The Forum

In the ongoing struggle to contend with America’s dire racial history, diabolical surgeon J. Marion Sims—the so-called Father of Gynecology—may not command the top billing of figures like Robert E. Lee and Stonewall Jackson, but the battle over his checkered legacy is no less disturbing, and no less critical to a full reckoning with the past.

Sims long enjoyed an unquestioned reputation as a pathbreaking researcher and experimenter in American medicine. His actual career—which was built on gruesome experimental surgeries performed on enslaved women, without anesthesia—was doubly insulated from serious public scrutiny. First, Sims benefited from a culture of impunity that dehumanized the Black women he victimized on grounds of both race and gender. And as a pivotal figure in the professionalization of American medicine, Sims claimed uncontested patriarchal authority to abridge the basic Hippocratic canons of Western medicine in the service of the sort of “scientific” inquiry that would eventually enable routine medical atrocities. This all meant that Sims’s modern medical reputation was well-nigh unassailable—until very recently.

Decades-old cracks in Sims’s professional veneer finally ruptured in August 2017, when the infamous “Unite the Right” march of white nationalists in Charlottesville, Va., turned violent and murderous. Protesters and counter-protesters feuded over a statue of Robert E. Lee that now has a date with a smelting pot. A week later, four women in East Harlem donned bloody hospital gowns for a photo snapped in front of a statue of J. Marion Sims that had stood in New York for 130 years. The image went viral. Eight months later, even before the Lee statue was taken down, the Sims monument was removed, though whether it too will be destroyed has yet to be determined. (The removal was announced as a relocation of the statue to Sims’s gravesite in Brooklyn’s Green-Wood Cemetery, but the monument has not been reinstalled there.) Sims had many detractors in his lifetime—indeed, his closest colleagues were his greatest critics—but early in the twentieth century, a vast campaign of hagiography, laudatory articles written by doctors and metastasizing from every corner of the country, silenced those who had questioned Sims’s highly romantic narrative. This remarkable image makeover tracked closely with the rise of the apartheid Jim Crow regime in the American South—hence, Sims is medical history’s version of the Lost Cause.

Sims opened Woman’s Hospital in New York in 1855, with the expressed purpose of creating a larger version of his backyard “Negro Hospital” in Alabama. The goal was to monetize his procedure for the cure of “vesico-vaginal fistula,” which he had strived to perfect with years of experiments on Black women in downtown Montgomery. In addition, the new hospital would create a venue for additional experiments to be conducted on Irish immigrants. Irish women were in no way enslaved, but they were another vulnerable population, having recently fled Ireland’s great famine aboard “coffin ships.”

Sims ran the new hospital for six years, and he left for Europe for the duration of the Civil War, returning in 1868. He did not perform surgery again at Woman’s Hospital until 1872.

A great deal had changed in the interim—none of it to Sims’s benefit. Before the war, Woman’s Hospital’s “Board of Lady Managers” had remained a mostly ceremonial body, easily manipulated by Sims. Some of the managers, however, emboldened by experiences of battlefield medicine, became more assertive now. Specifically, the managers initiated an investigation into growing mortality rates at the hospital. In addition, they set about enforcing rules that were long-standing, but long-ignored. Among Woman’s Hospital doctors, Sims was particularly egregious in avoiding a restriction on the number of visitors who were invited to observe vaginal surgeries, and in admitting cancer patients to an institution whose mission was supposed to be limited to fistula and diseases peculiar to women. In short, the managers were curtailing Sims’s relentless pursuit of fame and medical glory.

Sims’s second tenure as a Woman’s Hospital surgeon lasted two years, ending with a dramatic confrontation at the organization’s 1874 annual gala. Ostensibly, the feud was about the hospital rules, which Sims likened to totalitarian oppression. But it was the study of mortality rates that got him ejected from his own hospital. The institution that had once prided itself on virtually no deaths was seeing more and more due to mission creep and zealous surgeons like Sims, who in the pursuit of honor and renown took on cases that either didn’t require surgery at all or should have only come under the heading of palliative care. Put most bluntly, Sims’s colleagues had concluded that he was killing too many women.

