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

Wall, L., Lewis, MD, DPhil

Female Pelvic Medicine & Reconstructive Surgery: March/April 2018 - Volume 24 - Issue 2 - p 66–75
doi: 10.1097/SPV.0000000000000546
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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 early fistula repair operations performed on enslaved women in the 1840s by J. Marion Sims are reviewed and discussed with reference to their historical context.

From the Department of Anthropology, College of Arts and Sciences, Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, MO.

The J. Marion Sims Lecture, delivered at the annual meeting of the American Urogynecology Society, October 6, 2017, Providence, RI.

The author has declared that there are no conflicts of interest.

Correspondence: L. Lewis Wall, MD, DPhil, Department of Anthropology, Campus Box 1114, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130–4899. E-mail:

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