The Father of Gynecology and the Women He Built It On: J. Marion Sims and the Experiments That Modern Medicine Still Reckons With
A vesico-vaginal fistula is one of the most devastating complications of obstructed childbirth. It is an abnormal opening between the bladder and the vagina, created when prolonged pressure during difficult labour destroys the tissue wall between the two organs. Women with fistulas leak urine constantly and involuntarily. In the nineteenth century, when the condition was far more common than it is today and surgical repair was unavailable, it was associated with chronic infection, skin damage, and social exclusion so severe that affected women were often abandoned by their communities and their families.
James Marion Sims developed the technique to repair vesico-vaginal fistulas in the 1840s, working in Montgomery, Alabama. His technique was genuinely valuable. It saved lives and restored dignity to women who had no other recourse. The surgical instrument he designed, the Sims speculum, is still used today. He founded the Woman’s Hospital in New York in 1855, the first institution in the United States dedicated specifically to women’s health. He served as president of the American Medical Association. He was celebrated on two continents as a pioneer and a benefactor.
The women on whom he developed his technique were enslaved. He operated on them repeatedly, without anaesthesia, over a period of several years, in procedures he chose not to perform using anaesthetic agents that were available to him. He later used anaesthesia when performing the same operations on white women. He operated on one woman, named Anarcha, at least thirty times. The knowledge he acquired through those operations became the foundation of a surgical discipline from which enslaved women were excluded as patients for much of their lives, while being essential to its development as subjects.
Background: The Surgeon of Montgomery
James Marion Sims was born in Lancaster, South Carolina, on January 25, 1813. He obtained his medical degree from Jefferson Medical College in Philadelphia in 1835 and established a practice in Montgomery, Alabama, where he initially focused on general medicine and surgery. He was not originally interested in women’s health and had, by his own later account, a strong aversion to gynaecological practice.
What changed his trajectory was a series of referrals in the late 1830s and 1840s of enslaved women with obstetric fistulas, injuries their enslavers wanted to see repaired so that the women could return to work. Sims began attempting repairs, finding the existing techniques entirely inadequate. He developed a modified surgical approach, working in a purpose-built outbuilding behind his house that served as a small hospital, on a group of enslaved women whose names are partly preserved in the historical record.
The three women most often named are Anarcha, Betsey, and Lucy. Anarcha had developed a fistula during an extremely prolonged labour. Sims performed the first recorded experimental procedure on her. He would eventually operate on her at least thirty times. Betsey and Lucy were also subjected to multiple experimental operations. An unknown number of other enslaved women were also treated in Sims’s outbuilding during this period, their names not preserved in records that were not maintained with their identities in view.
Anaesthesia and the Decision Not to Use It
The most discussed aspect of Sims’s practice is his decision not to use anaesthesia when operating on the enslaved women in Montgomery. The available evidence suggests that Sims conducted his early fistula repair experiments between approximately 1845 and 1849. Ether anaesthesia was publicly demonstrated in 1846, and news of its anaesthetic properties spread rapidly through the American medical community. Chloroform was in use as an anaesthetic agent by 1847. By the time Sims was deep into his experimental programme, the tools to eliminate surgical pain were available and their use in surgical procedures in the United States was increasing.
Sims chose not to use them on his enslaved patients. The justification he offered, and that was widely accepted in the medical culture of his time, was the doctrine that Black patients were constitutionally less sensitive to pain than white patients, a belief that was asserted without evidence, contradicted by everything that was known about human physiology, and served the specific interest of making it more convenient to perform surgery on Black individuals than on white individuals. When Sims later performed the same surgical procedures on white women at the Woman’s Hospital in New York, he used anaesthesia as a matter of course.
The physiological claim that underpinned the decision was false. Its falseness was not unknowable in 1845 or 1847: it was simply unexamined, because examining it would have required taking seriously the reported experiences of people whose reported experiences the dominant culture did not take seriously. The decision to operate without anaesthesia on Anarcha, Betsey, Lucy, and the others was not the product of a scientific conclusion. It was the product of a cultural assumption expressed through the bodies of enslaved women who had no power to refuse.