What happened next was remarkable for its audacity. Sims was by then a world-famous surgeon, and so his expulsion became a national scandal in the American medical community. The response, a few months later, was to elect him to the presidency of the American Medical Association. Even Sims’s principal twentieth-century hagiographer, Seale Harris, was forced to acknowledge that the election amounted to the male medical establishment’s rebuke of the female managers of Woman’s Hospital. Sims promptly went on to use his annual address before the Association to further a lifelong campaign against medical ethics, which he described as an “engine of torture” victimizing innovative physicians.

This high-profile propaganda offensive played a key role in allowing the fantastical myth of J. Marion Sims—as heroic medical innovator and flouter of small-minded convention—to survive well into the twenty-first century. His biographical façade rationalized the erection of other Sims monuments in Alabama and South Carolina in addition to the New York statue.

The first stirrings of a Sims reappraisal began in the late 1960s, with dissertations-turned-books by scholars G.J. Barker-Benfield, who placed Sims in a dastardly triumvirate of belle epoch patriarchy alongside the Reverend John Todd (author of advice books for men) and Augustus Kinsley Gardner (proto-obstetrician and reproduction theorist), and Deborah Kuhn McGregor, who took wider aim at the matricide committed by newly labeled “gynecologists,” all male, who had rudely shoved women out of the practice of midwifery. But the work of Barker-Benfield and McGregor never really penetrated public consciousness, and awareness of Sims’s troubling legacy—to put it euphemistically—remained a tiny subdivision of academic study.

In 2007, Harriet Washington’s award-winning Medical Apartheid changed all that. Documenting a broad-ranging history of medical experimentation on African Americans, Washington employed Sims as a symbolic, fulcrum-like figure to prize out a hidden narrative linking medical history and white supremacy. This time, people noticed. In Montgomery, Al., artist and activist Michelle Browder read Medical Apartheid and began to imagine counter-narratives: a monument to the young women who were Sims’s enslaved experimental subjects, and an annual conference to enable maternal health professionals to collaborate in challenging false histories that feed ongoing racial health disparities.

In East Harlem, a woman named Viola Plummer, also fired up by Medical Apartheid, began handing out flyers, questioning the presence of a statue that for decades had gone unnoticed on the outer wall of Central Park. A group called East Harlem Preservation took up the cause, and soon joined forces with a number of community and activist organizations calling for the removal of the Sims monument. Groups of women marched up Fifth Avenue chanting “Say her name! Anarcha! Say her name! Betsey! Say her name! Lucy!”—references to Sims’s earliest experimental subjects. The protestors soon learned an important lesson that stands out in high relief in the battles over the Sims legacy: institutions that find themselves on the wrong side of history will abandon their posts only reluctantly—and only when they are vigorously dislodged and dragged kicking and screaming across the deliberately blurry, often obfuscated line that separates right from wrong.

The Sims story began to go viral shortly before the world did. In the early days of the pandemic, when everyone (or so it seemed) eagerly awaited a vaccine, it wasn’t clear that Sims’s legacy would be particularly relevant. However, after the Delta variant of Covid-19 surfaced in late summer 2021, Sims had become more or less synonymous with vaccine hesitancy in the African American community. For a time, it was impossible to read a news story about hesitancy that did not mention Sims’s Alabama fistula experiments alongside the more infamous Tuskegee syphilis study.

Now it seems entirely appropriate to ask whether vaccine hesitancy might have been mitigated—and lives saved—had medical organizations whose own histories were twined together with that of the “American Mengele” made a more robust effort to reckon with his horrific past. The purpose of this article is not to re-debate Sims’s legacy. Those interested in exploring the many fine points of Sims’s experiments can consult the work of the scholars listed here, or read the author’s own work on the subject, here and here and here.

New York City’s initial response to the request to remove the Sims monument was to delay, spread falsehood, and express bemusement. The Parks Department dug cursorily into the history, and claimed that the statue had been funded by 12,000 donations, mostly from Sims’s female patients. (The actual number was closer to 800, with more than 95 percent of the total coming from white male doctors.) The Parks Department’s director of art and antiquities glibly noted that New York’s statuary featured monuments of not just one gynecologist, but two! The other gynecologist is Dr. A.J.C. Skene, whose bust sits atop a pedestal in Grand Army Plaza in Brooklyn. A Sims disciple and an amateur sculptor himself, Skene once fashioned his own Sims bust, but after Sims died Skene also leveled a withering criticism of Sims’s surgery for “vaginismus.”

