Nineteenth-century white gynecologist Dr. James Marion Sims made headlines recently when a statue honoring him in New York City became newly targeted for removal. Despite his deeply problematic legacy of operating on enslaved Black women and Irish immigrants to advance the field of gynecology, his statue included the inscription: “His brilliant achievement carried the fame of American surgery throughout the entire world. In recognition of his services in the cause of science & mankind.”

The most recent #TakeDownSims campaign followed on the heels of other statue removal efforts, including the push to remove monuments of Confederate icons across the country, and a viral protest against the surgeon’s memorialization by four Black women activists associated with Black Youth Project 100 this past August. They protested in front of the statue wearing blood-stained hospital gowns, a striking representation of the women upon whom Sims’ work relied.

Sims had come to represent a diversity of issues over the years—yes, the racist and violent legacy of slavery, but also the complicated and problematic history of medicine, and the roles that women, often from marginalized or disenfranchised groups, have played in these arenas. Although the statue removal issue in New York had stagnated amid city bureaucracy and debate, including the question of whether historical monuments could ever be taken down, resolution finally came in April when New York City Mayor Bill de Blasio ordered the statue removed from its Central Park location.

Even amid all the celebration, the public and the historical record have paid little attention to the women instrumental to Sims conducting his experiments. Thankfully, some researchers have been working to center these women’s stories to ensure they are not completely erased from history.

Searching for the Montgomery Women

Deirdre Cooper Owens, Ph.D., historian and author of the 2017 book Medical Bondage: Race, Gender and the Origins of American Gynecology, understands the importance of clarifying the experiences and legacy of the women who suffered at the hands of Sims and his search for a cure. “As soon as midwifery changes to gynecology, women are removed from the conversation as healers. They are really just seen as medical specimens and objects. These are women whose bodies helped to advance this field because they were so accessible and vulnerable.”

While there are many objectionable parts of Sims’ legacy, he is most publicly criticized for his surgical experiments as he tried to cure vesicovaginal fistula—a problem where tissue in the vagina dies due to prolonged or obstructed childbirth, and causes incredibly disruptive and debilitating incontinence. He took on this search for a surgical cure by operating on a group of enslaved Black women in Montgomery, Alabama. Sims, quoted from his autobiography, explains the relationship this way: “I made this proposition to the owners of the negroes: If you will give me Anarcha and Betsey for experiment, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them. I will keep them at my own expense.”

Anarcha, Betsey, and Lucy are the only women whose names are known of a group probably numbering nine or ten enslaved women conscripted into Sims’ fistula repair experiments. Most of what is cited about the three women is from Sims’ autobiography, and more is known about Anarcha, possibly because she is believed to be among the first women who Sims operated on, and the one who endured the most surgeries—upwards of 30. She’s also the woman he first claimed to have cured. As a result, some researchers have argued she is a hero in this story.

Cooper Owens takes issue with singling out any one woman as a heroine. “I’ve dedicated my professional life to writing about the stories of enslaved people,” she told Rewire.News in a recent phone interview. “I have great regard for them. [But] Anarcha is no more of a hero than her other enslaved sisters. I think there is a danger in replacing one fallen hero for someone else. Of course enslaved people should have their due. Anarcha dealt with with the racism and sexism of being an enslaved experimental patient just like many others’ we do know, and folks we don’t yet know about. If we elevate Anarcha, then we must elevate all of the women who endured what she did.”

The challenge becomes figuring out exactly how to elevate these women’s experiences, given the limited information that exists about their lives. And what is known is all filtered through the voices and perspectives of white men—slave owners, doctors, writers. “When you are writing about subjects who are dead and illiterate, they don’t leave sources for us,” explained Cooper Owens. “Everything we excavate is based on the words, the remembrances of white men. When we’re looking at medical textbooks, case narratives, they are all white men. When we’re looking at all the oral histories of slaves they are for the most part made by white folks.”

So instead, Cooper Owens says, the narratives of these enslaved women have to be pieced together from fragments and inferences that exist within these texts. “So much of the history of slavery is speculative in some sense. In my book, I have no shame about the number of questions that I raise. We can read between the lines, we can disrupt the silences.”

We do know a bit more about the women’s roles while they were at the hospital Sims created in his backyard in Montgomery. Not only were they the patients for these experimental operations, they were also working to keep the hospital running, supporting each other, and even working as Sims’ surgical assistants and nurses. “The patients were still the ones drawing water out of the well,” elaborated Cooper Owens. “They were the ones who assisted [Sims] when the white community abandoned him after years of surgery.”

