Is South Carolina Making Another
by honoring J. Marion Sims?
BY WENDY BRINKER
Among the clutter of monuments on the State House grounds is one honoring J. Marion Sims, "the Father of Gynecology." The monument itself is impressive. Center stage, in front of a large cement archway, is a bust of Sims, looking down with crooked brow and patronly grin. Etched in a panel to the left, an inscription reads: "The first surgeon of the ages in ministry to women, treating alike empress and slave." On the panel to the right, the inscription continues, "He founded the science of gynecology, was honored in all lands and died with the benediction of mankind."
What an epitaph. What had this guy done to deserve such accolades?
To acquaint myself with Dr. Sims, I searched the Internet and borrowed books through interlibrary loan. At first glance, it seemed South Carolina’s opinion of the doctor from Lancaster was diametrically opposed to that of other, outside sources. (Nothing new for southern historians.) Among the information I discovered was an academic paper titled, "Human Experimentation: Before the Nazi Era and After."
By South Carolina’s account, Sims innovated techniques and developed instruments that changed the landscape of women’s reproductive health. By outside accounts, he had a reputation for being a monster who performed experimental operations on captive women, leaving a swath of misery and death in his wake.
Between 1845 and 1849, in a makeshift hospital he built in his back yard, Sims performed a series of gynecological operations on countless enslaved African women. One woman endured 34 experimental operations to treat a prolapsed uterus. This was all done without anesthesia or antiseptic. After suffering unimaginable pain, many of these women lost their lives to infection. It is their story that history has failed to tell, and their legacy that should be honored.
In his autobiography, The Story of My Life, Sims writes that he felt himself quite unexceptional. Born in 1813 and schooled at Columbia College, predecessor of the University of South Carolina, Sims received his bachelor’s degree in 1832. His father, John Sims, was a dominant figure in his life. To his son’s announcement that he had chosen medicine as his profession, he said, "To think that my son should be going around from house to house through this country, with a box of pills in one hand and a squirt in the other, to ameliorate human suffering, is a thought I never supposed I should have to contemplate."
His father sent Sims to apprentice under Dr. Churchill Jones. Once respected in the community, Jones suffered from alcoholism. Although the young Sims said Jones was unfit, Sims would watch the failing doctor perform many surgeries and deliver many lectures.
Inspired to become a surgeon, Sims left for Charleston Medical College in November of 1833. He admits, "I was afraid to be a man; I was afraid to assume its responsibilities and thought that I did not have sense enough to go out into the rough world, making a living as other men had to do."
He was unprepared for the rigors of Charleston Medical College. While there, he forged a friendship with a fellow classmate, and they agreed to attend Jefferson Medical College in Philadelphia their next term.
It was there Sims met Prof. George McClellan, whom he describes as, "very eccentric and erratic as a teacher."
In May 1835, equipped with a few surgical instruments and an eight-volume medical text, Sims returned to Lancaster ready to practice medicine. He had no clinical experience, had logged no actual hospital time and had no experience diagnosing illnesses.
After weeks of sitting alone in a Main Street office his father had rented, Sims got his first patient, the young son of a prominent citizen of Lancaster.
Sims wrote, "When I arrived, I found a child about 18 months old, very much emaciated, who had what we would call the summer complaint, or chronic diarrhea. I examined the child minutely from head to foot.… as I saw some swelling of the gums I at once took out my lancet and cut the gums down to the teeth. This was good so far as it went. But, when it came time to making up a prescription, I had no more idea of what ailed the child, or what to do for it, than if I had never studied medicine."
Sims returned to his office and studied his medical text for any clue as to how to proceed. The reference books Sims relied on were by a professor at Jefferson, John Eberle, who was known for his unorthodox approach to medicine. Sims administered a haphazard regimen of prescriptions to the child, going from chapter to chapter in one of Eberle’s books, but to no avail. After a few days, the infant died.
Sims’ second case came two weeks later. It was another infant with the same symptoms. Sims retracted the gums and administered another series of treatments, this time starting at the last chapter and working backwards in the book. He accomplished the same result.
Sims lamented, "I had the misfortune to lose my first two patients, and the thought of it was too terrible to be borne. I had never heard of such terrible luck, and never thought that such misfortune could ever happen to any young man in the world."
Immediately after the death of the two infants, Sims and his father moved to Alabama. While it is unclear why the young doctor left Lancaster, his reputation there had no doubt suffered.
