James Marion Sims (January 25, 1813 – November 13, 1883) was an American medical doctor in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth. He developed this technique via non-consensual and unanesthetized surgeries on enslaved black women Anarcha Westcott, Lucy and Betsey and impoverished Irish women.
He is also remembered for inventing the Sims speculum, the Sims sigmoid catheter, and Sims' position. Against significant opposition, he established, in New York, the first hospital in the United States specifically for women. He was forced out of the hospital he founded because he insisted on treating cancer patients; he played a small role in the creation of the nation's first cancer hospital, which opened after his death.
Sims was one of the most famous and admired American physicians of his era. He was elected President of the American Medical Association in 1876, and he was one of the first American physicians to become famous in Europe. He openly boasted that he was the second-wealthiest doctor in the country. However, as medical ethicist Barron H. Lerner states, "one would be hard pressed to find a more controversial figure in the history of medicine." A statue in his honor was erected in 1894 in New York City's Bryant Park, the first statue in the United States in honor of a physician. It stood for 124 years before being removed in 2018.
Today, many medical ethicists criticize how Sims developed his surgical techniques. He operated on some enslaved black women and girls who, like prisoners, could not meaningfully consent because they could not refuse. During the 20th century, his experiments began to be condemned as an improper use of human experimental subjects. Sims has been described as "a prime example of progress in the medical profession made at the expense of a vulnerable population". Some medical historians have defended Sims' practices as consistent with the accepted standards of his time. According to Sims, the enslaved black women upon whom he experimented were "willing" patients who had no better options for treatment.
Sims was a prolific writer and his published reports on his medical experiments, together with his own 471-page autobiography (summarized in an address just after his death), are the main sources of knowledge about him and his career. His positive self-presentation has, in the late twentieth and early twenty-first centuries, been subject to revision.
Childhood, education, and early career
James Marion Sims, who preferred to be called "Marion", was born in Lancaster County, South Carolina, the son of John and Mahala (Mackey) Sims. His father, Colonel John Sims participated in the War of 1812, being stationed at Charleston. His paternal grandfather was one of Marion's men; his great-grandfather was with Washington at Braddock's defeat. His maternal grandfather, Charles Mackey, was taken prisoner by Banastre Tarleton, and would have been hanged, but for the intervention of his wife.
For the first twelve years of his life, Sims and his family lived in Lancaster Village, north of Hanging Rock Creek, where his father owned a store. Sims later wrote of his early school days there.
After his father was elected sheriff of Lancaster County, he sent Sims in 1825 to the newly established Franklin Academy, in Lancaster. In 1832, after two years of study at the predecessor of the University of South Carolina, South Carolina College, where he was a member of the Euphradian Society, Sims worked with Dr. Churchill Jones in Lancaster, South Carolina. He took a three-month course at the Medical College of Charleston (predecessor of the Medical University of South Carolina), but found it too rigorous.
He moved to Philadelphia, Pennsylvania, in 1834 and enrolled at the Jefferson Medical College, from which he graduated in 1835 as "a lackluster student who showed little ambition after receiving his medical degree". As he put it:
I felt no particular interest in my profession at the beginning of it apart from making a living.... I was really ready at any time and at any moment to take up anything that offered, or that held out any inducement of fortune, because I knew that I could never make a fortune out of the practice of medicine.
He returned to Lancaster to practice. As of that date "he had had no clinical experience, logged no actual hospital time, and had no experience diagnosing illnesses." After his first two patients (infants) died, Sims was despondent. He left and set up a practice in Mount Meigs, near Montgomery, Alabama. He described the settlement in a letter to his future wife Theresa Jones as "nothing but a pile of gin-houses, stables, blacksmith-shops, grog-shops, taverns and stores, thrown together in one promiscuous huddle". He was in Mount Meigs from 1835 to 1837. Sims visited Lancaster in 1836 to marry Theresa, whom he had met many years earlier, when a student in Lancaster. She was the daughter of B.C. Jones, and the niece of Churchill Jones, and had studied at the South Carolina Female Collegiate Institute.
In 1837 Sims and his wife moved to Cubahatchee, Alabama, where they remained until 1840. He was a "plantation physician", who had "a partnership in a large practice among rich plantations." "Sims became known for operations on clubfeet, cleft palates and crossed eyes." This was his first experience treating enslaved black women, whose owners summoned Sims to treat them. Being a "plantation physician" was not as lucrative as Sims hoped a life as a doctor would be.
In 1840 the couple moved to Montgomery, Alabama, where they lived until 1853. Sims later described this period as the "most memorable time" of his career. Within a few years he "had the largest surgical practice in the State", and the largest practice of any doctor in Montgomery up to that time. "He was immensely popular, and greatly beloved." When he returned to the city for a visit in 1877, he was treated as a hero.
In Montgomery, Sims continued essentially his practice as a plantation physician: treating the enslaved, who then made up two thirds of the city's population. He built a hospital or "Surgical Infirmary for Negroes", for those women their owners brought him for treatment. It began with four beds, but it was so successful he added a second floor, doubling capacity to eight beds. One source says it expanded to twelve beds. It has been called "the first woman's hospital in history". It was also the first hospital specifically for Black people in the United States.
In 1840, the field of gynecology did not exist; there was no training on the subject, for Sims or anyone else. The only books were on midwifery. Medical students did not study pregnancy, childbirth, or gynecological diseases. Student doctors were often trained on dummies to deliver babies. They did not see their first clinical cases of women until beginning their practices. "The practice of examining the female organs was considered repugnant by doctors." Sims shared this view, remarking in his autobiography that "if there was anything I hated, it was investigating the organs of the female pelvis".
Medical experimentation on enslaved women and girls
Repair of vesicovaginal fistulas