J. Marion Sims - 'The Father of Gynecology' - One Among Many Monumental Mistakes
by Wendy Brinker
Copyright 2000. Wendy Brinker, Columbia, South Carolina. Posted by permission.
The controversy over the Confederate flag has brought the scrutiny of the world to South Carolina. It has exposed old racist wounds in a place where blacks and whites have always lived a jagged, grossly unbalanced coexistence. South Carolina's struggle to reconcile its history is far from over. There are reminders everywhere of the harsh, shameful reality of slavery. The stigma of that fateful era reaches to us from the depths of centuries and is ever-present in the undercurrent of both sides of the debate.
Pharaohs believed that as long as their likeness or name existed somewhere, they lived on. Having one's legacy preserved in stone is perhaps an expression of the human desire for immortality or the immortalization of an idea. The statehouse grounds in Columbia, South Carolina is wrought with statues of men whose contributions have been deemed worthy of homage. Their tributes stand tall among the well-manicured beds for future generations to ponder. Nestled on the shady northwest corner at the intersection of Assembly and Gervais Streets, stands an impressive monument honoring J. Marion Sims, a South Carolinian from Lancaster County, curiously dubbed "The Father of Gynecology."
The monument itself is one of the largest on the grounds. Center stage, in front of a large cement archway, is a bronze bust of Sims, looking down with crooked brow and patronly grin. Directly beneath his image is a quote from Hippocrates, "Where the love of man is, there is also the love of art." Etched in a panel to the left, an inscription touts, "The first surgeon of the ages in ministry to women, treating alike empress and slave." On the panel to the right, the inscription continues, "He founded the science of gynecology, was honored in all lands and died with the benediction of mankind."
What an epitaph. What had this guy done to deserve such accolades? My efforts to acquaint myself with Dr. Sims began innocently enough on the Internet. After locating several articles and books praising the good doctor, one article seemed out of place. It was an academic paper entitled, "Human Experimentation: Before the Nazi Era and After." South Carolina's opinion of Dr. James Marion Sims was being vehemently opposed by some outside sources. But this is no real buck in the trend for southern historians. South Carolina's opinion of itself is often diametrically opposed to that of the outside world's. This is evidenced by South Carolina's portrayal of the entire Civil War, or rather, their rendition of "The War of Northern Aggression."
By South Carolina's account, Dr. Sims innovated techniques and developed instruments that changed the landscape of women's reproductive health. By another account, he had a reputation for being an absolute monster. Without regard for human suffering, he performed excruciating, experimental operations on captive women, leaving a swath of misery and death in his wake. What is not in dispute is that between 1845 and 1849, in a makeshift hospital he built in his backyard, Sims inaugurated a long, drawn-out series of gynecological operations on countless enslaved African women. He performed over 34 experimental operations on a single woman for a prolapsed uterus. This was all done without the benefit of anesthesia or before any type of antiseptic was used. After suffering unimaginable pain, many lost their lives to infection. It is their story that history has failed to tell and their legacy that should be honored, not their captor's.
By his own account, in an autobiography entitled, "The Story of My Life," Sims felt himself quite unexceptional. He was born in 1813 and received his higher education at Columbia College, predecessor of University of South Carolina, and received a BA in 1832. His father, John Sims, was a dominant figure in Sims' early life. To his son's announcement of medicine as his profession, he replied, "To think that my son should be going around from house to house through this country, with a box of pills in one hand and a squirt in the other, to ameliorate human suffering, is a thought I never supposed I should have to contemplate." Mr. Sims reluctantly sent his son to apprentice under the tutelage of Dr. Churchill Jones. Once respected in the community, Dr. Jones suffered from chronic alcoholism. Although James Marion recalled him unfit to perform his duties, he observed the failing doctor perform many surgeries and deliver many lectures. Inspired to become a surgeon, an insecure Sims left for Charleston Medical College in November of 1833. He admits, "I was afraid to be a man; I was afraid to assume its responsibilities and thought that I did not have sense enough to go out into the rough world, making a living as other men had to do."
He was unprepared for the rigors of Charleston Medical College. While there, he forged, by his own description, an intimate friendship with a fellow classmate and they agreed to attend Jefferson Medical College in Philadelphia for their next term. It was there that Sims met another great influence in his life, Professor George McClellan. He describes him as, "very eccentric and erratic as a teacher... Not that he had much system, but whatever he said was to the point." In May of 1835, equipped with some surgical instruments and an eight-volume medical text, Sims returned to Lancaster ready to practice medicine. He had had no clinical experience, logged no actual hospital time and had no experience diagnosing illnesses.
