J. Marion Sims

J. Marion Sims
Born	January 25, 1813 Lancaster County, South Carolina, U.S.
Died	November 13, 1883 (1883-11-14) (aged 70) New York City, U.S.
Alma mater	Jefferson Medical College
Occupation	Surgeon
Spouse(s)	Theresa Jones
Children	Mary Virginia Carr Eliza Theresa Sims Granville Sharp Sims Carrie Marion Sims Merry Christmas Sims Fannie Marion Sims Dr. Harry Marion-Sims William Marion Sims Florence Nightingale Wyeth
Parent(s)	John Sims Mahala Mackey
Relatives	John Allan Wyeth (son-in-law) Marion Sims Wyeth (grandson) John Allan Wyeth (grandson)

James Marion Sims (January 25, 1813 – November 13, 1883) (known as J. Marion Sims) was an American physician and a pioneer in the field of surgery, known as the "father of modern gynecology".^[1] His most significant work was to develop a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth.

Sims' use of enslaved African-American women as experimental subjects has been regarded by many modern historians and ethicists as highly unethical.^[1][2] He has been described as "a prime example of progress in the medical profession made at the expense of a vulnerable population."^[1] However, his contributions are also defended by many, including physician L.L. Wall, who has emphasized Sims' 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.^[3]

Early life, education and career

J. Marion Sims (called Marion) was born in Lancaster County, South Carolina,^[4] 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, and where he would later write of his early school days.^[5]

Upon his father's 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, where he was a member of the Euphradian Society, 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.^[5]

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.^[5]

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," ^[3] that affected many women and had no effective cure or treatment.^[6] The frequently-occurring injuries left the women subject to incontinence and, subsequently, to marginalization from society. Furthermore, in the mid 19th century, gynecology was not a robustly developed field: social norms regarded the medical study and examination of female reproductive anatomy as immoral, and doctors were often trained to deliver babies on dummies in medical school and did not see their first cases until beginning their practices.^[6] As a result, Sims had no formal background in gynecology prior to beginning his practice in Alabama.^[5]

When a woman came to him with an 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.^[6][5] Soon after he developed a precursor to the modern speculum out of a pewter spoon and strategically placed mirrors.^[7] From 1845 to 1849 Sims started doing experiments on slave women and 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.

Sims Speculum

Experiment's Victims

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.^[7] He named three enslaved women in his records: Anarcha, Betsy, and Lucy. Each suffered from fistula, and all were subjected to his surgical experimentation.^[2] From 1845 to 1849 he experimented on each them several times, operating on Anarcha 13 times before her fistula repair was declared a success.^[6] She had both vesicovaginal and rectovaginal fistulas, which he struggled to repair.^[3]

Although anesthesia had recently become available, Sims did not use any anesthetic during his procedures on Anarcha, Betsy, and Lucy.^[2] According to Sims, it was not yet fully accepted into surgical practice and he was unaware of the possibility of the use of ether.^[3][7] However, ether as anesthesia was available as early as the beginning of the 1842.^[7] A common belief at the time was that black people did not feel as much pain as white people, and thus did not require anesthesia when undergoing surgery.^[8] Nevertheless, in a memoir he stated that "Lucy's agony was extreme...she was much prostrated and I thought she was going to die".^[9] After he operated on her in the presence of twelve doctors without anesthetics, she nearly died from septicemia following his experimental use of a sponge to wipe urine from the bladder during the procedure.^[6] He did administer opium to the women after their surgery, which was accepted therapeutic practice of the day.^[10]

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.^[1] He was then able to repair the fistulas of several other enslaved women under his medical authority.^[11] 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.^[8]

Trismus Nascentium

During his early medical years, Sims also became interested in "trismus nascentium", also known as Neonatal tetanus. It is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from the mother having been immunised are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.^[12]

"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. It is now believed that the conditions of the slave quarters were the cause. 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 inferior.^[13] 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."^[13]

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.^[13] 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.^[14][15]

Critiques of Sims' Work

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. This sheds a light on the historically violent oppression of blacks and vulnerable populations in the United States.^[1] 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." ^[6]

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 have been 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:

"modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims."^[3]

New York and Europe

Statue of Sims in New York's Central Park

Sims moved to New York in 1853 because of his health and determined to focus on diseases of women. In 1855 he founded the Woman's Hospital, the first hospital for women in America. Here he performed operations on indigent women, often in a theatre so that medical students and other doctors could view it, as was considered fundamental to medical education at the time;^[16] notably, the patients remained in the hospital "indefinitely" and underwent repeated procedures.^[16]

