"Sims acquired a total of eleven women slaves with vesicovaginal fistula from their masters by promising to lodge, board, and treat them, and he built a spartan wooden building, where he conducted surgical experiments on them for the next four years.

"Sims acquired a total of eleven women slaves with vesicovaginal fistula from their masters by promising to lodge, board, and treat them, and he built a spartan wooden building, where he conducted surgical experiments on them for the next four years. 

During the Victorian period, layers of dress signaled sexual chastity, and doctors were not in the habit of viewing women's unclothed bodies; not even their professional stature gave them license to gaze at women's genitalia. When Sims undertook his fistula experiments, even the term 'gynecology' was a few years in the future. Instead, 'women's doctors' averted their eyes in a chivalrous fashion as they knelt to tend to the modestly clothed ladies of their class, relying upon their sense of touch beneath voluminous Victorian skirts. 

However, Sims, working with enslaved blacks, was constrained by no such delicacy. He made the women undress completely, then kneel on hands and knees while he and several physicians took turns inserting a special speculum he had devised to open the women's vaginas fully to view. 'I saw everything as no man had seen before,' marveled Sims. Montgomery physicians flocked to Sims's shack to see what no man had seen before. So did prominent citizens and local apprentices.

The surgeries themselves were terribly painful. Not only had Sims to close the unnatural openings in the ravaged vaginal tissues; he had to make the edges of these openings knit together. He opted to abrade, or 'scarify,' the edges of the vaginal tears every time he attempted to repair an opening. He then closed them with sutures and saw them become infected and reopen, painfully, every time. 

Several male doctors had initially assisted Sims by holding down the enslaved women as he made incisions, but within a year they could bear neither the bone-chilling shrieks of the women nor the lack of progress any longer. The doctors left, leaving the women to take turns restraining one another. Later, Sims recruited Dr. Nathan Bozeman as a protégé and assistant. …

Medical journals and professional word of mouth had detailed the inhalation of ether as anesthesia since the early 1840s, and Sims knew of this, but he flatly refused to administer anesthesia to the slave women and girls. He claimed that his procedures were 'not painful enough to justify the trouble and risk attending the administration,' but this claim rings hollow when one learns that Sims always administered anesthesia when he performed the perfected surgery to repair the vaginas of white women in Montgomery a few years later. 

Sims also cited the popular belief that blacks did not feel pain in the same way as whites. However, Sims's own words belie him. In his memoirs, he noted that 'Lucy's agony was extreme . . . she was much prostrated and I thought she was going to die.' Sims further obscured the truth in 1852, when he described the first surgery on Lucy, writing, 'That was before the days of anesthetics, and the poor girl, on her knees, bore the operation with great heroism and bravery.'

Sims's refusal to administer ether seems even less defensible in light of his willingness to administer it very freely to another group of women, without apparent regard for its 'trouble and risk.' In New York during the 1860s, Sims attended white women patients who suffered from vaginismus, a disorder marked by painful vaginal muscle contractions that prevent the entrance of the penis, making intercourse impossible. Complaining husbands approached Sims, who regularly etherized their wives, rendering them unconscious so that their husbands could have sex with them.

Sims's writings often utilized imprisonment as a metaphor for the control that he saw as key to restoring a woman's health. His enslaved experimental subjects were the ultimate in controllable patients, and he eventually chose to control his slaves' pain in a peculiar manner: He addicted the slave women to morphine, but he gave it to them—'some form of opium in as large doses as can be borne, at least twice in 24 hours'—only after surgery, administering it for several weeks each time. Sims explained that opium 'calms the nerves, inspires hope, relieves the scalding of the urine,' and permitted 'the patient doomed to a fortnight's horizontal position [to] pass the time with pleasant dreams, and delightful sensations instead of painful forebodings and intolerable sufferings.' The morphine did ease recovery, but it did not allay the pain of the procedure itself, so this practice perplexed some of Sims's contemporaries. The most logical explanation is that this practice had more to do with controlling the women's behavior than controlling their pain, because the addiction weakened their will to resist repeated procedures.

As mentioned earlier, the medical association between assiduous cleanliness and infection had not yet been drawn, and although Sims was a man of scrupulously clean surgical habits, the constant exposure of the organic sutures to pathogens caused the women repeated infections. Sims, however, had a serendipitous inspiration: He decided to devise sutures of silver. Silver did not harbor pathogens, and the infections were finally tamed, allowing the possibility of healing. In the end, Sims triumphantly recorded closing Anarcha's largest, fingertip-size fistula. 

He announced that he had perfected the vesicovaginal fistula operation in May of 1849, after scores of operations over five years—more than thirty operations on Anarcha alone. In 1852, Sims's paper on vesicoraginal fistula repair was published in the prestigious American Journal of the Medical Sciences. It made his national reputation. Sims became the celebrated 'father of American gynecology,' and as such his place in history was assured. W. J. S. McKay, M.D., spoke for his fellow surgeons in predicting that 'when the history of modern gynecology is written, the work that [Dr. Ephraim] McDowell did will be represented as the dawn; and the first bright planet that appeared in the dim light of that dawn was Marion Sims . . .'

In the early 1850s, bouts with malaria forced Sims north to New York City, where he became a medical lion who built a society practice, did research with blacks and immigrant women, taught medicine, and held many influential positions in hospitals, medical societies, and in academe. He founded the New York Women's Hospital, 'the first hospital for women,' which was built at Park Avenue and Fiftieth Street, the present site of the Waldorf-Astoria Hotel. Beginning in 1862, he also sojourned abroad, where his medical fame gave him entree into royal circles. He and his family became the toast of Second Empire Paris while Sims attended the Empress Eugénie and other members of the French royal family. Across two continents, monuments, memorials, and clinics sprang up in his wake ... all celebrating his statue as a physician 'treating alike empress and slave.'

Sims wrote copiously about his work and medical philosophies as well as his life.  In Alabama, Sim's vigorous defense of the slavery system had been liberally seasoned with 'nigger.' However, once up north, he hid the ethnicity of his subjects, portraying them as white in the illustrations that accompanied his accounts of the surgery. His duplicitous praise of 'the indomitable courage of these long suffering women' failed to mention that it was chattel slavery and morphine, not courage, that had bound the women to his surgical table." 

Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, 2007, image by Robert Thom, 1952 

(The illustration was commissioned by the Parke-Davis pharmaceutical house—now owned by Pfizer—as one of its History of Medicine in Pictures series.  Pfizer refused Harriet Washington rights to even this sanitized image for her book. She writes, "This act of censorship exemplifies the barriers some choose to erect in order to veil the history of unconscionable medical research with blacks.")