Anarcha,Betsey,Lucy,and the women whose names were not recorded: The legacy of J Marion Sims

Abstract

In April 2018, a statue commemorating J Marion Sims was removed from Central Park, New York, and relocated to Green-Wood Cemetery in Brooklyn, where he is buried. In 1849, Sims developed a repeatable surgical solution for obstetric fistula, a debilitating condition caused by prolonged, obstructed labour, which damages the vaginal wall, resulting in permanent leakage via the vagina from either the bowel or bladder and sometimes both. Initially, Sims appears worthy of widespread adulation. There are several commemorative statues of him, he has been afforded the title of the ‘father of modern gynaecology’, and for 37 years, the American Urogynecological Society held an annual eponymous lecture, among other honours. Obstetric fistula rendered women social pariahs, unable to engage fully in either domestic or public life. Sims was able to create a reliably repeatable surgical solution but did so through ongoing experimentation on enslaved women. One of these women, Anarcha, was operated on at least 30 times without the use of anaesthesia over a four-year period, despite the availability of anaesthesia for the majority of the experimentation period. Over 170 years later, Sims’ story retains its relevance because it represents a clear point at which race, gender and class intersect with medicine. This paper will use Sims’ own account to drive the narrative, then examine matters of agency, ethics and consent that come from it, to show that his work, and subsequent renown, were only possible because of the inherent violence of chattel slavery and other systemic forms of oppression.

Introduction

In 1845, Anarcha went into labour. She was 17 years old, and this was her first delivery. She struggled for three days before medical help arrived. Anarcha was an enslaved woman whose body had been formed by slavery.

Biological anthropologist, Patricia Lambert, writes that ‘nutritional deficiency diseases such as rickets, scurvy, pellagra, and iron deficiency anemia are thought to have been common’ in enslaved communities. ¹ Perhaps, like other enslaved people, Anarcha’s diet was nutritionally deficient and she developed rickets, which caused malformation of her pelvis. Obstructed labour was a common result. Paradoxically, Anarcha’s primary value to her slaveholders may well have been in her capacity to reproduce, even more so than the work she performed on a daily basis. The transatlantic slave trade had been formally discontinued in 1808 with the passing of a federal law, which made it illegal to transport captive people from Africa to the United States of America. ² However, the international slave trade continued illegally until at least 1860, and slavery was not fully abolished until 1865 with an amendment to the United States Constitution. ³ In a cruel twist of circumstance, enslavers required the enslaved to reproduce in order to ensure the continuation of the institution of slavery.

When medical help arrived for Anarcha, it was in the form of a local doctor with no particular interest in reproductive health. In his own words, ‘if there was anything I hated, it was investigating the organs of the female pelvis’. ⁴ The doctor was able to deliver the baby using forceps, which he had little, if any, experience of using. The baby’s head, he wrote, ‘was so impacted in the pelvis that the labor pains had almost ceased’. ⁴ Forceps could be dangerous to both mother and baby, potentially resulting in haemorrhage, or injury to the fetus, particularly in inexperienced hands, but there was little choice. Anarcha survived this labour, but the doctor, James Marion Sims, did not record the fate of the baby. As a result of the complicated labour Anarcha sustained several fistulae. This was the first case of obstetric fistula Sims had seen, and he recorded her condition as ‘hopelessly incurable’. ⁴

History has recorded a lot more information about James Marion Sims, the doctor who went on to develop a repeatable surgical repair for obstetric fistula, than it has about Anarcha who suffered through it. She left no verbal or written records of her life, and this is important to acknowledge. As an enslaved woman it is likely Anarcha was illiterate, and her position of powerlessness would have created immense barriers to being heard. Anarcha’s understanding of the situation, along with those of the other women experimented on by Sims, will never be revealed. They have been made voiceless.

In contrast, Sims was a prolific author of medical texts. He also penned a memoir, The Story of My Life, which includes detail of his quest to develop a surgical solution for obstetric fistula. This paper will use Sims’ own account to drive the narrative. Matters of agency, ethics and consent within the narrative will be examined. This will show his work and subsequent renown were only possible because of the inherent violence of chattel slavery and other systemic forms of oppression, such as class and gender.