Cooper Owens is referencing a point, a few years into Sims’ fistula repair experiments, when his medical counterparts wanted to give up on his attempts to cure fistula. So, Cooper Owens explained, the women themselves assisted. “As Sims’s surgical nurses, they learned the fundamentals of gynecological surgery from arguably the most successful gynecologist of the nineteenth century,” Cooper Owens explained in Medical Bondage. “During the five years they lived on Sims’s farm, they helped him birth a new field. It is no exaggeration to state that these enslaved women knew more about the repair of obstetrical fistulae than most American doctors during the mid- to late-1840s.”

The Experience of Fistula

Author J.C. Hallman became interested (some might say obsessed) with Sims and his legacy after reading about the problem of obstetric fistula. He is a writer whose work dances the line between literary and journalistic, and he takes on primary source research with a fervor. “It was kind of a random stumbling across the story,” Hallman recently told Rewire.News in a phone interview. “I was looking at someone’s bio and she had done some work on fistula. Within about ten minutes of googling I realized there is this big untold story. Within a few days of that I was on a plane to Alabama to look for Anarcha.”

Anarcha is the focus of Hallman’s forthcoming book, The Anarcha Quest: The Story of a Slave and a Surgeon, to be published by University of Virginia Press in 2020. His book adds to a growing body of work that looks to re-examine Sims’ legacy and the stories of Anarcha, Betsey, and Lucy. While Hallman asserts that he’s uncovered new information about Anarcha in his research, he’s not the first person to write about Sims, or to try to contextualize his experiments on enslaved women. In addition to Cooper Owens, Harriet A. Washington’s 2007 book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present also includes research about Sims and his experiments.

But Hallman believes that through what he’s discovered about Anarcha, his narrative can help transform her story from simply a victim of immoral experimentation to a woman with an important legacy of her own.

One important lens into her experience and that of the other women at Sims’ Montgomery hospital can be found through the medical understanding of what it’s like to live with a fistula. While a lot of debate about Sims focuses on the question of whether the women consented to be part of the surgeries (and whether any enslaved person can truly consent given the constraints of slavery), no one questions that living with the effects of fistula is debilitating. “[It’s traumatic] not being able to have a baby or [being] permanently incontinent,” described Cooper Owens. “These women are young, and they don’t want to smell like shit and piss continuously.” Because of the incontinence caused by fistula, it’s a condition that causes high levels of stigma, in addition to the logistical challenges of incontinence.

One piece of information about Anarcha’s life that Hallman said he’s discovered for the first time is that she, years after Sims had claimed to have cured her fistula, traveled to Sims’ New York Woman’s Hospital to be operated on again by him. Hallman explains that Anarcha actually had a double fistula when she first was sent to Sims—a rupture in the lining between vagina and urethra and between vagina and rectum. “She was probably never really fully cured,” said Hallman. Another detail that he uncovered is that when she was living in Virginia, “she [appeared] to be living at a separate house from the main house.” While it’s unclear whether it was due to separate quarters for people enslaved generally or stigma, Hallman explained that her separation was “what you would expect from a woman with an ongoing fistula condition.”

“It was just a really unsanitary and displeasurable disease,” emphasized Cooper Owens. “You were constantly made to know that you had been damaged because of the smells, because of the ostracism, the infection.”

What happened to the women after their time with Sims is difficult to piece together. Hallman can trace their movement through slavery ownership records, so he knows what plantations they ended up on as their lives progressed. Anarcha, he said, “was leased out to a hotel in downtown Montgomery that would also serve as a hospital for very wealthy people,” one of the places he claims she used the nursing skills she’d developed at his hospital. “Anarcha worked as a nurse and a midwife later in life,” explained Hallman. He also shared that “later on she belongs to a family in Virginia, and she is caring for other women about to give birth.”

Sims himself left Alabama and went to New York, where he founded New York Woman’s Hospital, and continued his experiments, this time focusing on a different marginalized population—poor Irish immigrants, as Cooper Owens has documented.

Villain or Hero?

Sims’ legacy and reputation, has, at this point, been exhaustively debated in the public sphere. Cooper Owens, writing for Rewire.News last August, resists portraying him as a hero or a villain—instead choosing to situate him within the sociopolitical historical context in which he worked. Hallman, while adamant about understanding the factual realities that shaped Sims’ choices, takes a more hard-lined opinion of the man. “There is no bigger Sims antagonist than me,” said Hallman.

But in some ways the debate about Sims as a villain or a hero is besides the point. Instead, what Cooper Owens, Hallman, and other researchers are trying to do is bring Anarcha, Betsey, Lucy, and the others who were part of these experiments into the spotlight. They are just a few among many women who, because of the power structures that shaped their role in society, are only just being acknowledged for their contributions to modern medicine.

By doing so, we provide a more accurate historical understanding of this period of medicine, and give the women who suffered these operations their due. As the legacies of men like Sims are deconstructed alongside the monuments to them, there is room for the women on whose shoulders they stood to be lifted up alongside.