There are three statues of Dr. James Marion Sims on public display in the United States. Dr. Sims is known to some as the father of modern American gynecology for reportedly developing the first successful and reproducible surgical technique for vesicovaginal fistulas and for opening the first public hospital for women dedicated to repairing inuries from pregnancy and childbirth. Sims achieved his reputation because of experimentation on enslaved women and the whole sordid history of Sims has tragically been rewritten. This is what I know about Sims from reading multiple journals and textbooks from the 1800s (both before and after Sims infamy), his autobiography and the autobiography of Dr. Emmet, as well as the work of modern historians and ethicists and if you are defending anything to do with Sims you should know it as well. 

Vaginal fistulas are connections between the bladder and the vagina or the rectum and vagina and the most common cause in Sims’ day was a long, obstructed labor with days of a fetal head sitting low inside the vagina reducing blood flow until the tissues died and sloughed off leaving gaping holes resulting in constant drainage of urine and/or feces through the vagina. The skin on the vulva and around the anus develops an intense irritant reaction from the constant bath of urine and/or feces and the odor, even with modern sanitation and absorbent garments, can be unbearable. In Sims’ era fistulas were more common among the poor, the result of nutritional deficiencies and lack of access to health care. Women who were enslaved were at highest risk as many had contracted pelvises due to rickets and more likely to have obstructed labors.

Dr. James Marion Sims, by his own admission, was a below average medical student who didn’t really want to be a doctor it was simply a way to make a living. At one point, long before his infamy, he thought of leaving medicine to go into a merchant clothing business. “What is the use of my struggling here always, for two thousand or three thousand dollars a year…” he wrote. In his autobiography he writes of actively seeking wealthy clients and Jews as they could pay. He also writes of disbelieving a nurse that a young baby was ill. When the baby died he claimed he was more upset than the parents because the bad outcome could end his practice. It’s not a crime to want to make money but it is sickening to read about it page after page from the man who is supposed to be the father of gynecology.

Sims did not start out with any desire to operate on women but as chance would have it in short succession he was referred three women who were enslaved for repair of fistulas. He turned down all three because at that time and with his knowledge base he believed fistula repair was hopeless. Almost immediately after seeing these three women Sims was called to help a white woman with severe pelvic pain. When he put her in a knee chest position to do an exam a sequence of events happened that allowed him to get a glimpse inside her vagina and Sims correctly deduced if he could see inside the vagina maybe he could actually see to operate and attempt to repair fistulas. He went home and used two spoons to facilitate an exam of Lucy, an enslaved woman who was still in his infirmary. 

A typical scenario for a surgeon with a bold new idea would be to try his first surgery and then wait to see what happened. After reflecting on the success and/or failure and on the recovery and after discussing with like-minded colleagues perhaps another case would be found. This is the slow, meandering organic pathway of new surgical procedures and from reading the writings of many of Sims’ contemporaries what happened in the 1840‘s was not unlike what happens today. We surgeons tip toe into new procedures because unanticipated bad things can happen and we want to limit the carnage.

Sims chose another path. It is clear what he saw inside the vagina was not a fistula but cash. If there were three women in rapid succession with slave owners willing to pay there must be many more. Sims did not immediately operate on Lucy what he did was spend three months making surgical instruments and expanding the hospital in his backyard to accommodate twelve patients.

He was building a lab for human experimentation.

I cannot get that out of my mind and honestly that fact alone should be enough to remove Sims from any position of glory, but I also want the whole story to come out because that is the only thing I can offer to Lucy, Anarcha, and Betsey and the other eight enslaved women who suffered at Sims’ hands. 

Lack of informed consent

Surgery was barbaric up to and including the 1840s. Many patients declined surgery because often the cure was a more certain death than the disease. In London the mortality rate from surgery in the first half of the 19th century was about 25%. Patients were held or strapped down for surgeries and there are numerous reports of the agony. We can simply not imagine. It is not surprising that surgical consent often involved badgering patients into procedures, a fact noted by Sims in his autobiography who detailed the steps he had to take to convince a white man to have surgery.

Sims did not obtain consent from Betsey, Anarcha and Lucy although he claims he told them he would treat them for free for six months, they’d be cured and that he would not “endanger their lives” (Sims was probably deluded enough to think he would master a fistula repair in six months and then make a fortune hence the hospital). Some who support Sims say this was informed consent of the day but of course it’s easy to promise outcomes for a surgery you’ve never performed on women who have no recourse for false claims and no ability to say no.

