumental Error" appeared on the cover of ''Harper's Magazine''. The article played a role in the broader discussion about Confederate monuments, and in a later op-ed for the Montgomery Advertiser, Hallman revealed Sims' career as a spy during the Civil War and the fraudulent history of another Sims monument in Montgomery, Alabama. • Another memorial was installed on the grounds of his alma mater, Jefferson Medical College (now Thomas Jefferson University) in Philadelphia. • There is a statue on the grounds of the Alabama State Capitol in Montgomery. "An alternative statue of Sims's 'first cure', the young woman known as Anarcha, was erected in protest only to be stolen in the night." • Another statue of Sims, installed in 1929, is at the South Carolina State House in Columbia; in 2017, the mayor of Columbia, Stephen K. Benjamin, called for its removal, as have other protestors. • A painting by Marshall Bouldin III, entitled Medical Giants of Alabama, that depicted Sims and other white men standing over a partially clothed black patient, was commissioned for $20,000 in 1982 (paid for by donors). It was on display at the University of Alabama at Birmingham's Center for Advanced Medical Studies, but was removed in late 2005 or early 2006 because of complaints from people offended by it as well as the ethical questions associated with Sims. • The Medical University of South Carolina, whose predecessor Sims attended, set up around 1980 an endowed chair in his honor. In February, 2018, the chair was renamed. However, a "J. Marion Sims Chair" in obstetrics and gynecology still appears in a March 2018 program. A J. Marion Sims Society, a student organization, existed there from 1923 to 1945. • A Sims Memorial Address on Gynecology, delivered before the South Carolina Medical Society at Charleston, is documented from 1927. • In 1950, a historical marker was erected near the site of his parents' farmhouse in Lancaster County, South Carolina, where he was born. Present at the dedication ceremony were Congressman James P. Richards and representatives of the American Medical Association, the Medical College of South Carolina, the University of South Carolina, the chairman of Lancaster's Marion Sims Memorial Hospital board, the state archivist of South Carolina, and four of Sims' children. Dr. Roderick McDonald, president of the South Carolina Medical Association, introduced the speaker, Dr. Seale Harris, past president of the Southern Medical Association and former editor of the Southern Medical Journal, whose biography of Sims, ''Woman's Surgeon: the Life Story of J. Marion Sims'', had just been published. • A cartoon of Sims appeared on the cover of the November 2017 issue of The Nation. • A J. Marion Sims Foundation was founded in 1995 in his home town of Lancaster, South Carolina. It has dispensed almost $50,000,000 in grants. • The Marion Sims Memorial Hospital is located in Lancaster. • In Montgomery, Alabama, a historical marker at 37 South Perry St. marks the location of Sims' house and backyard hospital or infirmary. The building on the site is from the early twentieth century. • In 1953, Sims was elected to the Alabama Hall of Fame. ==Contributions==

• Vaginal surgery: fistula repair. Invented silver wire as a suture. • Instrumentation: Sims' vaginal speculum; Sims' sigmoid catheter. There is a petition campaign to have Sims' name removed from the devices he invented: "Sims uterine curette, uterine sound, vaginal retractor, uterine scissors, and rectal speculum." New names would be chosen by "a committee of POC (People of Color)." • Exam and surgical positioning: Sims' position. • Fertility treatment: Insemination and postcoital test. • Cancer care: Sims argued for the admission of cancer patients to the Woman's Hospital, despite contemporary beliefs that the disease was contagious. • Abdominal surgery: Sims advocated a laparotomy to stop bleeding from bullet wounds to this area, repair the damage and drain the wound. His opinion was sought when President James Garfield was shot in an assassination attempt; Sims responded from Paris by telegram. Sims' recommendations later gained acceptance. • Gallbladder surgery: In 1878, Sims drained a distended gallbladder and removed its stones. He published the case believing it was the first of its kind; however, a similar case had already been reported in Indianapolis in 1867. ==See also==

Papers of Dr. Sims – about 150 items – are held by the Wilson Library, University of North Carolina at Chapel Hill. The collection has been microfilmed and some is available online. A small number of letters are in the libraries of the Medical University of South Carolina and Duke University. ==References==

• Critical of Sims • • • {{cite book • • Comments on the article of O'Leary just cited. • {{cite news • {{cite news • • • • L.L. Wall responded in the same journal in 2021; cited below. • • Defenses of Sims • • {{cite journal • {{cite journal • {{cite news • • • {{cite journal | pmid = 17082217 | doi=10.1093/jhmas/jrl045 | volume=62 | journal=Journal of the History of Medicine and Allied Sciences | pages=336–356 • {{cite journal • • • • • • • • Unclassified • • • {{cite news • {{cite book • {{cite journal ==Further reading (arranged by date)==

• • {{cite journal • {{cite book |last=Sims • • {{cite book • • {{cite book • • • • {{cite book • {{cite book • {{cite news • {{cite book • • {{cite journal • {{cite book • {{cite journal • • ==Video==

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