Obstetric fistula and enslaved women

An obstetric fistula is a debilitating condition most frequently caused by prolonged, obstructed labour, which results in permanent bladder leakage, sometimes bowel leakage, and sometimes both. If the fetus cannot fit through the birth canal, it will become wedged into a position where its skull and the woman’s pelvic bones trap the soft tissue, ‘and the blood supply to entrapped tissues is shut off’. ⁵ L Lewis Wall, a medical anthropologist and obstetrician, describes obstetric fistula as the result of a ‘massive crush injury’. ⁵ The vagina eventually sheds the dead tissue which leaves a hole—a fistula. Urine and faeces can then find their way through the vagina via that fistula.

Another surgeon and contemporary of Sims’, George Hayward of Boston, Massachusetts, describes a fistula patient’s condition, including peripheral problems. There was no suitable method of controlling or stemming the flowing urine, and as a result the woman’s ‘limbs, from the upper part of the thighs to the knees, were inflamed, excoriated and extremely sensitive’. ⁶ Hayward noted that even attempting to examine a woman with this condition was difficult because of the ‘exquisite sensitivity of the parts’. ⁶

Before Sims, some attempts at treatment had been made but either failed or were not reliably repeatable. As early as 1675, Swiss physician Johannes Fatio successfully treated two fistulae using a method described by Henrik van Roonhuyse in 1663. ⁷ Montague Gossett was the first to close a fistula in England in 1834, and in 1840 John Paul Mettauer, of Virginia, also published on his fistula success from two years earlier. ⁷ By 1855 he was able to report 27 successful operations for obstetric fistula. ⁸ In addition, George Hayward also closed a fistula and published his success in 1839. ⁶ Thomas F Baskett, author of Eponyms and Names in Obstetrics and Gynaecology wrote that while Sims was definitely not the first of the fistula pioneers he was certainly the most ‘tenacious’. ⁸ Despite these various successes, obstetric fistula remained a largely untreatable condition of pain, incontinence, smell, infection and, ultimately, isolation from society, but it was not fatal; although there is evidence to suggest it sometimes led to suicide. ⁹ For an enslaved woman, this condition brought other considerations to the fore, and having a fistula meant she could no longer be considered the lucrative asset she once was to her enslaver.

Enslaved women were not only expected to reproduce but, it seems, reproduce often. As Dorothy Roberts wrote, ‘slave women’s child bearing replenished the enslaved labor force: Black women bore children who belonged to the slaveowner from the moment of their conception’. ¹⁰ Thomas Jefferson, third president of the United States of America, acknowledged that ‘a woman who brings a child every two years [is] more profitable than the best man of the farm’. ¹⁰ Obstetric fistula also had the potential to bring years of neglect as the afflicted woman could not effectively work in either the fields or the house. ¹¹ In addition, obstetric fistula could result in other fertility issues, such as reduced ability to conceive and increased likelihood of miscarriage. ¹¹ The condition marked the woman as an economic liability, impacting the plantation’s profit, and compromised an enslaved woman’s commercial value. ¹² Sims recorded a discussion with Mr Wescott, Anarcha’s enslaver, entreating him to look after Anarcha, as she was now unfit for her usual duties. ‘She will not die’, Sims told Wescott, but she ‘will never get well, and all you have to do is take good care of her so long as she lives’. ⁴

The doctor

Sims began his medical studies at Charleston Medical School in 1833, with a three-month course in conjunction with an internship with Dr Churchill Jones. From there, he moved on to Jefferson Medical College in Pennsylvania to complete his studies, graduating in 1835. ⁴ After graduation he returned home to Lancaster County, Alabama. Following several bouts of malaria, he relocated to Montgomery, the capital of Alabama, in 1840, which he considered a healthier climate. ⁴ There, he became a plantation physician, a very lucrative business with a large patient pool of enslaved people. Some plantation physicians worked on a retainer system and, in addition, charged mileage for visiting, a separate visiting fee, separate charges for treatments, and further charges for any medications issued. ¹³ Although plantation work was a significant source of patients, and therefore income, Sims did not work exclusively in this area.

