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Sims' use of enslaved African-American women as experimental subjects has been regarded by many modern historians and ethicists as highly unethical. He is considered by some to be "a prime example of progress in the medical profession made at the expense of a vulnerable population." However, his contributions are also defended by many. Physician L.L. Wall, who has attempted to defend Sims on the basis of his conformity to accepted medical practices of the time, the therapeutic nature of his surgery, and the catastrophic nature for women of the condition he was trying to fix.

Early life, education and career

J. Marion Sims (called Marion) was born in Lancaster County, South Carolina, the son of John and Mahala Mackey Sims. Sims's family spent the first twelve years of his life in Lancaster Village north of Hanging-Rock Creek, where his father owned a store. He would later write entertainingly of his early school days.

Upon John Sims' election as sheriff of Lancaster County, Sims entered the newly established Franklin Academy in 1825. In 1832, after two years of study at the South Carolina College in Columbia, Sims worked with Dr. Churchill Jones in Lancaster, South Carolina, and took a three-month course at the Medical College of Charleston. He moved to Philadelphia, Pennsylvania in 1834 and enrolled at the Jefferson Medical College, where he graduated in 1835. He returned to Lancaster to practice but left shortly after upon the death of his first two patients to set up a practice in Mount Meigs, Alabama.

He returned to Lancaster in 1836 to marry Theresa Jones, whom he met in his youth at Franklin Academy. In 1840 they moved to Montgomery, Alabama where Sims took up surgery and gynecology. It was here that Sims began some of his most noteworthy and controversial work.

Medical experimentation on slaves

Repair of Vesicovaginal Fistula

Sims' office in Montgomery, Alabama.

In the 19th century, vesicovaginal fistulas was a common, socially destructive, and "catastrophic complication of childbirth," that affected many women without an effective surgical procedure or cure. The frequently occurring injuries left the women subject to incontinence and marginalization subsequent marginalization from society. Furthermore, gynecology was not yet a robustly developed field in the mid 19th century, as social norms regarded the medical study and examination female reproductive anatomy as immoral; doctors were often trained to deliver babies on dummies in medical school and did not see their first cases until assuming practice. As a result, Sims had no formal background in gynecology prior to beginning his practice in Alabama.

When a woman came to him with a injured pelvis and retroverted uterus from a fall off of a horse, he placed her in a knee-chest position and inserted his finger into the vagina; this triggered a full distention of the vagina with air, allowing Sims to see the vagina clearly. The distention inspired him to investigate fistula treatment further. Soon after he developed a precursor to the modern speculum out of a pewter spoon and strategically placed mirrors.

In Montgomery between 1845 and 1849, Sims experimented by surgery on 12 enslaved women with fistulas, brought to him by their masters; Sims took responsibility for their care on the condition that the masters provide clothing and pay taxes. He named three enslaved women in his records: Anarcha, Betsy, and Lucy. Each suffered from fistula, and all were subjected to his surgical experimentation. From 1845 to 1849 he experimented on each them several times, operating on Anarcha 13 times before her fistula repair was declared a success. She had both vesicovaginal and rectovaginal fistulas, which he struggled to repair.

Although anesthesia had recently become available, Sims did not use any anesthetic during his procedures on Anarcha, Betsy, and Lucy. According to Sims, it was not yet fully accepted into surgical practice and he was unaware of the possibility of the use of ether. However, ether as anesthesia was available as early as the beginning of the 1842. A common belief at the time was that black people did not feel as much pain as those who were white, diminishing worry from the consequences of operating without anesthesia. Nevertheless, in a memoir he stated that "Lucy's agony was extreme...she was much prostrated and I thought she was going to die". After operating on her in the presence of twelve doctors without anesthetics, she nearly died from blood poisoning following his experimental use of a sponge to wipe urine from the bladder during the procedure. He did administer opium to the women after their surgery, which was accepted therapeutic practice of the day.

After the extensive experiments and complications, Sims finally perfected his technique. He repaired the fistula successfully in Anarcha. His technique using silver-wire sutures led to successful repair of a fistula, and this was first reported in Sims' published surgical reports in 1852. He was then able to repair the fistulas of several other enslaved women under his medical authority. It was only after his success in early experiments on the enslaved women that Sims attempted the procedure on white women with fistulas; he used anesthesia for their surgeries.

Sims Speculum

These experiments were the basis for modern vaginal surgery. The Sims' vaginal speculum 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 after him.

Human Experimentation section:

Sims has continued to be cited for his groundbreaking work in medical textbooks, but, since the late 20th century, historians and ethicists have questioned his practices. His experimental surgeries without anesthesia on enslaved African-American women who could not consent are considered by many to be unethical; as well as symbolic of the violent oppression of blacks and vulnerable populations in the United States. Both patients of Sims' fistula and trismus nascentium operations were not given available anesthetics, and the trismus nascentium infants whom Sims operated on perished as a result of his surgeries. In regards to Sims' discoveries, Durrenda Ojenunga wrote in 1993:

"His fame and fortune were a result of unethical experimentation with powerless Black women. Dr Sims, 'the father of gynaecology' was the first doctor to perfect a successful technique for the cure of vesico-vaginal fistula, yet despite his accolades, in his quest for fame and recognition, he manipulated the social institution of slavery to perform human experimentations, which by any standard is unacceptable."

Still, some consider his work a product of the culture and the era, with a modern ethical lens serving as an unfair and unreasonable grounds with which to criticize or disregard Sims' work. Physician L.L. Wall argues that Sims was operating for therapeutic purposes and for the good of medicine, asserting that the consent of patients may not be completely absent and that his course of action was within acceptable medical practices of his time. He believes Sims cannot be judged only in relation to today's standards, noting in 2006 that:

Trismus

During his early medical years, Sims also became interested in "trismus nascentium", also known as Neonatal tetanus. Trismus nascentium is now recognized to be the result of unsanitary practices and nutritional deficiencies. At the time its cause was unknown, and it was an affliction of many African slave children. While Sims somewhat alluded to the idea that sanitation and living conditions played a role in contraction, he believed that the disease could be attributed to the idea that enslaved Africans were intellectually and morally superior. He described in his writing:

"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."

In addition to these racial beliefs, Sims thought trismus nascentium arose from skull bone movement during protracted births. To test this, Sims used a shoemaker's awl to pry the skull bones of enslaved women's babies into alignment; these experiments had a 100% fatality rate, and Sims often kept the corpses for autopsies and further research on the condition. He then blamed these fatalities on "the sloth and ignorance of their mothers and the black midwives who attended them," as oppose to the extensive experimental surgeries that he conducted upon them.