In 1861, during the American Civil War, Sims moved to Europe, where he worked on several fistula patients in London, Paris, Edinburgh, Dublin and Brussels.^[13][5] In 1863, he was summoned to treat Empress Eugénie for a fistula, solidifying his worldwide acclaim as a surgeon.^[13] Back in the United States, Sims' private practice became extremely expensive and only available to the wealthy. Sims also became known for the Battey surgery which contributed to his "honorable reputation". The Battey surgery was the removal of both ovaries, which became a popular "treatment" for insanity, epilepsy, hysteria, and other disorders of the nerves that were thought to be from the female reproductive system (Terri Kapsalis).^[17] Honors and medals were heaped upon him for his successful operations in many countries. The necessity of many of these surgeries have since been called into question. Several of his patients had surgery for what were considered gynecological issues: such as clitoridectomies, believed to control hysteria or 'improper' behavior related to sexuality. These were done at the requests of their husbands/fathers, who were permitted under the law to commit the women to surgery involuntarily.^[11]

Under the patronage of Napoleon III, Sims organized the American-Anglo Ambulance Corps, which treated wounded soldiers from both sides at the battle of Sedan.^[11]

In 1871, Sims returned to New York. After quarreling with the board of the Woman's Hospital over the admission of cancer patients (which he favored and which the board opposed because of the mistaken belief that cancer was contagious) he became instrumental in establishing America's first cancer institute, New York Cancer Hospital.^[18]

From 1876–77, Sims served as president of the American Medical Association ^[13]

Death

In 1880, Sims contracted a severe case of typhoid. Although he suffered from delirium, W.Gill Wylie described how he was "constantly contriving instruments and conducting operations".^[5] After several months and a move to Charleston to aid the process, Sims recovered in June 1881 and traveled to France. After his return to the United States in September 1881, he began to complain of an increase in heart problems, which had first become a concern after he suffered two anginas in 1877. According to Wylie, Sims sought out medical consultations for his unknown cardiac condition both in the United States and in Europe, and was 'positive that he had a serious disease of the heart and it caused deep mental depression'.^[5] He was halfway through writing his autobiography and planning a return visit to Europe when he died of a heart attack on November 13, 1883 in New York after visiting a patient with his son, Dr. H. Marion Sims. He is buried at Green-Wood Cemetery in Brooklyn, New York.^[19]

Legacy and honors

J. Marion Sims statue in Columbia, South Carolina

• A bronze statue by Ferdinand Freiherr von Miller (the younger), depicting Sims in surgical wear,^[20] where it is located on the peripheral wall at Fifth Avenue and 103rd Street, opposite the New York Academy of Medicine. This is the first statue in the United States to depict a physician.^[11]
• Other memorials were installed on the grounds of his alma mater, Jefferson Medical College, and in both the South Carolina State Capitol in Columbia and Alabama's capitol in Montgomery.^[1]
• The historical marker of his birthplace honors him for “his service to suffering women. Empress and slave alike."^[1]

Contributions

• Vaginal surgery: fistula repair.
• Instrumentation: Sims' speculum; Sims' sigmoid catheter.
• Exam and surgical positioning: Sims' position.
• Fertility treatment: Insemination and postcoital test.
• Cancer care: Sims argued for the admission of cancer patients to the Woman's Hospital, at a time when people opposed him, as they feared that cancer was contagious.
• Abdominal surgery: Sims advocated that in the case of an abdominal bullet wound, a laparotomy was needed to stop bleeding, repair the damage and drain the wound. His opinion was sought when President James Garfield was shot; he responded by telegram from Paris. Sims' recommendations later gained acceptance.^[11]
• Gallbladder surgery: In 1878, Sims drained a distended gallbladder and removed its stones. He published the case believing it was the first of its kind; however, a similar case had already been reported in Indianapolis in 1867.^[11]

Death

Sims died in New York City in 1883 at the age of 70.

See also

• Unethical human experimentation in the United States
• Medical Apartheid

References

Further reading

• Gamble, Vanessa. "Under the Shadow of Tuskegee: African Americans and Health Care". American Journal of Public Health, November 1997, page 1773.
• Harris, Seale. Woman’s Surgeon (1950), short biography
• Sims, J. Marion. The Story of My Life. Appleton, New York, 1889, pages 236–237, online text at Internet Archive.
• Sims, James Marion (1866). Clinical notes on uterine surgery. Robert Hardwicke. Retrieved 16 July 2015. 
• Speert H. Obstetrics and Gynecologic Milestones. The MacMillan Co., New York, 1958, pages 442–54.
• Spencer, Thomas. "UAB shelves divisive portrait of medical titans: Gynecologist's practices at heart of debate," Birmingham News, January 21, 2006.
• Washington, Harriet A. "Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present" Medical Apartheid at the Wayback Machine (archived July 14, 2011)

External links

• "J. Marion Sims", Encyclopedia of Alabama
•  "Sims, James Marion". Appletons' Cyclopædia of American Biography. 1900. 
• J. Marion Sims Letters, South Carolina Digital Library