Dr. Jones had since left the area. After weeks of sitting alone in a Main Street office his father had rented, Dr. J. Marion Sims got his first patient. It was the young son of a prominent citizen of Lancaster. Sims documented, "When I arrived I found a child about eighteen months old, very much emaciated, who had what we would call the summer complaint, or chronic diarrhea. I examined the child minutely from head to foot. I looked at its gums, and as I always carried a lancet with me and had surgical propensities, as soon as I saw some swelling of the gums I at once took out my lancet and cut the gums down to the teeth. This was good so far as it went. But, when it came time to making up a prescription, I had no more ideas of what ailed the child, or what to do for it, than if I had never studied medicine."
Sims returned to his office and studied his medical text for any clue as to how to proceed. The reference books Sims relied on were by a professor at Jefferson, John Eberle, who was known for his unorthodox approach to medicine. He drew from various schools of thought, including the use of leeches. Sims administered a haphazard regimen of prescriptions to the child, going from chapter to chapter in Eberle's books, but to no avail. After only a few days, the infant died. Sims' second case came only two weeks after the first. It was another infant with the same symptoms. Sims retracted the gums and administered another series of treatments, this time starting at the last chapter and working backwards in the book. He accomplished the same result. Sims lamented, " I had the misfortune to lose my first two patients, and the thought of it was too terrible to be borne. I had never heard of such terrible luck, and never thought that such misfortune could ever happen to any young man in the world."
In October of 1835, immediately after the death of the two infants, the elder Sims took his son to Alabama. It is unclear why the young doctor left Lancaster, but his reputation could not have been favorable. After three weeks by wagon, they made it as far as Mt. Meigs, Alabama. There were two doctors in Mt. Meigs he apprenticed under. One, a Dr. Charles Lucas, was a politician and had made his fortune from cotton. Sims was impressed by the fact that Lucas owned two to three hundred slaves and could exert his influence over the community. The other was Dr. Childers, an old-fashioned country doctor that allowed Sims to accompany him on his house calls. After witnessing Childers "bleed" a patient to death, one of his favorite cure-alls, Sims admitted, "I knew nothing about medicine, but I had sense enough to see that doctors were killing their patients; that medicine was not an exact science; that it was wholly empirical, and that it would be better to trust entirely to Nature than to the hazardous skills of the doctors."
One month after his arrival, Sims bought out Dr. Childers' practice for a two hundred-dollar promissory note. His first patient came to him when Dr. Lucas was away in Tuscaloosa on legislative business. Sims was summoned 40 miles away to the home of another cotton farmer, whose sister had taken ill with fever after delivering a child. The attending doctor was present, but obviously drunk. Sims refused to take over the care of the woman because once again, he had no idea what treatment to administer. He returned to Mt. Meigs and the woman died the day after he departed. A month later, with Dr. Lucas still away, another request for a doctor came. This time, on behalf of an ailing slave overseer. Sims reluctantly mounted up and rode off to examine the man. He found a lump inside his abdomen and explained, "This is matter here and it must come out or this man will die." He was granted permission to operate and described the procedure as such, "We went in to the room - it was before the days of anesthetics - and, pulling out a bistoury (scalpel), I plunged it into his belly. I think it was one of the most happiest moments of my life when I saw the matter flow and come welling up opposite the bistoury." After days of continued discharging, the man eventually made a full recovery. Such was the nature of Sims' first surgical experience as he began to "practice" medicine.
Acting primarily as a plantation physician, Sims became known for operations on club feet, cleft palates and crossed eyes. He began to treat enslaved babies suffering from what he called "trismus nascentium." Today, we know this condition as neonatal tetanus. Tetanus originates in horse manure, and it is probable that the proximity of horse stables to slave quarters was the direct cause of the high rate of tetanus in enslaved babies. In an article published by Sims on the subject, he comes to quite another conclusion that offers us a glimpse into his personal bias. "Whenever 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." Because he attributed the cause of the disease to the moral weakness of the enslaved Africans, he never suggested the need to improve their living conditions.
Sims also attributed the condition in part to an accident at childbirth. He argued that the movement of the skull bones during a protracted birth lended to trismus. Clearly designating patients by class and race, Sims began to exercise his freedom to experiment on his captives. He took custody of suffering, enslaved infants and with a shoemaker's awl, a pointed tool used for making holes in leather, tried to pry the bones of their skulls into proper alignment. According to his published articles, this procedure was only practiced on enslaved African babies. Because he "owned" these poor, innocent children, he had free access to the bodies of the ones that died to use for autopsies, which he usually performed immediately after death. Sims routinely blamed "slave mothers and nurses for infant suffering, especially through their ignorance."