Some historians have also argued the enslaved women would have been suffering so much that they would have leapt at the chance for repair. Betsey, Lucy and Anarcha and eight other women have been rendered voiceless by history so we shall never know their thoughts. It is true as surgeons we see desperate patients with horrible conditions who say “I don’t care” when we detail complications but these patients are speaking about modern surgery with anesthesia and have the ability to make an autonomous decisions, they are not enslaved women who will be held down for a surgery that had never been tried before by this particular surgeon.

We have the words of one of Sims’ contemporaries, Dr. Cotting, on informed consent and fistula surgeries as recounted in 1844 when he saw a young woman who “resolutely refused to submit to any operation, in spite of earnest and repeated persuasion, and at length declined all further interference.”  Despite the horrors of a fistula many women of Sims day who had the ability to decline surgery did so. To say that the enslaved women would have been willing participants is simply not supportable and is offensive.

Lack of anesthesia

Ether for anesthesia was first used publicly and successfully at the end of 1846 at Massachusetts General Hospital and Dr. Emmet, who trained under Sims, wrote ”anesthesia did not come into use, at least in the Woman’s Hospital except for special cases such as ovariaectomies, until about the close of our civil war.” Even in 1859 Dr. Simpson, the biggest advocate of chloroform for women during childbirth, felt fistula surgery wasn’t painful enough for anesthesia.

It is important in the hunt for truth to not use the ether argument against Sims as that is not what distinguishes Sims from his peers. What distinguishes him is his absence of empathy and absoluite lack of consideration of pain. Dr. Bozeman, who trained for a time with Sims in Alabama, wrote that he could only persuade a young enslaved woman with a fistula to have an exam with an anesthetic and there is mention in the writings of many of Sims’ contemporaries about the pain and suffering they were inflicting with fustula repairs. 

In 1855 Dr. Emmet describes Sims removing an obstructed pessary from the vagina from an Irish immigrant, Mary Smith, and while Emmet remarks on Sims’ dexterity he also noted Sims was oblivious to Mary Smith’s “screams from intense suffering.” The passage is interesting because Emmet didn’t have to include that part and clearly Emmet was not oblivious. Many of Sims’ contemporaries had subtle and often not so subtle contempt for him in their wriitngs. 

Sims was obviously oblivious to screams of pain. By his own account three women endured forty surgeries. Without anesthesia. They would have been held down, initially by the assistants who worked with him but as his assitants left the women would likely have been forced to hold each other down in a horrific Antebellum version of Saw.

Sims “success”

The enslaved African-American women lived in Sims’ infirmary not for six months but for four years. One women, Anarcha, endured thirty surgeries. In the end Sim’s declared success with the key methods being on hands and knees, a special clamp of his own design left inside as the tissues heal (like a binder clip), a special catheter to drain the bladder, the vaginal wall retractor or that he developed for visualization, and a silver (so non reactive) suture. He published his report in the American Journal of Medical Sciences in 1852 and achieved many accolades.

Sims was excellent at self promotion and so what has been forgotten by history about his report is that Sims was not the first to write about successfully closing a fistula. Dr. Hayward did in 1839, so several years before Sims even started. Many surgeons were tackling fistulas in different countries and it doesn’t appear from my research than any mentioned enslaved women. Knee chest or hands and knees position was known to those who read medical textbooks long before Sims first tried it. Other surgeons had invented catheters for this surgery. Many had developed retractors for the vaginal walls. Dr. Bozeman reported extensively (as did others) on the cumbersome and damaging nature of Sims’ clamps and so they were not used by other surgeons. Even silver sutures had been used for fistula surgery 15 years before Sims.

I doubt Sims knew about silver sutures as by his own admission he was not well read so whether he had access to the edition of the London Lancet that reported on silver sutures  years before is not possible to know. What is possible to know is that every so-called “revolutionary” part of Sims technique was either not possible to reproduce by other surgeons (the clamps) or already known to other surgeons. Those who cling to defending Sims because he supposedly advanced health care for women have simply not done their research. We surgeons would have exactly what we have now if Sims had never set up his lab for human experimentation. 

The Woman’s Hospital

Shortly after Sims “discovery” of how to repair fistulas he became ill again with dysentery, which put an end temporarily to his operating and he moved to New York for his health.   