Undeterred, activists eventually forced a public meeting on the question. Things got a little strange. Parks Department officials reached out to the archivist of the venerable New York Academy of Medicine to recruit an expert who could prepare a report on Sims’s life and work. The obvious choice would have been Harriet Washington—especially since the Academy had supported Washington’s work for some time. But the Academy didn’t refer Washington to the Parks Department. Instead, the archivist in question suggested a university bioethicist who had written a short chapter on Sims in a brief history of medical ethics in America, and who had already posted online his opinion that the Sims statue should be retained.

The report—sloppy and full of inaccuracies—was read aloud at the long-awaited public meeting. The bioethicist claimed that Sims did not use racial slurs in his autobiography (he did), and that he had manumitted his slaves before he left Alabama for New York in 1853 (he didn’t). The activists continued to hold that the statue should be removed; Parks continued to argue that Sims’s legacy was, on balance, laudable. Years of stalemate followed.

I began researching Sims in 2015. I set out to find hard evidence of the existence and later life of Anarcha—the most consequential of Sims’s experimental subjects—and I was eventually able to recreate most of her life story, using primary-source documents to track her movement from the Montgomery plantation where she was born to the lonely forest in Virginia where she is buried. In addition, I pitched to Harper’s Magazine an article that would read like a biography of the Central Park monument, which appeared in November 2017.

The toxic nature of the Sims story became apparent the moment I began researching the article. When I approached institutions for comment, they ran for cover. Strangest of all was the New York Academy of Medicine. In an interview, the then-president, Dr. Jo Ivey Boufford, denied that the organization had any association with Sims, even though the statue had been moved in 1934 from its original Bryant Park location to 103rd and Fifth Avenue—directly across the street from the Academy.

In fact, Sims had a long history with the New York Academy of Medicine. In 1857, he delivered the organization’s prestigious annual address. In 1870, he was tried and convicted by the Academy’s special committee on ethical violations committed by members. After Sims died, the Academy played a role in the creation and erection of his statue. And in 1934, when the city temporarily removed it for subway construction, the Academy seized on the moment to reinstall it a stone’s throw from their front door. Public celebrations at the site of the Sims statue continued until at least 1963, the 150th anniversary of Sims’s birth.

My reporting took a cloak-and-dagger turn when I was leaked a set of internal Academy correspondence. An informal star-chamber group of doctors and historians had been convened to draft a statement that would contextualize the Sims statue—and once again Harriet Washington was left out of the mix. The group was hardly a model of academic rigor. Boufford, the Academy president who would soon deny any association with Sims, lamented the group’s “overboard” research and claimed that she felt like a “member of a CSI team trying to get down to a microscopic level on Sims.” An intern tasked with investigating the Sims legacy complained that her work had caused her to spend “almost all of Wed. afternoon” at the library—suggestive of the group’s overall mien of huffy hauteur before the demands of historical accountability. It seemed, in short, that the group gathered to consider the history was not all that interested in considering the history.

The stalemate continued until 2017, when Confederate monuments began to come down across the South. My work revealed that Sims had acted as a spy in Paris on behalf of the Confederacy during the Civil War, but that bit of damning intel was no longer needed to convict Sims in the court of public opinion. After Charlottesville, the viral protest at the site of the Central Park monument was enough—Mayor Bill De Blasio created a special commission to reconsider the city’s policy on public art of all kinds. With the de-installation of the Sims monument in April 2018, the city took an unprecedented step in the metropolitan history wars: a statue could now be removed explicitly because of public concerns over the person or the values it represented.

This precedent left the country’s elite medical institutions in an uncomfortable bind. Sims had served terms as president of the American Medical Association and the American Gynecological Association, and he had been a founder and officer of the Medical Association of the State of Alabama. What should they do? Should they act decisively in rejecting a man they had once counted as member and colleague, or should they issue a vague statement, lay low, and hope the debate over Sims amounted to one more “cancel culture” furor—burning bright through the social mediasphere, but soon to be relinquished and forgotten?