Early in 1845, Mrs Merrill, a white washerwoman living in Montgomery, was thrown from her pony and suffered retroversion of the uterus. Sims was called in for medical assistance. He wrote that he placed the patient on her knees and elbows, the ‘genu-pectoral’ or knee–chest position, and through digital manipulation was able to return her uterus to its rightful place. ⁴ This experience gave him the inspiration to adopt the same position for fistula examinations. As luck would have it, another enslaved woman with obstetric fistula was already in his eight-bed hospital at the back of his house. Sims recorded her name as Betsey. ⁴ On his way home from treating Mrs Merrill, he stopped to purchase a pewter spoon to fashion into a speculum which, he hoped, would aid in making the vagina visible to the naked eye.

Earlier in his memoir Sims recorded Dr Harris visiting him to discuss Betsey’s plight, and request an examination. Betsey was enslaved to Harris, had recently given birth, and now suffered with an obstetric fistula. Sims insisted an examination was pointless as he could confirm the diagnosis from afar, and there was nothing he could do to help her. ⁴ While Harris agreed there was nothing to be done, he also insisted on having his overseer send Betsey for examination. Sims examined Betsey the following day and returned her to Harris within a couple of days.

It was Lucy, not Betsey, in the backyard hospital. This episode reveals Sims as a potentially unreliable narrator, confusing events, names and time frames. Only days earlier than his encounter with Mrs Merrill, Sims was visited by Tom Zimmerman who wanted him to examine Lucy. Lucy was an 18-year-old enslaved woman who had given birth about a month beforehand and, since then, had ‘been unable to hold any water’. ⁴ Zimmerman was a planter whom Sims had met when he was living and working in Mount Meigs, about 17 miles outside of Montgomery. ⁴ Sims had been the Zimmerman family physician. Zimmerman was an important planter in the area, regularly increasing his landholdings and more than doubling his slaveholdings between 1840 and 1850.^14,15 The conversation recorded by Sims follows a similar pattern as his earlier conversation with Harris. Zimmerman wanted him to examine Lucy. Sims refused as there was no treatment he could offer for the condition. Despite these protests, Zimmerman insisted on sending Lucy to Sims by train. When she arrived, Sims examined Lucy and told her she would be returned the following afternoon as his initial diagnosis was correct and there was nothing he could do to relieve the condition.

But now, in possession of his pewter spoon speculum, Sims wanted to examine her once again. Sims writes that Lucy ‘willingly consented’ to this examination and, in his own words, described how ‘introducing the bent handle of the spoon [he] saw everything as no man had seen before. The fistula was as plain as the nose on a man’s face’. ⁴ Sims was convinced that, having properly seen the fistula, he could now develop an operation to correct it.

A few months later he had invented, made or purchased all the equipment he thought he would need, although equipment needs would be modified several times over the course of the next four years. Sims requested Dr Harris once again to send Betsey to him, and also requested Anarcha be sent to him from the Wescott farm. Sims made arrangements with the slaveholders to care for the women at his own expense, although the owners would continue to pay the property taxes, and that he would not perform any operation which would endanger their lives. ⁴ In addition, he had located another ‘six or seven cases’ of enslaved women with obstetric fistula, and they were all living in the hospital in his yard. ⁴ Sims did not record the other women’s names in his memoir. In this way he not only rendered them voiceless, but denied them an identity at all.

Sims first operated on Lucy in December 1845. He was impressed by her resolve during the operation. ‘That was before the days of anaesthetics’, he wrote, ‘and the poor girl, on her knees, bore the operation with great heroism and bravery’. ⁴ Although begun in the pre-anaesthesia era, within 12 months ether had been successfully demonstrated as an anaesthetic. Within another seven months, news of ether anaesthesia had travelled the world. Sims did not use anaesthesia for the entire four years of experimentation.