In his autobiography this move is dominated by his financial issues. He showed some local physicians how to do fistula repairs his way and then they started doing them without him. When he realized his “thunder had been stolen” he came upon the idea of a woman’s hospital so he could reap the financial rewards from his four years of human experimentation.

Sims had trouble getting other doctors on board and it is clear from his writings and from his contemporaries that he was not well liked. Eventually he recruited a board of women (a smart business decision) and secured the funding and the Woman’s Hospital opened May 1, 1855. It was a charity hospital and one of the by laws was that a woman had to be present for all surgeries. Sims was too ill to do much by his own accounts and so he hired another surgeon, Dr. Emmet who did the bulk of the operating and ran the hospital for 37 years. Dr. Emmet writes about Sims being at his own office seeing private patients in the morning and often not showing up for surgeries unless it was a special patient yet Sims gets much of the historical credit. 

Sims was not a teacher and while Emmet says that Sims operated skillfully others did not. According to Emmet very few surgeons were able to receive much benefit from watching Sims operate because he was so fast and didn’t explain anything.

In 1861 Sims left the country for Europe supposedly for his health but Emmet wrote that Sims’ private New York practice was not thriving. “As a Southern man he had not been prudent in the expression of his beliefs and as a large proportion of his practice had always been from the South it naturally decreased, and ceased when the war began.” Whether he left because of health or finances is not known, but it is convenient that his health was bad enough to leave and yet it was restored so quickly by the climate that he was able to start operating rapidly. He promoted his method of fistula repair in England, Ireland, and France. He worked the medical scene enough to become the physician to the Duchess of Hamilton who lent him her château to live in for the summer. He established a reputation operating on royalty and on his return to the United States it was clear he hoped to use that infamy.

After his return Sims had a falling out with the board of directors of the Woman’s Hospital. The accounts vary, but it does seem that Sims pushed for unnecessary surgeries on women, was rarely there unless it benefited him, and wanted large amounts of observers for his surgeries. In one surgery he had 73 observers crammed into the theater. Whether he charged these visiting surgeons or if it was to raise his reputation or just pump up his ego I don’t know. The idea that he left the Woman’s Hospital because the board of directors were scared of cancer being contagious isn’t supported by the facts. The Woman’s Hospital was not suited to care for cancer patients as the wards were not built for the odor from the women with uterine cancer and Sims was too interested in having hoards of ego building units watching his every knife stroke.

The surgeons on the board of the Woman’s Hospital wrote at the time that he was “adverse to the rules and regulations.” He was furious and established another hospital for cancer and I can’t help thinking that he saw in cancer what he had seen earlier in fistulas, fame and fortune.

How Did Sims get known as the father of American Gynecology?

Sims was a master of self promotion and was at one point the president of the American Medical Association. In reading countless articles and textbooks from Sims’ day I am struck by the number of great, caring surgeons who worked to cure fistulas, who made important discoveries before Sims, and yet who we do not know. I don’t mean their erasure in any way equals the pain and suffering and erasure of the women who suffered under Sims rather I am simply stunned at how masterfully and terribly the history of fistulas and Sims have been completely rewritten. Shame on all of us in medicine.  

Here are the facts:

  1. Sims writings and actions embody the overconfident, arrogant, below average white man who gets ahead by simply being an overconfident, arrogant, below average white man.
  2. Nothing Sims left to modern OB/GYN is unique to him.
  3. Had Sims actually read a textbook or articles on fistulas, which is what one does when one wants to help women not build a laboratory, he would have known what to do for the first three enslaved women he saw with fistulas.
  4. Other surgeons of the day working to advance fistulas operated on women from all walks of life. 
  5. Other surgeons of the day had empathy for the suffering of their patients. Sims’ writing and his behavior suggests his empathy was reserved for the wealthy.
  6. Sims initial success was based entirely on completely unethical medical experimentation on 11 enslaved women. He built a laboratory for this purpose. If that doesn’t shame someone over supporting Sims then I truly believe nothing can.  
  7. Sims sought out famous patients in Europe, was a shameless self promoter, a poor teacher and abused his position at the Woman’s Hospital for fame and regularly flouted the rules at the hospital.


The body of Sims work and how he lived his life tells us that his medical experimentation on enslaved women was a purposeful exploitation of the most vulnerable of patients for profit.

