A year ago in an Upper East Side Manhattan hospital room, I experienced the most intense physical pain of my life. I was beginning my first phase of fertility treatments, and my endocrinologist was dilating my cervix. He did not administer anesthesia during the 20-minute procedure.
Despite my agony, I could not help but be reminded of the Southern physician James Marion Sims and his fraught medical legacy, especially as I was finishing my forthcoming book on the history of American gynecology. I am a scholar who teaches and writes about slavery, race, medicine, and the American origins of gynecology. In my work, I cannot escape the looming shadow of Sims—often called the “father of American gynecology”—within the history of medicine. Nor can I sidestep the conversations that surround Sims’ early work on enslaved women. Over a five-year period of experimentation, he repaired their obstetrical fistulae, a chronic condition caused by childbirth and in which an abnormal opening between the bladder and vagina causes incontinence.
As I began my fertility journey, I was fully aware that Sims helped to pioneer fertility treatments in this country. I also recognized the irony of my situation: Like Dr. Sims’ enslaved women patients, I too had undergone a procedure without anesthesia that was to help me bear children.
During the past 20 years, Sims has emerged as a notorious figure in the history of medicine. Today, more than a hundred years after his death, his work and legacy are as relevant as ever. He, much like other slaveholding American “heroes,” represent the United States’ inconsistent and hypocritical relationship with democracy and freedom.
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Modern-day critics are angry that J. Marion Sims operated on nearly a half-dozen enslaved women without the use of anesthesia. They are also are incensed that he has been so widely lauded in the Western world for his work in gynecology. Statues depict and honor him in New York’s Central Park and the South Carolina Capitol in Columbia, and activists have demanded the removal of such memorials, even before recent protests about Confederate monuments. Hospitals in Dublin, Ireland, and in his home of Lancaster, South Carolina, bear his name. The lives of the enslaved women on whom he experimented—Anarcha, Betsy, and Lucy, among others—have been largely forgotten.
The controversy is twofold and tends to lack historical nuance. Sims has been painted as either a monstrous butcher or a benign figure who, despite his slaveowning status, wanted to cure all women from their distinctly gendered suffering. As a historian and researcher, I am usually frustrated by the ahistoricism and reductionism that has emerged on both sides of the Sims debate. To better understand Sims, his enslaved patients, and the state of medicine, we must contextualize the antebellum South and its racial politics.
Sims was a South Carolinian who grew up in a world where slavery and anti-Black racism was normal. As a slaveowning physician, he practiced, as did so many of his peers, on sick Black bodies for profit. Before Sims’ most famous gynecological surgical work on Anarcha, Betsy, Lucy, and at least three other unidentified enslaved women, he examined and treated enslaved people with ailments that ranged from tetanus to cleft palate repair. In his medical writings and his memoir, Sims used patronizing and offensive language to describe his thoughts and treatment of women and Black Americans. In this regard, just like in his experimental medical work, his views proved to be the norm and not the exception in his racial and gendered beliefs.
In my conversations during the last decade, I have had the most difficulty convincing others that Sims was not a deviant bent on mangling Black women’s reproductive organs. He followed a practice that medical doctors and schools established decades before he began his own work in gynecology.
As a slaveowner, Dr. Sims was intimately aware of the economic value of having a healthy slave labor force. Maintaining Black women’s reproductive health was a major concern for slaveowners. Medical colleges in Southern urban enclaves like Charleston, South Carolina, placed newspaper advertisements that sought out sick enslaved people to perform experimental medical surgeries and treatments. In order to gain access to enslaved people’s bodies, medical professionals entered into legal contracts with slaveowners. In these contractual agreements, doctors agreed to take on the financial costs of caring for sick slaves and promised not to intentionally harm enslaved patients during their hospitalization. Sims entered into such a contract with the owners of his enslaved experimental patients. It would not have been in his economic interest to physically harm his leased charges.