Lucy’s operation appeared to go well but resulted in blood-poisoning due to an improvised and ineffective system devised to draw urine away from the fistula. Although it took several months, she recovered and rejoined the experiment. Sims noted structural change in the fistula. The opening had decreased significantly but he had not effected a cure. After modifying the technique, he operated on Betsey. Again, he effected an improvement of sorts, but not a cure. He then operated on Anarcha. This operation did not appear to make any advance on the previous two. For the next four years this process of operation and modification continued for Lucy, Betsey and Anarcha, as well as the ‘six or seven [other] cases’, whose names we will never know. ⁴

Originally, Sims had a lot of support from the local medical community. For Lucy’s operation he records another dozen or so doctors in attendance, to witness his work and to assist and support him. As time passed, he received less and less support. His brother-in-law, also a doctor, all but begged him to stop, citing the expense of housing additional enslaved women, as well as the injustice to his young and growing family because his attention was so diverted. ⁴ Within two years of beginning his experimentation, Sims was cast into professional isolation. He wrote that, despite the many problems he experienced, his patients were ‘…all perfectly satisfied with what I am doing for them. I can not depend on the doctors, and so I have trained them to assist me’. ⁴

In 1849, four years after he began, Sims did develop a surgical solution; one that could be reliably repeated. He also recorded that Anarcha had 29 failed operations before the successful one. Over a four-year period she endured 29 failed operations on her vagina, without anaesthesia, before success was achieved. He offers no specifics for the other women, but it seems safe to assume they each underwent a similar number of experimental operations. His description of the first three operations provides a glimpse into what was undoubtedly a rotating roster of operation and recovery. Having at least nine women, possibly more, on which to experiment would enable him to work almost continuously.

Willing consent

Sims mentions the idea of consent only once. Lucy, he wrote, ‘willingly consented’ to examination with the pewter spoon. ⁴ In 1845, when he began his experiments, there was no overarching ethical framework for human subject experimentation. The closest framework available was probably the work of William Beaumont who, in 1833, determined voluntary consent should be obtained. ¹⁶ Beaumont was working in an area of non-therapeutic human experimentation and by current standards his own ethical compass leaves much to be desired. He did, however, emphasise consent should be obtained for any human subject experimentation. ¹⁶ Perhaps Beaumont’s work inspired Sims to record the supposed willingness and consent of his human subjects. Because of the lack of governing ethics, it is left to the law to provide a better understanding of the situation regarding consent.

Lucy was an enslaved woman. She had no bodily autonomy. Under antebellum law, Lucy was considered chattel. Deidre Cooper Owens wrote that, ‘even if an enslaved woman stated that she did not want to be operated on, once her owner granted permission to the surgeon to perform surgery, an operation occurred’. ¹⁷ Not only was Lucy unable to give or withhold consent, her consent was not required. The only consent that mattered was that of her enslaver who, Sims tells us, purposefully visited him and all but forced Lucy on him, despite his own very strong objections to the idea. Todd L Savitt describes the way in which slaves were ‘…rendered physically visible by their skin color but were legally invisible because of their slave status’. ¹⁸

So, when Sims wrote ‘willingly consented’, it is difficult to know exactly what he meant. Due to her status as a slave, Lucy’s willingness and her consent are moot. In addition, Sims does not record consent being obtained from each of the women for each of the procedures. Sims’ memoir was published in 1884, the year after his death. A lot had changed in the United States since he first experimented with correcting obstetric fistulae. Not only had anaesthesia been introduced, the institution of slavery had been abolished for almost 20 years. In New York, where Sims saw out his final years, emancipation had been achieved by 1827. ¹⁹ Published almost 40 years after he began his experiments, Sims’ memoir is as likely to be a reflection of changing attitudes towards formerly enslaved people, and self-conscious image making, as it is to be an accurate portrayal of events.

Perhaps it is more accurate to say Lucy offered no physical resistance that required restraining her to conduct the examination. It is also important to ask whether, given a true opportunity to consent or withhold consent, would Anarcha or any of the other women have consented to these operations? It seems just as likely they would have withdrawn their consent at some earlier point and resigned themselves to a life of suffering.

