Jack E. Riggs
Matthew S. Smith
Morgantown, West Virginia, United States

“Reputation is what men and women think of us;
character is what God and angels know of us.”
— Thomas Paine (likely inaccurate attribution)

Few medical legacies have been more controversial than that of J. Marion Sims, the Father of American Gynecology.^1-3 Sims rose from humble and obscure origins to reach the pinnacle of medical recognition and reputation, including the presidency of the American Medical Association.⁴ Sims’ fame rests primarily on his successful operative procedure for treating vesicovaginal fistula.⁵ Of this devastating condition, Sims wrote:

“It occurs principally in first labours where the pelvis is small, the soft parts unyielding, and the foetal cranium large … Incontinence of urine, following a tedious labour … will always prove its existence … The clothes and bedding of the unfortunate patient are constantly saturated … alike disgusting to herself and repulsive to others.”⁵

Sims’ use of slave women has evoked debate over his reputation because of the ethics of his medical experimentation. Sims’ detractors have made the following arguments:

1. Gynecology developed by experimentation and exploitation of slave women.⁶
2. Because of their enslavement, these women could not agree to experimentation as they lacked decision-making capacity.⁷
3. Sims’ lack of shared values because of differences in class, gender, and race suggest that he could not decide what was in their best interest.⁸
4. Sims’ fame was an example of medical progress at the expense of a vulnerable population.⁹
5. Framing Sims’ reputation as a choice between medical pioneer or notorious villain is not appropriate as it clouds the higher moral issue of slavery.¹⁰

Sims’ defenders have made the following arguments:

1. Sims was a product of his time and it is difficult for us to envision the desperate state of 1850s women with total urinary incontinence.¹¹
2. Although hideous to sensitive twentieth-century eyes, Sims’ role in the development of gynecology is incontestable and we should remember the slave women who contributed to the successful repair of vesicovaginal fistulas.¹²
3. Although lacking informed consent, “by virtue of the simple fact that all these women had an opportunity to observe the procedures being performed, it is highly likely that they at least had a reasonable understanding of the procedure.”¹³
4. Sims was simultaneously a man of his time and a man ahead of his time, “While it might be concluded that his place in history results from the latter and any ethical questions arise from the former.”¹⁴
5. While “true that under Southern law, slaves were the property of others and Sims could not have legally operated on them without the consent of their owners; however, this cannot be taken as a priori proof that these slaves were unwilling patients.”¹⁵
6. Sims demonstrated the core competencies currently fostered in graduate medical educational programs as “he described his patients’ implicit desire for care, willing participation, and enormous bravery.”¹⁶
7. The lives of these slave women “would have been even more wretched without surgery and the knowledge gained have subsequently been applied to achieve successful fistula repair for thousands of women.”¹⁷
8. Sims was a medical pioneer “who changed the lives of women forever … without statues of Sims, dialog ceases and thus future generations of African American children will never know that their ancestors were responsible for many of the cures in medicine today.”¹⁸

Sims’ critics and defenders describe the same reality but reach dichotomous judgments regarding his reputation. Critics focus on his experimental subjects. Defenders focus on his medical achievement.

One of Sims’ defenders wrote, “It is impossible for me to ‘get into his mind’ about the use of slaves in developing an operative approach to cure their devastating condition.”¹³ Sims’ words correlated over time and context, however, provide just such a window into his mind. Sims’ autobiography, written in the 1870s, was published posthumously by his son in the 1880s.¹⁹ Sims owned slaves and of them in his autobiography when moving to New York in the 1850s, wrote:

“We hadn’t many negroes … the dozen negroes we had were house negroes and town negroes—cooks, waiters, and body-servants only. We called them together, and I said, ‘Now we are going away, never to come back again. You must all select masters with whom you are willing to live, and the man that you select, as a matter of course, will be your master hereafter’ … They all began to weep, and felt very badly over the thought of our leaving them. They said, ‘Oh, no, master, we don’t want to know any other person for a master but you, and we don’t want to know any other woman for a missus but Mrs. Theresa’ … I told the negroes to do exactly as they pleased, and that I would not put any of them in slavery against their will.” (pgs. 265-266)¹⁹

When Sims’ son published his father’s autobiography, he included (possibly inadvertently) contemporaneous letters that his father had written to his mother in the 1850s regarding these same slaves and situation:

January 2, 1855
“My Dear Theresa … I know you will do what is exactly right in reference to the negroes. Sell what are necessary for immediate purposes. They will be sacrificed, but no matter, we must live, let it cost what it may.” (pg. 400)¹⁹

February 18, 1855
“My dear Wife … Whatever you do about the negroes is all right. I don’t allow myself a moment’s thought, further than the anxiety I might naturally feel about the trouble it gives you, my model wife.” (pg. 405)¹⁹

The contradictions in Sims’ private words in the 1850s and his public words in the 1870s regarding his slaves are revealing. When judging Sims’ character (as opposed to his reputation), contemporaneous private words are as important, if not more so, than later reputation judgments made by others.

References

1. Editorial. Marion Sims and the southern gynecologists. JAMA 1918; 60: 285-286.
2. Ward GG. Marion Sims and the origin of modern gynecology. Bull NY Acad Med 1936; 12: 93-104.
3. Moir C. J. Marion Sims and the vesico-vaginal fistula: then and now. Br Med J 1940; 2(4170): 773-778.
4. Harris S. Woman’s Surgeon, The Life Story of J. Marion Sims. New York, NY: MacMillian Company, 1950.
5. Sims JM. On the treatment of vesico-vaginal fistula. Am J Med Sci 1852; 23: 59-82.
6. Axelsen DE. Women as victims of medical experimentation, J. Marion Sims’ surgery on slave women, 1845-1850. Sage 1985; 2(2): 10-13.
7. Ojannuga D. The medical ethics of the ‘Father of Gynaecology’, Dr J Marion Sims. J Med Ethics 1993; 19:28-31.
8. Richardson DA. Ethics in gynecologic surgical innovation. Am J Obstet Gynecol 1994; 170: 1-6.
9. Spettel S, White MD. The portrayal of J. Marion Sims’ controversial surgical legacy. J Urol 2011; 185: 2424-2427.
10. Wailoo K. Historical aspects of race and medicine, the case of J. Marion Sims. JAMA 2018; 320: 1529-1530.
11. Kaiser IH. Reappraisals of J. Marion Sims. Am J Obstet Gynecol 1978; 132: 878-884.
12. de Costa CM. James Marion Sims: some speculations and a new position. Med J Aust 2003; 178: 660-663.
13. O’Leary JP. J. Marion Sims: a defense of the father of gynecology. South Med J 2004; 97: 427-429.
14. Sartin JS. J. Marion Sims, the father of gynecology: hero or villain? South Med J 2004; 97: 500-505.
15. Wall LL. The medical ethics of Dr J Marion Sims: a fresh look at the historical record. J Med Ethics 2006: 32: 346-350.
16. Straughn JM, Gandy RE, Rodning CB. The core competencies of James Marion Sims, MD. Ann Surg 2012; 256: 193-202.
17. West MJ, Irvine LM. The eponymous Dr James Marion Sims MD, LLD (1913-1883). Med J Biogr 2015; 23: 35-45.
18. Vernon LF. J. Marion Sims, MD: why he and his accomplishments need to continue to be recognized, a commentary and historical review. J Natl Med Assoc 2019; 111: 436-436.
19. Sims JM. The Story of My Life. New York: D. Appleton and Company, 1884.