In Mt. Meigs, Sims apprenticed under two doctors. Dr. Charles Lucas was a politician who had made his fortune from cotton. Sims was impressed by the fact that Lucas owned 200 to 300 slaves and could exert his influence over the community. Childers was an old-fashioned country doctor who allowed Sims to accompany him on his house calls. After witnessing Childers "bleed" a patient to death, one of his favorite cure-alls, Sims said, "I knew nothing about medicine, but I had sense enough to see that doctors were killing their patients; that medicine was not an exact science; that it was wholly empirical, and that it would be better to trust entirely to Nature than to the hazardous skills of the doctors."
A month after his arrival, Sims bought Childers’ practice for a $200 promissory note. His first patient came to him when Lucas was away on legislative business. Sims was summoned 40 miles away to the home of a cotton farmer, whose sister had taken ill with fever after delivering a child. The attending doctor was present but obviously drunk. Sims refused to take over the care of the woman because, once again, he had no idea what treatment to administer. He returned to Mt. Meigs, and the woman died a day later.
In a few weeks, with Lucas still away, another request for a doctor came on behalf of an ailing slave overseer. Sims reluctantly mounted up and rode off to examine the man. Finding a lump in the patient’s abdomen, Sims was granted permission to operate. He described the procedure, "We went in to the room — it was before the days of anesthetics — and, pulling out a (scalpel), I plunged it into his belly. I think it was one of the most happiest moments of my life when I saw the matter flow and come welling up opposite the bistoury."
After days of continued discharging, the man eventually made a full recovery. Such was the nature of Sims’ first surgical experience as he began to "practice" medicine.
Acting primarily as a plantation physician, Sims became known for operations on club feet, cleft palates and crossed eyes. He began to treat enslaved babies suffering from a condition known today as neonatal tetanus.
Tetanus originates in horse manure, and it is likely that the proximity of horse stables to slave quarters caused the high rate of tetanus. But in an article published by Sims on the subject, he comes to quite another conclusion. "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." Because he attributed the cause of the disease to the moral weakness of the enslaved Africans, he never suggested the need to improve their living conditions.
Clearly designating patients by class and race, Sims began to exercise his freedom to experiment on his captives. He took custody of slave infants and, with a shoemaker’s awl, tried to pry the bones of their skulls into proper alignment. According to his published articles, the procedure was only practiced on enslaved babies. Sims routinely blamed "slave mothers and nurses for infant suffering, especially through their ignorance."
In the mid-19th century, doctors’ beliefs about childbirth were changing. For hundreds of years, physicians did not attend births. Instead, midwives served this function, using knowledge handed down orally across generations. On the frontier there were very few physicians, and women relied on midwives to assist them.
In the mid-19th century, medicine began to challenge female-governed childbirth. With tensions mounting over who was to supervise deliveries, early obstetricians excluded midwives from their research. The old persecution of midwives, common during witch hunts, was playing out again, this time on the southern plantation.
There were undoubtedly many enslaved African midwifes in the South. Their distinct tradition of spiritual rituals, their use of herbs and knowledge of the process earned them an honored place in their communities. Just as the Southern physicians were at the core of their social web, midwives enjoyed the same social status in the slave community. This could have fueled the white master’s drive to remove them from positions of prominence.
On a spring day in 1845, Sims was summoned to the Westcott plantation about a mile out of Montgomery. A young, enslaved African named Anarcha, had been in labor for three days. Sims tried to aid the birth by applying forceps to the impacted head. He recalled having little experience using the instrument.
The baby was born (no record if it lived or died) but the mother sustained several vaginal tears, resulting in incontinence.
Several days after Anarcha delivered, she was sent to Sims in hopes he could help her. He found her condition repugnant but, obliged to her master to restore her value as property, he reluctantly began to attempt to repair Anarcha’s badly damaged body.
The culture and economy of slavery imposed the role of "breeder" on enslaved women, whose ability to reproduce was equated with their worth as property. They did not receive enhanced diets or lower work loads during pregnancy, and often endured great hardships during childbirth.
Reasons for prolonged labor among African women were probably closely related with their diet. Calcium deficiencies during childhood often resulted in rickets. This condition wasn’t fatal, but caused skeletal deformities, among them a contracted pelvis that would have resulted in a prolonged delivery and, not surprisingly, vaginal tears.
Sims showed an uncommon willingness to break cultural barriers in his treatment of female disorders. Most physicians in the Victorian period did not visually examine women internally. Instead, they generally relied on the use of touch.
Early in his career, Sims treated a female patient who had been thrown off a pony. He fashioned a crude tool from a pewter spoon to expand the walls of her vagina. This spoon was the first prototype for the speculum.
The patient’s relief was immediate, since the change in air pressure successfully relocated her uterus to its proper position. Sims described the moment as if he’d had a spiritual epiphany. "I cannot, nor is it needful for me to describe, my emotions when the air rushed in and dilated the vagina to its greatest capacity whereby its whole surface was seen at one view, for the first time by any mortal man." His success with this single procedure convinced Sims he could find a surgical remedy for vaginal tears. Finally, he could make a name for himself.