The women’s contributions to the experiments, through assisting Sims, fall somewhere into the same argument as the issue of consent. Their position as slaves within a slaveholding society rendered them incapable of refusing to assist. In his memoir, Sims does not reveal any detail about what that assistance entailed. It is in his medical writings he reveals the requirements for assistance. Sims first published ‘On the treatment of vesico-vaginal fistula’ in the American Journal of Medical Sciences in January 1852. ²⁰ He then republished it as a ‘brief monograph’ in 1853, although a critical reading of his preface suggests it also functioned as an advertisement for his ‘infirmary for the treatment of the accidents of parturition, such as injuries of the bladder, rectum, perineum, etc.’. ²⁰ In this account, Sims describes several occasions in which assistance is required, including cleaning instruments for re-use during the procedure, and holding both the patient and the speculum in the correct position for the duration of the operation. ²⁰ The women were required to hold each other down while Sims performed his operations.

Anaesthesia

Initially, anaesthesia was not met with universal approval. There was some resistance to its use. Nevertheless, word travelled quickly and within seven months, news had even reached Australia. Within four weeks of its arrival there, doctors and dentists were experimenting with ether anaesthesia in geographically distant parts of the country. Sims was working in Alabama, and in the neighbouring state of Georgia Crawford Long is said to have been using ether as anaesthesia from as early as 1842. Anaesthesia was available to Sims if he wanted to use it.

Sims began his experiments in December 1845, nearly a full year before that historic demonstration of ether as anaesthesia at Massachusetts General Hospital in October 1846. During the first year of experimentation there was no alternative but to perform surgery without anaesthesia. Not using anaesthesia after 1846 is a point repeatedly used in criticism of Sims.^9,10,18

Leonard F Vernon argues Sims’ lack of training and experience in the use of ether would have prevented him from using it, as it may ‘have been more of a danger than the actual surgery’. ²¹ This idea recurs in defence of Sims. Yet, lack of training and experience did not stop him using forceps on Anarcha, certainly did not stand in his way when attempting surgical repair for obstetric fistulae, and it did not prevent other medical practitioners from using ether anaesthesia in their day-to-day practice either.

George Hayward was a contemporary of Sims, although he qualified in medicine some 20 years before Sims, graduating from Harvard in 1809, and gaining his medical degree in Philadelphia in 1812. ²² Hayward began his career as a surgeon at the Massachusetts General Hospital and continued to work there until 1851. ²³ Although invited to witness that monumental public demonstration of ether as anaesthesia, he was unable to attend. ²³ However, the following day he used ether anaesthesia to perform an operation to remove a fatty tumour from a woman’s arm. ²² A few weeks later he again employed ether as anaesthesia when he amputated a woman’s leg. ²² This has been hailed as the first major operation using ether as anaesthesia.

Obstetric fistula was not a condition afflicting only enslaved women, and the northern states were not immune to the problem. In 1839, informing his de-identified, 34-year-old patient that, although the operation had been successfully performed, it failed more than it succeeded, Hayward still easily secured her consent. ⁶ The operation was scheduled for 10 May 1839 and Hayward was able to close the fistula successfully on the first attempt. ⁶ He published details of this case in August of that same year.

In 1851, Hayward published further evidence of having performed some 20 operations on obstetric fistula, although on only nine patients. ²⁴ This article, in the Boston Medical and Surgical Journal, provided detailed information about each of the operations. Of particular note is ‘Case VIII’, in which he made the patient ‘insensible by ether’ on 4 March 1847. ²⁴ Hayward goes on to describe three main advantages of using ether: the operation can be performed much more easily, the time taken to complete the operation was reduced from one hour to 20 minutes, and it could be completed ‘without causing the slightest suffering to the patient’. ²⁴ At the conclusion of his article, Hayward reflects that in all the cases where he did not administer ether ‘most of that time the patient was suffering severely’. ²⁴

Once again, the idea emerges that Sims may not be a reliable narrator. In 1845, after examining Anarcha’s condition, Sims returned home ‘and investigated the literature of the subject thoroughly and fully’. ⁴ He does not record discovering any possible treatment in his investigation, although Hayward published his first account in 1839 and Mettauer published his successes in 1840. The story Sims paints is of a doctor searching for a cure which no-one has, as yet, effected. However, his monograph of 1853 mentions both Hayward and Mettauer and pays tribute to their work while promoting his own.

