#SayHerName: Should Obstetrics and Gynecology Reckon with the Legacy of JM Sims?

Dr. James Marion Sims has been heralded as the "father of modern gynecology" for his groundbreaking surgical technique to repair post-partum vesicovaginal fistulas (VVF); however, the ethical concerns around his inhumane practices and the contributions of the enslaved women he refined his technique on are rarely recognized. Acknowledging the personal sacrifice of the enslaved women and addressing the truth behind the immoral practices of Sims, encourages reconciliation of the race-based medical atrocities of the past and sets the tone for moral, more equitable medical care moving forward.

Henry van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).

INTRODUCTION AND HYPOTHESIS: Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition. METHODS: Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam. RESULTS: Van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed. CONCLUSIONS: Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.

J. Marion Sims, MD: Why He and His Accomplishments Need to Continue to be Recognized a Commentary and Historical Review.

This review provides a fresh perspective on the work of J. Marion Sims, an Antebellum era physician who invented the vaginally speculum that bears his name. His accent to become the "Father of Modern Gynecology" was his groundbreaking development of the surgical techniques for the repair for vesicovaginal fistula. Recent scholarship, however, has pointed to the dark side of Sims in that his techniques were perfected through his use of Black slave women as his research subjects. In addition, he has been criticized for his failure to use anesthesia during his research operations. This article argues that Sims's work needs to be understood in a broader historical context and within the broader framework of other forms of human experimentation that took place in the nineteenth and twentieth centuries. There is a strong argument that recent attempts to remove Sims from history also have the unintended consequence of removing the contributions of not only the Black slave women who were his subjects in the development of modern obstetrical medicine, but the important role Blacks played in the development of other medical procedures.

J. Marion Sims and the Vesicovaginal Fistula: Historical Understanding, Medical Ethics, and Modern Political Sensibilities.

OBJECTIVES: To review the historical background surrounding the early work of Dr. J. Marion Sims, who developed the first consistently successful surgical technique for the repair of obstetric vesicovaginal fistulas by operating on a group of young, enslaved, African American women who had this condition between 1846 and 1849. METHODS: Review of primary source documents on Sims and his operations, early 19th century clinical literature on the treatment of vesicovaginal fistula, the introduction of ether and chloroform anesthesia into surgical practice, and the literature on the early 19th century medical ethics pertaining to surgical innovation. The goals are to understand Sims's operations within the clinical context of the 1840s and to avoid the problems of "presentism," in which beliefs, attitudes, and practices of the 21st century are anachronistically projected backward into the early 19th century. The object is to judge Sims within the context of his time, not to hold him accountable to standards of practice which were not developed until a century after his death. RESULTS: A narrative of what Sims did is presented within the context of the therapeutic options available to those with fistula in the early 19th century. CONCLUSIONS: Review of the available material demonstrates that Sims' first fistula operations were legal, that they were carried out with express therapeutic intent for the purpose of repairing these women's injuries, that they conformed to the ethical requirements of his time, and that they were performed with the patients' knowledge, cooperation, assent, and assistance.

The portrayal of J. Marion Sims' controversial surgical legacy.

PURPOSE: In the mid 1800s Dr. J. Marion Sims reported the successful repair of vesicovaginal fistulas with a technique he developed by performing multiple operations on female slaves. A venerated physician in his time, the legacy of Dr. Sims is controversial and represents a significant chapter in the mistreatment of African-Americans by the medical establishment. This review compares the modern debate surrounding his legacy with the presentation of his operation in widely consulted urological texts and journals. MATERIALS AND METHODS: A literature review was performed of medical, sociological and periodical sources (1851 to the present) regarding J. Marion Sims and vesicovaginal fistula repair. RESULTS: During the last several decades, while the controversy around Dr. Sims' surgical development has produced a steady stream of articles in the historical and popular literature, relatively little mention is found in standard urology textbooks or journals. With increased public attention, some have debated the removal or modification of public tributes to Dr. Sims. This move has been countered by arguments against the validity of judging a 19th century physician by modern standards. CONCLUSIONS: While historians, ethicists and the popular press have debated Dr. Sims' legacy, medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.

Did J. Marion Sims deliberately addict his first fistula patients to opium?

American surgeon J. Marion Sims (1813-83) is regarded by many modern authors as a controversial figure because he carried out a series of experimental surgeries on enslaved African American women between 1846 and 1849 in an attempt to cure them of vesicovaginal fistulas, which they had all developed as a result of prolonged obstructed labor. He operated on one woman, Anarcha Westcott, thirty times before he successfully closed her fistula. Sims performed these fistula repair operations without benefit of anesthesia but gave these women substantial doses of opium afterwards. Several modern writers have alleged that Sims did this in order to addict them to the drug and thereby to enhance his control over them. This article examines the controversy surrounding Sims' use of postoperative opium in these enslaved surgical patients. The evidence suggests that although these women were probably tolerant to the doses of opium that he used, there is no evidence that he deliberately tried to addict them to this drug. Sims' use of postoperative opium appears to have been well supported by the therapeutic practices of his day, and the regimen that he used was enthusiastically supported by many contemporary surgeons.

The medical ethics of Dr J Marion Sims: a fresh look at the historical record.

Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims's medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a "vulnerable population" in the 19th century American South, the evidence suggests that Sims's original patients were willing participants in his surgical attempts to cure their affliction-a condition for which no other viable therapy existed at that time.

[The "prince of surgery," Antoine Jobert de Lamballe (1799-1867) and the first radical cure of vesico-vaginal fistulae with his method of cystoplasty]. / Le "prince de la chirurgie", Antoine Jobert de Lamballe (1799-1867) et la première cure radicale des fistules vésico-vaginales par sa méthode de cystoplastie par glissement.

Jobert de Lamballe, consultant-physician of Louis-Philippe, first surgeon of Napoleon III, Professor of Clinic Surgery, President of the Academy of medicine and member of the Institute, was a very inventive research worker and provided to the surgical technique of his time an essential contribution to the area of intestinal, urologic, gynecologic and plastic surgery. He died, in 1867, by general paresis.

Thomas Addis Emmet, the vesicovaginal fistula, and the origins of reconstructive gynecologic surgery.

Thomas Addis Emmet (1828-1919), the foremost pupil of J. Marion Sims and his successor as chief surgeon at The Woman's Hospital in New York City, was probably the pre-eminent American gynecological surgeon of the last quarter of the 19th century. Among his many achievements were the first critical study of vescovaginal fistula repair, authorship of the first modern scientific textbook of gynecology, the invention of numerous special surgical instruments, pioneering the use of surgical scissors in vaginal operations, and the development of "staged" procedures for surgical reconstruction of the vagina. He was an active writer, a renowned collector of American historical documents and memorabilia, a devout Catholic and a steadfast Irish patriot. This article reviews his life and contributions to gynecologic surgery.