Throughout his career, Sims wrote about his disdain for anesthesia in surgical work. As a doctor, he privileged performing surgeries quickly so that the patient would not bleed to death. Toward the end of his career, he used anesthesia regularly because of the medical profession’s acceptance of the practice, especially after the Civil War ended. Although he certainly believed that Black women did not experience physical pain in the same ways that white women did, most white doctors ascribed to this ideology during the nineteenth century. The racial science and medicine of the day provided so-called conclusive evidence that Black and white people were biologically distinct from each other and these differences were manifested in various ways.
Further, what is less known about Sims’ experimental gynecological work on vesico-vaginal fistula is that he performed the same reparative surgical work on a poor Irish immigrant woman in New York, Mary Smith. He treated Smith as he did his enslaved patients. Sims did not anesthetize her during her operations and made her work in the hospital he founded, just as he made his enslaved patients work as his assistants during their experimental surgeries.
I have argued and continued to insist that James Marion Sims was a product of his time, but this fact does not detract from his role as a man who participated in a system that reduced human beings to moveable property, one that was built on violence, terror, and white supremacy. Yet, our assessments of him as a purveyor of racialized terror must include how historic figures were regarded by their peers. Sims noted in his memoir that the local white community and his two white medical apprentices abandoned him after two years of failed surgeries on his leased slave patients. Sims alluded in his autobiography that some of their criticisms stemmed from their concerns that he was more committed to building a reputation for himself than actually repairing these women’s bodies. After he lost white support, he continued his experimental work on his enslaved patients in another way; he trained and made these women assist him in his slave hospital. His explicit treatment of them as reproductive laborers was informed by his status as a slaveowner.
As a slaveowning physician, Sims did not believe in the humanity of his patients. He described Black people as “niggers” in his writings and practiced a Southern paternalism that was endemic of nearly every white man who lived during the time. His treatment of Mary Smith as a poor immigrant woman was just as problematic; he referred to her as a “loathsome creature.”
Like nearly every pioneering gynecological doctor who worked in the South during this time, his surgical work on enslaved women ultimately benefited all women. In fact, Sims’ suture technique is still used by doctors today in fistula repair operations.
Yet, ethical issues linger. What are we to make of commemorative statues and honorific medical awards that provide uncritical praise of James Marion Sims as an uncomplicated hero? I support efforts to recontextualize the historical text on monuments to Sims. The names, statuses, and labor of his enslaved patients must always be linked to Sims because he would not have achieved success as the country’s foremost gynecological surgeon without the institution of slavery and the forced availability of Black women’s bodies. His stature as a medical hero was built on the broken bodies of enslaved women. Just as “Founding Father” Thomas Jefferson’s relationship to his slave concubine Sally Hemings has come under scrutiny and attack, so has Sims’ legacy.
As a scholar who writes about the medical lives of enslaved women and slavery’s enduring legacy for these women’s descendants, I stress in my work and activism that we must continue to advocate for the end of health-care policies and practices that provide less than equitable care for Black, poor, and immigrant women. How can we ensure that medical institutions, doctors, insurance companies, and pharmaceutical research companies do not continue to experiment and practice on Black women’s bodies unethically?
Too many communities of color have inherited the medical racism of Sims’ era. Black women experience more invasive medical treatments in uterine fibroid treatment than white women and die in higher numbers in childbirth. Systemic racism requires that the fight for equality in medicine be rooted in the continued inclusion of medical humanities, a field that applies the humanities, social sciences, and the arts to medical education; in reforms in how biomedical ethics classes are taught in medical schools; and in legislation that does not harm women of color physically and legally.
Lastly, the legacy of medical racism affects us all despite our supposed social standing. The fact that I could be treated so callously in 2016 by a doctor who believed I did not need pain relief during my cervical dilation is a reminder that racism is ever-present in the medical field.
As recently as 2016, a University of Virginia study reported that some white medical professionals still believe there are biological differences between Black and white people that shapes their tolerance for pain. African Americans are thus often undertreated for pain.
My hope is that, while acknowledging how damaging racist symbols are for people of color who are reminded of the way “American heroes” achieved their status, we simultaneously work to eliminate racism within our educational and health-care systems at all levels. No medical doctor trained to heal women and their children should graduate with the same concepts about biological differences that Sims did in 1835.