Eager to devote the rest of his life to perfecting the procedure, he built a crude hospital in his back yard that had 16 beds. He also fashioned over 71 surgical instruments.
Plantation owners were happy to turn over their slaves to Sims for experimentation. Between 1846 and 1849, Sims experimented surgically on as many as 11 patients at a time.
Anarcha is believed to have undergone more than 30 operations. Together with two other enslaved women, Betsy and Lucy, they endured repeated experiments at Sims’s hands all the years the backyard hospital was operating.
Sims subscribed to a commonly held belief that Africans had a special tolerance for pain. He never anesthetized his black patients. The white women who came to him later, after the surgery was an accepted form of treatment, were unable to withstand the same operation without anesthesia, Sims noted.
In the first months of his backyard surgeries, Sims would invite his colleagues to witness the operations. As the number of operations grew and the failures mounted, Sims soon found himself operating alone, relying on the assistance of the patients themselves.
After years of repeated surgical failures, his brother-in-law, Dr. Rush Jones, begged Sims to stop his experiments. "We have watched you, and sympathized with you; but your friends here have seen that of late you are doing too much work, and that you are breaking down. And, besides, I must tell you frankly that with your young and growing family, it is unjust to them to continue in this way, and carry on this series of experiments."
Sims replied, "I am going on to the end. It matters not what it costs, if it costs me my life." To those close to Sims, it appeared his preoccupation was becoming an obsession.
Sims had been suturing vaginal tears with materials common to that era, mostly silk and catgut, which absorbed bodily fluid. This caused inflammation and promoted infection.
Sims had his jeweler fashion some fine silver wire for suturing wounds and used it on one of Anarcha’s tears at the base of her bladder. Days later, when Sims found no infection, he declared that silver sutures were the key to mending torn vaginal tissue. He quickly used the sutures on all of his captives, and claimed to heal them all, but there is no outside evidence to support his claim.
Sims said, "I had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity." Sims never recorded whether he was able to heal Anarcha and, to this day, physicians debate the type of suture to use in the operation, although the condition is rarely seen anymore. Sims’ "success" remains ambiguous by all medical accounts.
In the fall of 1849, Sims was stricken with an intestinal illness and spent several years moving from place to place in search of relief. In 1853, he moved to New York.
While Sims, a slave owner, maintained a strong belief in the morality of slavery and held a strong allegiance to the South, he moderated his tone for the different political climate he found on Madison Avenue. In his later years, Sims evaded the issue of race, and never admitted publicly that he had experimented on human beings.
In woodcuts that accompanied his lectures, he portrayed his earlier patients as white women. Of his surgeries on them, he said, "I thought only of relieving the loveliest of all God’s creations."
Sims went on to convince a group of philanthropic women of the old New York’s elite class that his motives were sincere and his methods proven. He garnered enough enthusiasm and financial support to set up a woman’s charity hospital in 1855.
Sims was once again in business, this time performing surgery on poor Irish immigrant women. He traveled extensively to Europe and enjoyed the reputation of a famous American doctor. While abroad in 1863, he was asked to examine Empress Eugenie of France. This is how the inscription on the State House monument came to read, "treating alike empress and slave."
Sims faithfully sent money to support the Confederacy, but never returned to the South. He died in New York in 1883.
The high price of Sims’ "success" in the United States was paid by the women he experimented on. Had they not been his property, leaving him free to cut them open and sew them back up as he saw fit, he could have never devised the surgical technique that brought him international recognition.
Sims never expressed any interest in the women beyond their usefulness as research. And never did he express moral uncertainty about keeping women captive for use in surgical experimentation.
While 19th century medical practices were undeniably crude and often painful, Sims’ contemporaries thought him unnecessarily cruel. While other physicians of that era experimented on enslaved people, Sims was among the worst.
Since it was illegal for slaves to read or write, Anarcha, Betsy and Lucy left no account of their ordeal. We can only imagine what they endured at the hands of Sims and what horror slave women must have felt at the news that they were being sent to him for treatment. Surely rumors must have run rampant in enslaved communities about what he did to women.
All across South Carolina, Sims has been honored and memorialized, with buildings, hospitals, schools and streets bearing his name. While it is impossible to negate the historical context of his obvious racial, class and gender biases, shouldn’t we agree to apply some standard of decency for those we choose to honor?
Wendy Brinker is an activist and artist. She co-hosts talk radio’s The Seed Show with attorney Tom Turnipseed. She wishes to thank Tom Pickett for his research assistance.