We must take down his staues and rename anything associated with his name.




Diseases of Females: Pregnancy and Childbed, Churchill, 1843 Lea and Blanchard

Vesico-Vaginal Fistula, Sims, 1953 Blanchard and Lea

Vesico-Vaginal Fistule, Bozeman, Montgomery, 1856

Cotting. Vesico-Vaginal fistula-spontaneous relief. “The American Operation.” The Boston Medical and Surgical Journal. July 1861, No. 23

Reply to James Marion Sims by his former colleagues, Pamphlet, Drs. Peaslee, Emmet and Thomas

Sims, MJ. The Story of My Life D. Appleton and Company

Wall LL. The medical ethics of Dr. J. Marion Sims. J Med Ethics. 2006 Jun; 32(6): 346–350. 

Wood Library Museum of Anesthesiology accessed September 8, 2017

Emmet T. Incidents of my life.

Vesico-vaginal fistula from parturition and other causes: with cases of recto-vaginal fistula, Emmet TL, January 1, 1868, W. Wood & Company

Washington, HA. Medical Apartheid: The dark history of medical experimentation on Black Americans from Colonial times to the present. Harlem Moon Broadway Books. New York.







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  1. I read Medical Apartheid last year and I was horrified by the stories of Dr. Sims. I’m glad to see an effort to right some historical wrongs.

  2. Dr Sims’ statue was mentioned in a clip on The Daily Show this week and they said that he had operated on enslaved women.

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  4. I couldn’t read some of the descriptions because it is very triggering for me, especially as a black woman who, while thankfully not burdened with the horror of a fistula, has severe enough pelvic floor issues to require seeing a specialist for regular exams. This is horrifying and serves to confirm and augment what I’ve seen elsewhere. Anyone defending this butcher needs to educate themselves.

  5. Horrible little man … I actually had to go back and re read it as I wasn’t sure I’d grasped certain parts correctly … 30 surgeries in 4 years is not medical care, it is torture.

    I’m not a fan of the removal of statuary, but given that nothing he did was original, I’ll can make an exception here. Most lives being honoured with statues, still had value, and their can be lessened learned from those lives, not this guy!

  6. I look at this the same way as I look at the movement not to use eponyms of unethical physicians – examples are the Nazi physicians like Reiter (so what used to be called “Reiter’s syndrome” is now just “inflammatory arthropathy”). See also: Wegener’s.Removing the statues is a necessary FIRST STEP, but not the end. There needs to be active education in medical school about the often unethical history of medical research, to prevent things like this from happening in the future; if you think unethical human experimentation doesn’t happen anymore, you’re crazy – even at well regarded places like Karolinska: (a brief article that doesn’t even get into all of the shadiness, including the complete lack of IRB oversight)

    1. The Nazis did important early research into hypothermia; it was entirely unethical. So, the question of whether to cite it or not occasionally arises. The usual response is to cite it, but to add a note that the experimental results were obtained using methods that were unethical.

  7. Great entry to outline a few things that were unknown to me, specially the greed driven actions of Dr Sims. This is the second column I have read about his blatant disregard to women’s cries of pain
    I encourage you to listen Hidden Brain’s episode on this topic from February 2016.
    Dr Vanessa Gamble mentions that he perfected a technique when it seems according to Dr Gunter’s point that this was more a setback. She remarks that there was a believe that black people cannot register pain the way white people did, and she reminds us that Enslave people cannot consent.
    Dr Vanessa Gamble’s book chapters and selected journal articles:

  8. “Dr. Simpson, the biggest advocate of chloroform for women during childbirth, felt fistula surgery wasn’t painful enough for anesthesia.”

    Surgery without anaesthesia? Not painful enough? It seems inconceivable today.

    I was an oby/gyn student nearly half a century ago. We saw births performed by midwives. At the time, I thought the midwives were, well, heartless and inconsiderate, cruel even.

    There was then a vogue for (right) postero-lateral episiotomies. It was then the view that they should be performed at the height of a contraction. It was the opinion that the pain of the contraction would ‘mask’ that of the episiotomy. And so, the midwife would take a pair of curved Mayo scissors and make the cut. No local anaesthesia was given; the women were not told what was going to happen. And yet the screams as they were cut made it transparently obvious just how much the women felt the pain; I guess the quality of this pain differed from the pain of labour.

