J. Marion Sims, the Father of Gynecology: Hero or villain?(Review Article)

Abstract: J. Marion Sims (1813-1884) has been called the "Father of Gynecology" for his revolutionary approach to treating the diseases of women. He rose from humble origins to become a successful surgeon, teacher, and writer. His innovations included the first successful treatment for vesicovaginal fistula, the first gallbladder surgery, and the introduction of antiseptic principles in all areas of surgical treatment. The "Sims position" and "Sims speculum" are eponymic tributes to his accomplishments. In recent years Sims has, however, become a focus of controversy because of his experimental surgeries on slave women. His powerful personality and messianic attitude led him to minimize moral problems, and to bristle against opposition. Ethical principles of autonomy and beneficence are important criteria for evaluating Sims' research. An exploration of the nature of Sims' work and the atmosphere in which he practiced will illuminate the critical ethical questions surrounding Sims' use of slave women as experimental subjects.

Key Words: antisepsis, civil rights, gynecology, history of medicine, medical ethics, women's rights

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J. Marion Sims (1813-1884) has been called "The Father of Gynecology," and was the first physician to have a statue erected in his honor in the United States. During his lifetime he treated European royalty and was rivaled only by William Osler in his reputation abroad. He is credited with originating the first successful treatment for vesicovaginal fistula, a common and odious condition in the mid-1800s. He made great strides in introducing antisepsis into the surgical modus operandi. Every day physicians refer to the "Sims position" and use the "Sims speculum," eponymic tributes to his accomplishments.

In recent years, however, Sims has become increasingly famous as a focus of controversy. From 1845 to 1849 he carried out a series of experimental surgeries on slave women that would bring him fame and fortune, as well as controversy. Indeed, controversy dogged him throughout life, even as his reputation grew, fueled by his forceful personality and self-righteousness. It is certainly ironic that an icon of medicine like Sims could be mentioned in the same context as Nazi medical experimenters and the authors of the notorious Tuskegee study on syphilis. (1) An exploration of this apparent paradox reveals as much about the state of medicine during Sims' lifetime as about the man himself.

Struggle, Accomplishment, and Controversy

J. Marion Sims was born in 1813 in Lancaster County, SC, to a father of modest means and a mother from a somewhat more respectable family. Education was for him, like so many other Americans of his background, a ticket out of a hardscrabble and uncertain life. His early college career was undistinguished: "I never was remarkable for anything while I was in college, except good behavior," Sims later wrote. (2(p115)) At age 20 he had to choose a professional course of study, and he chose medicine by default. "I would not be a lawyer; I could not be a minister; and there was nothing left for me to do but to be a doctor." (2(pp114-5) Sims found medicine very stimulating, and worked hard in medical school. Upon graduation in 1835, however, he went back to Lancaster County to establish a practice with more than a little trepidation because of his lack of practical knowledge and experience.

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This anxiety was soon borne out by events, as he lost his first two patients, infant children afflicted by persistent diarrhea. Deciding his luck might be better out West, he moved to Alabama in October 1835 and hung out his shingle. He mostly floundered that first year, finding himself compelled to treat grave conditions with the inadequate medical armamentarium of the times. The possibilities of aggressive empiricism were, however, suggested by an early experience in which a patient developed …