Consent and Its Absence
The question of consent in Sims’s experimental programme is structural rather than individual. An enslaved woman in Alabama in the 1840s did not hold legal personhood. She could not enter into contracts, bring legal actions, or own property. Her body was, under the law of the state of Alabama and the laws of the other slaveholding states, the property of the person who held her in bondage. Whether Anarcha or Betsey or Lucy personally agreed to the operations that Sims performed on them is something the historical record cannot tell us with any precision, because the record was not kept with that question in mind, and because even if they had declined, their declination was not a legal fact. Their enslavers had brought them to Sims for repair. The surgery took place within that framework.
Medical ethics as it was understood in 1845 did not require the consent of a patient in the way that modern informed consent doctrine requires. The principle that a patient’s autonomous agreement to a procedure is a precondition of its ethical performance was not yet articulated in the form that the courts would later give it. But the absence of a codified legal requirement does not exhaust the moral question. Sims had power over the bodies of women who could not effectively refuse. He used that power to conduct experimental surgery on them, repeatedly, in painful procedures performed without anaesthesia, for a period of years. The medical knowledge he acquired through those procedures he then applied in a hospital he founded in New York, where the patient population was white and the operating conditions included anaesthesia.
The structure of this story is the structure of the broader exploitation it reflects: the development of medical knowledge about women’s bodies through non-consenting experimentation on Black and enslaved women, followed by the application of that knowledge in institutions that excluded or marginalised the same population.
His Reputation, the Statues, and the Reckoning
Sims was celebrated throughout his lifetime and for more than a century after his death. He was president of the American Medical Association in 1876. He was the founding president of the American Gynecological Society. He was honoured in France and in Britain. A monument to him was erected in Central Park in New York City, on Fifth Avenue near 103rd Street, depicting him in full-length bronze looking the way a man who believed in his own significance might look.
It stood there for over a century.
The reckoning with Sims’s legacy began earlier than the statue’s removal suggests. Historians of medicine and scholars in fields including African American studies, feminist theory, and bioethics had been writing about Anarcha, Betsey, and Lucy for decades before the public monuments came down. Deirdre Cooper Owens’s 2017 book “Medical Bondage: Race, Gender, and the Origins of American Gynecology” placed the enslaved women’s experience at the centre of the historical account in a way that the conventional hagiography of Sims had never done. Harriet Washington’s “Medical Apartheid,” published in 2006, situated Sims’s work within a longer history of non-consensual medical experimentation on Black Americans.
In April 2018, New York City removed the Central Park statue of Sims following a recommendation from a mayoral commission reviewing monuments associated with contested historical figures. A statue at the New York Academy of Medicine was removed around the same time. Statues in South Carolina and Alabama remain subjects of ongoing public debate.
The Historical Complexity and Why It Matters for Medicine Today
The Sims case is uncomfortable precisely because the things that are true about it are both genuinely contradictory and genuinely important. He developed a technique that worked. The surgical repair of vesico-vaginal fistulas genuinely helped women, and his technique was a real contribution to medicine. He also developed it through a programme of non-consenting experimentation on enslaved women, performed without anaesthesia, in a context where the women’s inability to refuse was a structural feature rather than an incidental detail.
The discomfort the case produces is not a reason to avoid it. The question of how medicine came to know what it knows, and whose bodies produced that knowledge, is a live question in contemporary medicine and research ethics. The documented tendency of some healthcare providers to underestimate pain in Black patients has been the subject of ongoing research and concern, and the history of that tendency runs directly through the assumptions that Sims operated within. The documented gaps in health outcomes by race, the documented underrepresentation of Black patients in certain clinical trials, and the documented distrust of the medical system among some Black communities all have histories. Some of those histories pass through Montgomery, Alabama, in the 1840s.