The unspoken irony in such strategic evaluations was that Sims’s membership in the exalted caste of professional physicians had been purchased with a veritable cavalcade of cancellation, so far as the nation’s Black and female populations were concerned. In 1939, Alabama physician Seale Harris, wrapping up a one-year term as president of the Medical Association of the State of Alabama, exploited his office to erect a monument to J. Marion Sims on the lawn of the state capitol in Montgomery, a scant few hundred yards from where Sims had conducted years of experiments on Black women.

Harris had long championed Sims. His father had been one of Sims’s disciples, and various essays Harris produced culminated in Sims’s only full-length biography, Woman’s Surgeon, published in 1950. The wicked apotheosis of J. Marion Sims may be said to have peaked with a radio show adaptation of Harris’s book: Academy Award-winner Ray Milland starred in the preposterously titled episode, Sir Galahad in Manhattan.

The Alabama statue had a peculiar past. It was cast long before it was erected, with Harris using WPA money to commission a Rhode Island sculptor. Initially, the statue wasn’t intended for Alabama at all. Harris meant for it to become one of two monuments representing Sims’s home state of South Carolina in the U.S. Capitol’s Statuary Hall. There are no extant records explaining why the keepers of Statuary Hall rejected the monument. Harris was left in the lurch until he was elected president of the Medical Association of the State of Alabama—the professional physicians’ group that Sims had helped found. Harris used his position to unload on Alabama—the de facto storehouse of all manner of “Lost Cause” iconography—the ill-starred Sims monument no one else wanted. It could not have been lost on him that the erection of a monument to the man who was not only his hero, but also the subject of his biography, would secure the commercial fate of Woman’s Surgeon.

Today, Dr. Aruna Arora holds the office Seale Harris once occupied. Arora freely concedes that the Association had bestowed the Alabama Sims statue to the state. The Association’s statue continues to stand today, protected by a hastily conceived 2017 Alabama monuments law designed to shield the state’s legacy as the “cradle of the Confederacy.”

Less than a month after the removal of the Sims monument in New York, the Medical Association of the State of Alabama issued a half-hearted, sorry-not-sorry statement on Sims. “Many” of Sims’s innovations, it was claimed, had “stood the test of time” and were “still in use” (tools attributed to Sims are still in use, but his closest assistants challenged the origin of the devices and procedures for which Sims was most famous, indicating that they were in use long before him). The statement used the Alabama monument law as a fig leaf to hide the shame of capitulating to the longstanding racist and misogynist consensus that permitted the Sims statue to stand all this time. And with the banal and temporizing language that marks the establishment side of the statuary debate throughout the country, the Association claimed that it “encourage[d] further conversation” to recognize Sims’s experimental subjects (described as “patients” as though the enslaved persons he victimized had a measure of choice or agency in that setting). Curiously enough, no further public “conversation” transpired—for years—in the wake of the Association’s statement.

By 2021, the Association appeared to have evolved. Writing in her capacity as president, Arora noted that “especially recently, events and societal changes have brought about a needed re-examination of Dr. Sims’s legacy.” The Association had recognized that it had wound up on the wrong side of history, yet the call for re-examination rang hollow. The Association finally pledged support for Michelle Browder’s More Up Project in Alabama—a group that I am also affiliated with, and which included the “Mothers of Gynecology Monument,” completed months before promised Association funds were delivered—but it took no concrete steps toward a full reckoning with the legacy of one of its founders. In response to repeated queries, the Association issued another listless statement. Now it claims to be in favor of removing the monument, but as to timing it says only that it will pursue, at some indefinite future date, “available avenues to accomplish that objective.”

This foot-dragging proceduralism is characteristic of the efforts of high-profile institutions to dodge accountability and honesty in owning up to an ugly racial past. As became all too plain in the controversies over statuaries and monuments during the Charlottesville riot and the 2020 Black Lives Matter protests, public monuments represent values, not history. Before the pandemic, activists had targeted the removal of Confederate monuments as a crucial symbolic gesture to help jumpstart a nationwide reckoning on race that concerned much more than the question of whose histories were permitted to be etched in stone. After the virus began to spread, the stakes became correspondingly greater, as the demand for serious reform and historical accountability gained unprecedented popular traction.

