The controversial Dr. J. Marion Sims (1813–1883)

Abstract

J. Marion Sims (1813–1883) is often regarded as the founder of modern surgical gynecology. Widely known and respected during his lifetime, he was honored after death with a statue erected in New York City’s Bryant Park. It was later relocated to Central Park, where it remained until 2018, when it was removed after persistent public protests over its presence. The controversy arose over perceptions of Sims’s most famous achievement: the development of the first reliable surgical cure for vesico-vaginal fistula, a catastrophic complication of prolonged obstructed labor, which was common in the nineteenth century. Sims developed his surgical technique by operating on a group of enslaved African–American women with fistulas between 1846 and 1849. Modern attacks on Sims are based more on a presentist revulsion over the institution of slavery than on a clear understanding of what Sims actually did within the context of his time and place. Modern critics attack his “experimental” surgeries, the patients’ lack of “informed consent,” and Sims’s failure to use anesthesia during fistula surgery. None of these criticisms takes into consideration the appalling nature of the injuries these women had received, the suffering their condition caused them, the lack of any effective “standard-of-care” treatment for fistulas at that time, the social and legal constraints facing doctors who treated slaves, or the uncertain and problematic early history of anesthesiology. Although “retrospective indignation” may be emotionally satisfying, it does not illuminate the past nor help us understand difficult decision-making in surgery, whatever the time or place.