The standard of care analysis in the Sims case is complicated by the period, by the absence of the modern doctrine of informed consent, and by the normalisation of his practices within the medical culture of his time. What is not complicated is the fact that the women on whom he operated experienced pain that he could have reduced and chose not to. That fact does not require a legal framework to be assessed.
TL;DR: Key Facts, Legal Concepts, and Why This Case Matters
Who was J. Marion Sims?
James Marion Sims (1813-1883) was an American physician trained at Jefferson Medical College in Philadelphia who developed a surgical technique for repairing vesico-vaginal fistulas in Montgomery, Alabama. He founded the Woman’s Hospital in New York in 1855 and served as president of the American Medical Association and the American Gynecological Society. He is described in conventional medical history as the “father of modern gynecology.” He developed his key techniques through experimental surgery on enslaved Black women, performed without anaesthesia, while later using anaesthesia for the same procedures on white patients.
What is a vesico-vaginal fistula and why was its repair significant?
A vesico-vaginal fistula is an abnormal opening between the bladder and vagina caused by prolonged pressure during obstructed childbirth. It causes constant involuntary urinary leakage, chronic infection, and, in the nineteenth century, severe social stigma and exclusion. Before Sims developed his repair technique, the condition had no reliable surgical treatment. His contribution to the development of that technique was real and saved many women from a permanent condition of disability and marginalisation. The technique required advances in surgical approach, in the design of a new speculum (still used today), and in suture materials.
Why did Sims not use anaesthesia on the enslaved women?
The historical evidence indicates that Sims chose not to use anaesthesia on his enslaved patients based on the prevailing but medically false belief that Black individuals felt less pain than white individuals. Ether anaesthesia was publicly demonstrated in 1846 and chloroform was in use by 1847. Sims was performing experimental operations well into the period when these anaesthetic agents were available and in use in American surgery. He used anaesthesia when he performed the same procedures on white women at the Woman’s Hospital in New York. The physiological claim that underpinned his choice was asserted without evidence and contradicted by everything actually known about human physiology.
Could the women consent to the procedures?
Enslaved women in 1840s Alabama held no legal personhood and could not legally refuse their enslavers’ decisions about their bodies or their medical care. The enslaved women on whom Sims experimented, including Anarcha, who underwent at least 30 procedures, were brought to him by the people who owned them. Whether any of them personally objected to or resisted the operations, and whether any such objection was registered or accommodated, is not reflected in the available historical records, which were kept with Sims’s clinical purposes in view rather than with the patients’ perspectives recorded. The absence of formal consent in nineteenth-century medical ethics does not resolve the moral question of what Sims chose to do with the power he held over these women’s bodies.
What happened to the Central Park statue of Sims?
A bronze full-length monument to Sims stood in Central Park in New York City, at Fifth Avenue and 103rd Street, for over a century after its installation in 1894. In April 2018, New York City removed the statue following a recommendation from a mayoral advisory commission reviewing monuments associated with contested historical figures. A statue at the New York Academy of Medicine was also removed around the same time. Statues of Sims in South Carolina and Alabama remain subjects of ongoing public and political debate.
What does this case tell us about the history of medical ethics?
The Sims case illustrates the degree to which the formal doctrine of informed consent, which now requires that patients give meaningful, voluntary, and informed agreement before any medical procedure, did not exist in the form that protects patients today. The development of that doctrine across the twentieth century reflects, in part, a recognition that medical progress built on the bodies of people who could not refuse is both morally wrong and scientifically compromised by the conditions in which it was produced. The case also illustrates the persistence of racialised beliefs about pain and physiology within medicine: beliefs that originated in the period when Sims practised and whose documented remnants continue to affect the quality of care received by Black patients today.
Where can I learn more?
Deirdre Cooper Owens’s “Medical Bondage: Race, Gender, and the Origins of American Gynecology” (2017) places Anarcha, Betsey, and Lucy at the centre of the historical account and traces the broader patterns of medical experimentation on enslaved women in the antebellum South. Harriet Washington’s “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” (2006) situates Sims within a longer history of non-consensual experimentation on Black Americans. Both books are essential reading on the subject.