    I can still vividly recall this. I thought it barbaric then; I have not changed my opinion.

    1. I had an unmedicated labour and an ‘anterior lip’, which was resolved by a midwife at the height of a contraction. The pain was different, instant, clearly distinguishable from the labour pain and took me to a whole different level of suffering. It was over quickly but I will never forget how absolutely horrible it was, or how the pain was not at all ‘masked’ by the contraction.

      This had to be done, as I understand it, and they did tell me beforehand what was going to happen and why. Another reason to have the epidural, if another reason is required.

  9. I cannot imagine the agony those women must have gone through. I had to have a fistula repaired after the birth of my first child, twice It was extremely painful and traumatic when I experienced it in the 80’s.

  10. Thank you Dr. Gunter for posting this piece on Dr. Sims. As an African American Woman I have long been repulsed by the work of Dr. Sims and the praise for it in Medical and historical literature. While I don’t know if taking the statutes down is in any way going to repair the damage Sims has done, I agree with those who recommend a plaque be placed beside each statue describing in graphic detail what this man did to women who had no voice nor autonomy over their own bodies.

  11. One cannot but, be overwhelmed by Dr Sims lack of empathy, grandiose ego, and lacking in everything a health professional – do no harm, holds near & dear. Do we honor him, I think not, that’s my personal view.

  12. As others said, excellent research. Publish it more widely.

    As for the statues; their removal is a form of censorship, of removing Sims from the historical record. Think not of the statues as celebrating him, rather they cause us to remember exactly who he was.

    1. In order to remember him the way he was we need to remove statues and replace them with a plaque explaining his life and deeds. Statues are not a neutral representation.

      1. It would take a comment longer than Dr Jen’s post to fully explain, and that’s not appropriate.

        Removing statues is, to my mind, a form of censorship; little different from burning books.

        If we see a statue as a ‘celebration’, we should think rather of a ‘commemoration’, remembering the good and the bad. By all means add a plaque explaining today’s views.

        It doesn’t stop at statues; near me is a country house called The Argory; it was built in 1820, and is now run by the National Trust, a heritage organisation. They are coy as to it’s origins, referring to ‘plantations’. It is an Irish ‘Mansfield Park’, and was built on the proceeds of slavery. But at that time, owning a slave was a sensible investment, perhaps not quite ‘widows and orphans’ standard, but a reliable source of income.

        And of course, how we see things today isn’t how our ancestors saw things; and when Margaret Atwood’s ‘Gilead’ comes, things will look different again.

    2. Profoundly disagree. Sims will never be “removed from the historical record”, nor is removing statues “censorship”. We build statues for people that are admirable in some way. It has nothing to do with the historical record; it is how we celebrate some lives for what they have accomplished.

    3. Removing statues is nothing like burning books. A statue is not about telling history, it is about propaganda for a specific view about history. A statue of a person is made in a way as to promote a certain view of the person, positive or negative. They are made to elicit a specific emotional response.

      When the former communist countries brought down the statues of Lenin, when the Iraqis brought down the statues of Saddam Hussein they were not erasing their history, they were saying that it was time to end a certain form of propaganda.

      1. It rather depends on who erected the statues in the first place; it may be a power statement by the living or a commemoration of the dead.

        I think that the problem with removing statues is that future generations won’t realise just what these people did. So, for example, I’d leave the statues but add a plaque, a post script, to explain more.

        Alternatively, just inscribe ‘Ozymandias’.

    4. You don’t need a statue to know what a person did. You need museums that provide artifacts from the time with contextualizing information, and you need books.

      When our values diverge significantly from those of the dead we do not need to commemorate them anymore. We need to study their era, just like any other era, but the focus needs to be removed from these specific individuals.

      1. Many people these days have rather limited attention spans, so it’s said. They don’t always have the inclination to go to museums or do research; they are curious, but in a superficial way.

        If there are no statues or similar memorabilia, how do people know what happened? How do we widen their horizons? (While I knew of Marion Sims from the ‘double-duckbill speculum, I didn’t know just what he’d done; I need a Dr Jen to educate me.)

      2. There is this thing called the Internet. There are these things called libraries. People do not need statues to know what happened. They need accurate, detailed accounts of history — which are easily available in libraries and on the Internet.

    1. Agreed. Excellent post. Always look forward to your next post, appreciate your quest to educate the public on all things female health.

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