Enslaved African midwives were undoubtedly numerous throughout the South. For hundreds of years, childbirth was not considered a "sickness" and for the most part, physicians did not attend births. But in the mid-nineteenth century, the attitude of the medical practitioners towards midwifery was changing. Medicine was now challenging female-governed childbirth. The early obstetricians excluded midwives from their research and dismissed their collective knowledge. The African midwive's distinct tradition of spiritual rituals, usage of herbs and knowledge handed down orally across generations earned them an honored place within the enslaved communities. Just as the Southern physician was at the core of his social web, the midwife enjoyed the same social status. This could have fueled the white master's need to remove them from positions of prominence. The old persecution of midwives by white males, reminiscent of witch hunts, was beginning to play out again on southern plantations.
One spring afternoon in 1845, Sims was summoned to the Westcott plantation about a mile out of Montgomery. A young, enslaved woman named Anarcha, one of seventy-five enslaved Africans who lived there, had been in labor for three days without delivering. Sims tried to aid the birth by applying forceps to the impacted head of the fetus. He recalled having little experience using the instrument. The baby was born - no record if it lived or died - and the mother had sustained several vesico-vaginal fistulas, or vaginal tears, resulting in incontinence. It is unclear as to whether Sims inflicted the damage himself while using the unfamiliar forceps or whether it occurred as a result of the prolonged birth. Several days after Anarcha delivered, her master sent her to Sims in hopes he could repair the damage. He found her condition repugnant. Obliged to her master as her value as property was diminished considerably, he reluctantly began to attempt to repair Anarcha's badly damaged body.
Under slavery, women were pivotal in its very definition. Slavery was perpetuated through the status of the mother. If she was a slave, not only was she enslaved for life, but so were her children. They were frequently the objects of aggressive sexual rapes from those who held power over them. The culture and economy of slavery imposed the role of "breeder" on these women and their ability to reproduce was equated with their worth as property to the masters. They never received enhanced diets or lower work loads for pregnancy and often endured great hardships during childbirth. Reasons for prolonged labor among African women were probably closely related with their diet. In a relatively high percentage of African Americans, dairy products not only fail to yield calcium in digestion, but also can cause sickness. Calcium deficiencies during childhood often resulted in rickets. This condition wasn't fatal, however, it caused skeletal deformities, among them a contracted pelvis that would have resulted in a prolonged delivery. Not surprisingly, vesico-vaginal fistulas were prevalent among enslaved women.
Sims showed an uncommon willingness to break cultural barriers in his treatment of female disorders. Most physicians in the Victorian period shunned the impropriety of visually examining a woman internally. They generally relied on the use of touch as a more genteel method. Earlier in his career, Sims treated a female patient who had been thrown off a pony. He placed her on her hands and knees and fashioned a crude tool from a pewter spoon to expand the walls of the vagina. This spoon was the first prototype for the speculum, called the Sims speculum. The patient's relief was immediate, since the change in air pressure successfully relocated her uterus to its proper position. Sims described the moment as if he had a spiritual epiphany. "I cannot, nor is it needful for me to describe, my emotions when the air rushed in and dilated the vagina to its greatest capacity whereby its whole surface was seen at one view, for the first time by any mortal man." His success with this single procedure convinced Sims he could find a surgical remedy for vesico-vaginal fistulas. Finally, he could make a name for himself.
Eager to devote the rest of his life to this condition, he built a crude hospital in his backyard that had a capacity of sixteen beds and fashioned over 71 surgical instruments. Sims sent for as many cases as he could find. Plantation owners were happy to turn over their slaves to Sims for experimentation. They were of little use to their masters in their present condition. Over the next three and a half years, between January 1846 and June 1849, he experimented surgically on as many as eleven patients at one time. Two enslaved women in addition to Anarcha - Betsy and Lucy - were also young women who contracted fistulas giving birth for the first time. Together, these three women endured repeated operations and were patients of Sims for the duration of the hospital's existence. Anarcha is believed to have undergone over thirty operations.
Sims subscribed to a commonly held belief that Africans had a specific physiological tolerance for pain, unknown by whites. He never felt the need to anesthetize his black patients in Montgomery. The white women who came to him later, after the surgery was an accepted form of treatment, were unable to withstand the same operation without anesthesia according to Sims. While he never administered anesthesia during the experiments, he did include opium in his postoperative treatment. Opium kept the patients still, which aided the healing process, and Sims found the accompanying constipation a necessity in the aftermath of surgery. He also emphasized giving the patient minimal food and water for a two-week period.