A full reckoning with a difficult past can make a life-saving impact. Can this be measured? Perhaps not—but is it really so hard to imagine the cognitive dissonance you would feel if you were told you needed a shot by a physician who belongs to an organization that tacitly defends horrific experiments performed on your ancestors?

In the medical world, the learning curve on these issues remains forbiddingly steep. In 2021, the AMA became embroiled in scandal when its official publication, the Journal of the American Medical Association (JAMA), released a podcast and supporting tweet suggesting that structural racism was impossible in healthcare. Racism is simply “illegal,” the Association insisted, adding that “no physician is racist.”

At precisely the same moment, another wing of the AMA was preparing to release a three-year strategic plan to address racial justice and advance health equity. Inner turmoil on questions of race have opened fissures in many medical organizations. The result, as with the Medical Association of the State of Alabama, has been an anesthetizing, bureaucratic counteroffensive, featuring perfunctory disavowals of medical history’s worst episodes, which in practical terms amount to whiney pleas to move on from the politics of racial division. To date, the AMA has not acknowledged its link with Sims, nor offered a response to the more recent reappraisals of his life, apart from a one-hundred-word statement buried inside their otherwise laudable, eighty-page health equity plan. This brief statement inaccurately credits Sims with “renowned medical innovations.” The AMA did not respond to requests for further comment.

This is the norm across the professional associations of American medicine. In 2017, the American Urogynecologic Society (AUGS) abandoned a “J. Marion Sims Lectureship” it had sponsored for thirty-seven years. AUGS officials reported that Sims had become a “source of polarization [and] pain” inside the organization, and that they could “no longer speak with one voice on the topic.” They retired the annual speaking position, but issued a statement that repeated many factual inaccuracies and offered an active defense of Sims’s experiments on Black women. Sims was praised for “innovation and determination,” his contributions were described as “many” and “beyond dispute,” and the “reality” of his work was described as something “we cannot know”—which is true insofar as one cannot know what one refuses to look at it.

In 2020 the American Gynecological Society put out its own benign-yet-factually-challenged statement on Sims and racism in medical history. Specifically, the statement claimed that Sims’s experiments had led “to successful treatment of vesicovaginal fistula.” This ignores multiple fistula cures that predated Sims, and skirts the specifics of his method, which was challenged and abandoned only four years after he published it. More happily, the American College of Obstetricians and Gynecologists followed in 2021 with a substantive suggestion to rectify the ugly legacies of Sims from Dr. Veronica Pimentel. Pimentel proposed that the dates of February 28-March 1 be dedicated to Anarcha, Lucy, and Betsey, Sims’s experimental subjects. State measures endorsing “Anarcha, Lucy, and Betsey Days” have since passed in Connecticut and Alabama.

In 2017, Deirdre Cooper Owens’ Medical Bondage, another dissertation-turned-book, added fuel to the scholarly pyre already lit at Sims’s feet. But this time was different: it was the first time a Black woman had produced a full appraisal of the man who experimented on Black women. Now, there’s no going back. Sims’s champions—until recently quoted in news stories adhering to see-no-evil both-siderism—have become harder and harder to find.

There is little disagreement that Anarcha, Lucy, and Betsey deserve recognition. Greatest among the efforts to honor them—symbolizing the strength and sacrifice of many others, as well—has surely been Michelle Browder’s “Mothers of Gynecology Monument,” erected in Montgomery in September 2021. Browder’s More Up Campus will host an inaugural “Day of Reckoning” conference over this year’s Anarcha, Lucy, and Betsey Days. The event will feature lectures and presentations by many researchers and activists who have uncovered the true narrative of the Alabama fistula experiments.

To be sure, the institutions I’m criticizing here count among their memberships many well-intentioned people working from within to push back Examples of these efforts can be found here, here, and here. against physicians with long-standing investment in the Sims narrative. They will not easily be convinced the story is a fraud. The wan, noncommittal statements that such groups typically offer on the Sims legacy are the sort of half-measures that result when opposing sides opt for compromise. When the debate was about statues alone, that may have seemed the prudent course. But after the pandemic struck, the safe choice proved to be the deadlier option. One expects more from doctors than a Band-Aid plastered over a historical wound that continues to bleed and fester.