Thirty years ago, when I was training in gynaecology surgery in the United States of America, I published a chapter in a medical textbook about vesicovaginal fistulas (VVFs) in which I referred to the pioneering surgery of Dr James Marion Sims.
A VVF is a pathological connection between the vagina and bladder that results in continuous urinary incontinence through the vagina. In the past, the majority of VVFs occurred because of genital tract trauma associated with prolonged labour. Because of their position and the degree of tissue destruction, VVFs were, for a long time, incurable.
In 1852, Sims published the results of operations he performed on women with VVFs, detailing how he cured them. By the time of his death in 1883, he was the most famous surgeon in the world; his obituary in the New York Times said he was the “Father of Gynaecology”. In my chapter on VVFs, I commented on Sims’s surgical achievements – but went no further. At the time, there was a statue of Sims in Central Park, New York.
Today, Sims’s name is well known to medical students and doctors; the Sims speculum, an instrument designed by him, is frequently used in gynaecological procedures. A Sims IVF Clinic was established in Dublin in 1997, and there are several others in Ireland now. Childbirth-related VVFs are now exceedingly rare in the developed world – but remain a significant problem in some poor countries.
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What I wrote about Sims 30 years ago, however, was only one side of the story.
This is the other side.
In the early years of his medical practice, Sims lived in Mount Meigs, a small town near Montgomery, Alabama. Montgomery was a large slave-trading centre. Next to his house, he built a small hospital, in which, over a five-year period between 1845 and 1849, he conducted a series of experimental vaginal operations on twelve Black enslaved women who had VVFs. We know the names and ages of three of these women: Anarcha, Lucy and Betsey; they were 17 and 18 years old.
Sims tells us that he “ransacked the country” to find “cases” to operate on. In exchange for obtaining the consent of the slave-owners for surgery, he said he would not charge them for his medical services but insisted that they continue to pay taxes on their slaves and to clothe them. Sims described these operations in his autobiography The Story of My Life and in published scientific papers.
Initially, up to a dozen doctors were present when Sims operated – assisting and observing him. Sims says he did not use anaesthesia because it had not been developed at this time, but in later years, when it was available, he did not use it because he considered this kind of surgery was “not painful enough to justify the trouble or the risk”.
Lucy was the first patient Sims operated on and he testifies to her “heroism” and “bravery” and the “tedious” and “difficult” nature of the surgery. Sims records that Lucy’s “agony” after surgery was “extreme”; she nearly died, and it took her two to three months to recover from an operation that completely failed.
For the next four years, Sims had no success, despite operating repeatedly on his enslaved patients and experimenting with different suture materials and instruments.
Gradually his medical colleagues stopped attending the hospital; his brother-in-law, a doctor, strongly advised Sims to quit. But Sims was determined. To continue operating, he trained his enslaved patients to act as surgical assistants, saying they were “perfectly satisfied” with what he was doing for them.
Anarcha presented the greatest challenge to Sims because she had a second fistula between the vagina and rectum. After 30 operations spanning five years, Sims eventually cured her. Then he cured Betsey and Lucy.
After the United States Congress banned the importation of African-born slaves in 1808, it became an economic priority for slave-owners to increase the number of births to enslaved women. Doctors – white, male – were hired by slave-traders and slave-owners to examine women in relation to their fecundity and the absence of venereal disease. Doctors could also use enslaved women for the purposes of medical learning and experimentation. In 1861, the Alabama Supreme Court declared that a slave “has no legal mind, no will which the law can recognise”. For enslaved women who were sexually violated by their owners, there was neither protection nor escape.
During their time in Sims’s hospital, his enslaved patients also worked – cooking, cleaning, fetching water, minding children. After he cured them, Sims sent them back to their “masters”.
In 1855, Sims opened the Women’s Hospital in New York where he continued to operate on VVFs; his assistant and successor was Dr Thomas Addis Emmet, grandnephew of the executed Robert Emmet. Many of their patients were Irish immigrant women.
Sims visited Dublin in 1861 and performed successful surgery on a woman with a VVF in the Rotunda Hospital. Eleven years previously, the Black abolitionist Sarah Parker Redmond had addressed a public meeting in the Rotunda Rooms “on behalf of the female slave, the most deplorably and helplessly wretched of human sufferers”. One can only conjecture if anyone who met Sims in the Rotunda remembered Redmond’s words.
During the American Civil War (1861-1865), Sims was in Europe – performing operations, collecting honours and enjoying the life of a celebrity.
In 1871, Sims declared he had the “heart of a red southerner” and that “the immortal Calhoun” was one of his “political teachers”. Fintan O’Toole recently described John Calhoun as “the most eloquent and potent advocate of slavery”. Sims also criticised the Union for forcing on the South “conditions humiliating to our pride and subversive of our rights”. Five years later, Sims was elected president of the American Medical Association.
In 2018, the statue of Sims was removed from Central Park, New York after public protests and a unanimous vote by the New York City Public Design Commission. A monument entitled The Mothers of Gynaecology, unveiled in 2021, stands in Montgomery Alabama in honour of Anarcha, Betsey, and Lucy.
Sims was a gifted surgeon who used the absolute power that slavery gave him to perform experimental operations on enslaved women for a catastrophic medical condition that until then was incurable. Although the operation that Sims developed cured these women and thousands of other women since, his actions represent an egregious perversion of the practice of medicine.
[ First, do no harm? Medicine’s sometimes horrific treatment of womenOpens in new window ]
Sims should not be cancelled; instead, he should be remembered for everything he did – including what he did to Anarcha, Betsy, and Lucy, and to the women whose names we do not know.
I’m sorry I didn’t write this 30 years ago.
Chris Fitzpatrick is a retired consultant obstetrician and gynaecologist, and a clinical professor in UCD.