When, after years without success, Sims decided to stop operating until he could solve a problem with sutures, he describes the women in his hospital as becoming ‘clamorous’ for him to continue. ⁴ The impression he creates is that the women were desperate for him to continue his experiments, which cements their role as collaborators. Yet, Hayward records the way in which some women he treated simply returned home, although a cure had not been achieved, and he never heard from them again. With one patient in particular, he would have been glad of the chance to try again after an unsuccessful attempt. The patient presented in 1842, four years before anaesthesia and Hayward records ‘she evidently had no confidence in a successful result, and therefore returned home, being very much in the same condition that she was when she came’. ²⁴ Here, Hayward records a situation in which consent was conditional on a successful outcome. Given the opportunity to grant or withdraw consent for further surgery, this woman withdrew it, despite the limitations brought about by her condition.

Cooper Owens points to the idea that many antebellum-era physicians believed Black people ‘felt little or no pain as they underwent invasive surgical procedures’. ¹⁷ This belief continued well into the 20th century. An article in a 1914 edition of the Journal of the National Medical Association asserts Black patients ‘submit to pain with resignation, [their] sensibilities being less acute’. ²⁵ Yet, this same article also urges physicians to ‘look upon the colored patient surgically as upon a patient of any other race’ and understand they are in fact ‘favourable subject[s] for anesthesia’. ²⁵ Sixty-eight years after the introduction of anaesthesia, physicians were still using anaesthesia sparingly on Black people, and ideas of insensitivity to pain remained current. The persistence of the belief that Black bodies were less susceptible to pain points strongly to the idea that Sims himself believed this and saw no reason to use anaesthesia. Yet, on one occasion, Sims did recognise the women’s pain and recorded it. He wrote about Lucy, positioned on her hands and knees, and how she ‘bore the operation with heroism and bravery’. ⁴

Cooper Owens also extends that notion of pain insensitivity to other socially and economically marginalised groups, looking specifically at the way in which Irish immigrant women were treated. An 1862 edition of London’s Punch magazine cautioned readers about the Irish, describing them as a ‘creature manifestly between the Gorilla and the Negro’. ¹⁷ The general assumption being, as Cooper Owens describes, that they were ‘not quite white’, which placed them ‘alongside black people as biological models for racial inferiority’. ¹⁷

Mary Smith was one of the first women listed on the patient register at Sims’ newly opened Woman’s Hospital in 1855. ¹⁷ Her first delivery had been in Ireland where she had experienced a prolapsed uterus, a herniated and prolapsed bladder, faecal incontinence, and urine leakage had rubbed her vulva raw. Upon examination, Sims declared her a ‘most offensive and loathsome object’. ⁴ Sims, and his junior colleague Thomas Emmett, performed over 30 operations on Smith over a six-year period, without anaesthesia. ¹⁷ The Woman’s Hospital did not routinely administer anaesthesia until after the end of the Civil War in 1865. ²⁶

The way Sims wrote about treating a woman patient in France, in 1861, provides a stark contrast to Mary Smith’s treatment. Working with five other people who could assist, Sims performed two operations on a 21-year-old woman. She was, he wrote, ‘young, beautiful, rich, [and] accomplished’ and he had ‘never seen a case of this kind which was attended with such suffering’. ⁴ Clearly none of the enslaved or poverty-stricken women he treated earlier had displayed their suffering in quite the right way. This was a woman who, as Sims described, ‘belongs to the higher walks of life’. ⁴ Six months earlier she had been told her condition was incurable and had been ‘praying for death’ ever since. ⁴ Offered the chance of a cure, she allowed Sims to perform two operations. ⁴ In recounting the story of a complication with chloroform, Sims reveals the crucial difference in treatment for a ‘young, beautiful, rich, [and] accomplished’ French woman, as opposed to an ‘offensive and loathsome’ Irish one was the use of anaesthesia. ⁴ The contrast in treatment lends further weight to the idea Sims truly believed Black people, or ‘not quite white’ people as the case may be, were impervious to surgical pain.