In the first months of the original surgeries, Sims would invite his colleagues to witness the operations. As the number of operations grew and the failures mounted, Sims soon found himself operating alone, relying on the assistance of the hospitalized victims themselves. After a couple of years of repeated surgeries and failures, his wife's brother, Dr. Rush Jones from the neighboring county of Lowndes, implored him to stop his experiments. "We have watched you, and sympathized with you; but your friends here have seen that of late you are doing too much work, and that you are breaking down. And, besides, I must tell you frankly that with your young and growing family, it is unjust to them to continue in this way, and carry on this series of experiments." Sims replied, "I am going on.. to the end. It matters not what it costs, if it costs me my life." To those close to Sims, it appeared his preoccupation was becoming an obsession.
Sims had been suturing the vaginal tears with materials common to that era, mostly silk and catgut, which absorbed bodily fluid. This caused inflammation around the wounds, promoting horrible infections that would never heal. Sims had his jeweler fashion some fine silver wire for suturing wounds. He used it on one of Anarcha's fistulas at the base of her bladder. Days later, when Sims found no infection, he declared that silver sutures were the key to mending vesico-vaginal fistulas. He quickly utilized the sutures on all of his captives and claimed to have cured them all, but there is no outside evidence to support his claim. He declared, "I had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity." Sims never recorded if he was able to heal Anarcha of her other fistulas and to this day, physicians debate the type of suture to use in the operation, although the condition is rarely seen anymore. Sims' level of "success" remains ambiguous by all medical accounts.
In the fall of 1849, Sims was stricken with an intestinal illness and spent several years moving from place to place in search of relief. In 1853, he moved to the cooler climate of New York. While Sims maintained a strong commitment to the morality of owning slaves and held a strong allegiance to the South, he began to revise and moderate his tone for the different political climate he found on Madison Avenue. Sims evaded the issue of slavery and race and never admitted publicly that he experimented on patients who did not own their own bodies. In his use of woodcuts that accompanied his lectures, he portrayed his earlier patients as white women. Now that he chose to practice among white women of the upper and middle classes, he stated of his surgeries, "I though only of relieving the loveliest of all God's creation." It seems he'd forgotten his distaste for Anarcha, Betsy and Lucy and all of the other enslaved women he had mutilated and/or killed.
J. Marion Sims went on to convince a group of philanthropic women of the old New York's elite class that his motives were sincere and his methods proven. He garnered enough enthusiasm and financial support to set up a woman's charity hospital in May of 1855. Sims was once again in business to perform his operations, this time, on poor Irish immigrant women. He traveled extensively to Europe and enjoyed the reputation of being a famous American doctor. While abroad in 1863, he was asked to examine Empress Eugenie of France. This is how the inscription came to read, "treating alike empress and slave," although he employed very different methods of treatment depending on the patient's social status. He faithfully sent money to support the confederacy, but never returned to the south. He died in New York in 1883.
The success of J. Marion Sims as "the father of gynecology" in the United States rested solely on the personal sacrifices of the enslaved African women he experimented on from 1845 to 1849. Had they not been his property, giving him carte blanche to cut them open and sew them back up as he saw fit, he could have never devised the surgical technique that brought him international recognition. He never expressed any interest in the cause of vesico-vaginal fistulas or in the health of the women themselves. Nor did he concern himself with the extent of recovery made by the patients. And never did he express moral uncertainty because he had kept several women captive for the expressed purpose of painful surgical experimentation. Undeniably, nineteenth century medical practices were crude and painful, but Sims' contemporaries felt he was unnecessarily cruel. Other physicians of that unfortunate era experimented on the enslaved, but among them, James Marion Sims was one of the worst.
Since it was illegal for enslaved Africans to read or write, an offense punishable by death, Anarcha, Betsy and Lucy left no account of their ordeal. We can only imagine what they endured at the hands of Sims and what horror an enslaved woman must have felt at the news that she was being sent to him for treatment. Surely rumors must have run rampant among enslaved communities about what he did to women there. All over South Carolina, Sims has been honored and memorialized with statues and plaques. Buildings, hospitals, schools and streets bare his name. While it is impossible to negate the historical context of his racial, class and gender biases, shouldn't we agree to apply some standard of humanity to those we choose to honor?
Wendy Brinker is an activist and artist in Columbia, South Carolina. She co-hosts talk radio's The Seed Show, www.seedshow.com, with attorney Tom Turnipseed. She wishes to thank Tom Pickett for his research assistance. Email her at email@example.com.