ABSTRACT

J. Marion Sims (1813–1883) was one of the most prominent surgeons of the 19th Century, often referred to as the “Father of Gynecology” for his many contributions to the diagnosis and treatment of female pelvic floor disorders. His most notable contribution was the first reliably successful operation for the treatment of obstetric vesico-vaginal fistula. After Sims’s death, the medical profession raised funds to erect a monument to his memory in New York City. Sims developed his surgical approach to fistula closure while operating on a series of young, enslaved African-American women in Alabama. Modern writers have condemned Sims for providing innovative surgical treatment to women with a heretofore devastating and incurable condition. For several years these critics have been systematically seeking to eliminate Sims’s memory from the places where he had been honored. Because vesico-vaginal fistulas from obstructed labor are now almost unknown in countries with effective systems of maternal health-care, present-day critics fail to understand the immense suffering caused by these injuries. The argument is made here that a vesico-vaginal fistula was such an overwhelming injury that it dominated all aspects of the dayto- day lives of women with this condition. Rather than being unwilling participants in Sims’s surgical endeavors, it is far more likely that these women—even though they were enslaved—were active partners with Sims in their joint search for a cure. The extensive experience of modern surgeons working with poor women suffering from vesico-vaginal fistulas in Africa and Asia supports this perspective.