Sims’ legacy

For almost 124 years, a statue of James Marion Sims has stood in New York. Unveiled in October 1894, it was first located in Manhattan’s Bryant Park, then relocated in 1934 to Central Park. For many years residents of East Harlem lobbied for the removal of the statue. The Institute for Urban Health Fellows Library of the New York Academy of Medicine supported the East Harlem community by providing a submission to the committee reviewing monuments and statues within the city. The academy’s president, Jo Ivy Buofford, wrote in the submission, that ‘while [Sims’] actions led to advances in gynecology and obstetrics’ the means through which he achieved them were not acceptable and should not be defended. ²⁷ Further, Buofford wrote, public honours should be reserved ‘for those who have made achievements in health and medicine without infringing on the civil and human rights of others’. ²⁷

The statue was removed in April 2018 and relocated to Green-Wood cemetery in Brooklyn, where Sims is buried. Many Green-Wood residents resented the presence of the statue, voicing concerns that relocating the statue simply relocated the problem. ²⁸ Some residents began a petition, in which they stated there ‘was no space for honouring white supremacy in our neighborhood’. ²⁹ Some East Harlem community members called for the statue to be buried with Sims. ²⁸

In November 2018 three surgeons, from Australia, Austria and Tanzania, co-authored an article in the International Urogynecology Journal, expressing deep concern about the statue’s removal. They thought this was part of a campaign to rebrand Sims as a ‘symbol of hate’, and see his character ‘assassinated, buried and airbrushed from its rightful place in medical history’. ²⁹ This position was in stark contrast to a decision taken earlier that same year by the American Urogynecological Society to abandon their eponymous annual lecture, recognising that ‘the dynamics of power cannot be separated from his story’. ³⁰ The timing of this decision leaves an aggressive defence of Sims’ character and actions as the final J Marion Sims Lecture.^26,30 It also lays the charge of presentism on any who criticises Sims and questions the ethical compass which guided his work. ²⁶

Statues, monuments and eponyms are enduring reminders of who and what a society renders important at a particular point in time. In this way, they are a natural locus for contested values and understandings. Historian, Peter McPhee, asserts ‘societies have always used statues… as one of the ways of recognising power and eminence’. ³¹ The removal or relocation of a statue does not erase the history behind it but nor does it resolve the underlying tensions. The statue of Sims recognised his eminence within the history of medicine but failed, and still fails, to recognise the exploitation through which he achieved such eminence. It is possible for one man to be both a medical pioneer and a cruel exploiter of relations of power. Both things can be equally and simultaneously true.

The circumstances in which a reliably repeatable fistula repair was achieved were the direct result of the commodification of women’s bodies through chattel slavery. Under any other circumstances, it is unlikely Sims would have had such ‘willing’ subjects for his years of experiments. However, as Wall argues, Sims should not be held to current standards of practice. Instead, examining his work against his contemporary, George Hayward, reveals a remarkable contrast. Hayward’s work was equally as experimental as Sims’, and also began in the pre-anaesthesia era. Hayward not only regularly documents aspects of the women’s experiences of pain but, at the first available opportunity, employs anaesthesia to minimise pain. He also respects the women’s freedom to refuse experimental treatment. For these women, their willingness and consent are most evident when they performed the act of withdrawing it. There is no such certainty that had Anarcha, Betsey, Lucy, or any of the other women whose names were not recorded, wished to stop being part of the experiments, their wish would have been granted.

Sims’ story reveals a violent collision of gender, race and class systems which elevates Sims and banishes the women into relative obscurity. Within his own time, there were those who saw it and carefully distanced themselves from him, although often couching their disapproval and concern more in economic than humanitarian terms. James Marion Sims did an incredible thing by developing a reliably repeatable surgical solution for obstetric fistula, and deserves a place in the history of medicine. It is important to remember Sims and his contribution to women’s health. It is also important that his contribution is remembered in light of the way he exploited Black women’s bodies to achieve his successes and refused them relief in the form of anaesthesia. Anaesthesia was available for over half the period of experimentation and was no more experimental than the operations he was performing. The enslaved bodies of Anarcha, Betsey, Lucy, and at least another half dozen women whose names were not recorded, made Sims’ success possible. In the act of remembering Sims, these women must also be remembered and honoured.