James Marion Sims (January 25, 1813November 13, 1883) was an American physician 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." 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. 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. 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". He was in Mount Meigs from 1835 to 1837.

In 1837 Sims and his wife moved to Cubahatchee, Alabama, where they remained until 1840.

Practice in Montgomery

In 1840 the couple moved to Montgomery, Alabama, 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."

thumb|Sims' Surgical Infirmary for Negroes

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. 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 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". and a common, socially destructive, and a terrible complication of childbirth that affected many women. Vesicovaginal fistulas occur when the woman's bladder, cervix, and vagina become trapped between the fetal skull and the woman's pelvis, cutting off blood flow and leading to tissue death. The necrotic tissue later sloughs off, leaving a hole. Following this injury, as urine forms, it leaks from the vagina, leading to a form of incontinence. Because a continuous stream of urine leaks from the vagina, it is difficult to keep the area clean. Such personal hygiene issues often lead to marginalization from society as well as vaginal irritation, scarring, and loss of vaginal function. Sims also worked to repair rectovaginal fistulas, a similar condition in which flatulence and feces escape from the rectum through a tear in the tissue separating it from the vagina, thus leading to fecal incontinence.

thumb|right|Sims' vaginal speculum. Sims, however, was not the first to successfully treat a vesicovaginal fistula, not even in the United States; Dr. John Peter Mettauer had successfully surgically repaired one in Virginia in 1838; and Dr. George Hayward in Boston the following year. Moreover, Henry van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) had outlined essential repair steps for such conditions that are recognizable even today.

Between 1845 and 1849, Sims performed experimental surgery on enslaved black women and girls to treat vaginal problems. He added a second story to his four-bed hospital, doubling its capacity. Sims' vaginal speculum, described above, 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 for him.

Experimental subjects

Occasionally, Sims conducted experimental surgery on white women, but his main subjects were twelve enslaved black women and girls with fistulas, whom he treated at his own expense in his backyard hospital. They were brought to him by their owners. Sims searched for patients with this fistula, and succeeded in finding six or seven women and girls. A prospectus from the 1830s of the South Carolina Medical College, then the South's leading medical school, pointed out to prospective students that it had an advantage of a peculiar character:

The college announced, in advertisements in the Charleston papers, that it had set up a surgery (operating room) for negroes, and offered to treat without charge, while it was in session, any "interesting cases" sent by their owners, "for the benefit and instruction of their pupils". They extended the offer to free "persons of color". Sims conducted experimental surgery on each of them several times, including operating on Anarcha thirty times before the repair of her fistulas was declared a success. Anarcha, Lucy, and Betsy are memorialized in the statue Mothers of Gynecology, unveiled in Montgomery, Alabama, on September 24, 2021.

Sims' former collaborator, Nathan Bozeman, later supplied the names of at least four other African-American women treated by Sims during this period:

  • Ann McRee, 16, treated by Sims for fistula in 1849.
  • Delia, 23, "Dr. Sims' own servant [slave]", who between 1850 and 1853 underwent ten or more operations for fistula repair.

In addition, a common racist belief from the time, that often persists to this day, is that black people do not feel as much pain as white people. Given this, Sims did not anesthetize the women he operated on while developing his fistula repair technique. Anesthesia was itself still experimental; early anesthetic agents were much more dangerous than the replacements developed in the twentieth century. Dosing was also imprecise: underdosing did not kill the pain; overdosing could and sometimes did kill the patient. Chloroform could be obtained from a druggist, but nitrous oxide and the highly flammable ether had to be manufactured by the surgeon on the spot. In Sims' day, surgeons were trained to operate quickly on unanesthetized patients. Anesthesia was first used in dentistry, and was just being announced as an exciting novelty in privately published pamphlets, some claiming credit for the anesthetic's first use, at the same time as Sims' fistula repair surgeries.

Sims published a paper In 1868 on his work on using nitrous oxide as an anesthetic, and in 1874 on using chloroform. In 1874 Sims addressed the New York State Medical Society on "The Discovery of Anaesthesia," in which he claimed that Americans had discovered the practice before the British, and in 1880 he delivered a paper (published soon afterwards) at the New York Academy of Medicine about a death from anesthesia.

Sims also committed other errors due to the incomplete knowledge about sanitation and infection in surgical theaters at the time. One patient, named Lucy, nearly died from sepsis after Sims operated on her in the presence of twelve doctors, experimentally using a sponge during the procedure to wipe urine from her bladder.

Sims eventually perfected his technique. One of his key developments was the introduction in 1849 of silver wire as a suture, thus avoiding the infections associated with silk sutures, or the potential poisoning from using lead sutures (as Mettauer had done in 1838). He proceeded to repair fistulas in several other enslaved black women.

According to Durrenda Ojanuga, after Sims' successful treatment of Anarcha, he was asked by many white women to repair vesicovaginal fistulas, but most of them were apparently unable to endure the pain of the operation. The Journal of Medical Ethics reports a case study of one white woman whose fistula was repaired by Sims without the use of anesthesia during a series of three operations in 1849.

Trismus nascentium is a form of generalised tetanus. Infants who have not acquired passive immunity from the mother having been immunised are at risk for this disease. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. In the twenty-first century, neonatal tetanus mostly occurs in developing countries, particularly those with the least-developed healthcare infrastructure. It is rare in developed countries.

Trismus nascentium is now recognized to be the result of unsanitary practices and nutritional deficiencies, but in the nineteenth century its cause was unknown, and many enslaved African children contracted this disease. Medical historians believe that the conditions of the quarters of enslaved people were the cause. Sims alluded to the idea that sanitation and living conditions played a role in its contraction, writing that