[9][7] In the twentieth century, this was condemned as an improper use of human experimental subjects and Sims was described as "a prime example of progress in the medical profession made at the expense of a vulnerable population".

[7] Sims was a prolific writer and his published reports on his medical experiments, together with his own 471-page autobiography[12] (summarized in an address just after his death[13]), are the main sources of knowledge about him and his career.

[15] For the first twelve years of his life, Sims and his family lived in Lancaster Village, north of Hanging Rock Creek, where his father owned a store.

[13]: 7  He described the settlement in a letter to his future wife Theresa Jones as "nothing but a pile of gin-houses, stables, blacksmith-shops, grog-shops, taverns and stores, thrown together in one promiscuous huddle".

Although not fatal, in the nineteenth century, vesicovaginal fistulas were "one of the most loathsome and disagreeable maladies to which females are subject,"[25] and a common, socially destructive, and a terrible complication of childbirth that affected many women.

Sims also worked to repair rectovaginal fistulas, a similar condition in which flatulence and feces escape from the rectum through a tear in the tissue separating it from the vagina, thus leading to fecal incontinence.

[28][29] Moreover, Henry van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) had outlined essential repair steps for such conditions that are recognizable even today.

[35] A prospectus from the 1830s of the South Carolina Medical College, then the South's leading medical school, pointed out to prospective students that it had an advantage of a peculiar character: No place in the United States offers as great opportunities for the acquisition of anatomical knowledge, subjects being obtained from among the colored population in sufficient number for every purpose, and proper dissection carried on without offending any individual in the community.

Those impediments which exist in so many other places, to the prosecution of this study, are not here thrown in the path of the Student, public feeling being rather favourable than hostile to the advancement of the Science of Anatomy.

[36][37]: 190 The college announced, in advertisements in the Charleston papers, that it had set up a surgery (operating room) for negroes, and offered to treat without charge, while it was in session, any "interesting cases" sent by their owners, "for the benefit and instruction of their pupils".

Unlike his previous essays, which included at least a brief description of his patients, the article issued in The American Journal of the Medical Sciences omits any identifying characteristics of Anarcha, Betsy, or Lucy.

Anesthesia was first used in dentistry, and was just being announced as an exciting novelty in privately published pamphlets, some claiming credit for the anesthetic's first use, at the same time as Sims' fistula repair surgeries.

One patient, named Lucy, nearly died from sepsis after Sims operated on her without anesthetics in the presence of twelve doctors, experimentally using a sponge during the procedure to wipe urine from her bladder.

[54] According to Durrenda Ojanuga, after Sims' successful treatment of Anarcha, he was asked by many white women to repair vesicovaginal fistulas, but most of them were apparently unable to endure the pain of the operation.

Wall notes that, while Sims' refusal to use anesthetic may seem shocking, he believes that this is a reflection of the contemporary sensibilities of the mid-1800s, particularly among surgeons who began their practice in the pre-anesthetic era.

[57] Trismus nascentium is now recognized to be the result of unsanitary practices and nutritional deficiencies, but in the nineteenth century its cause was unknown, and many enslaved African children contracted this disease.

Sims alluded to the idea that sanitation and living conditions played a role in its contraction, writing that [w]henever there are poverty, and filth, and laziness, or where the intellectual capacity is cramped, the moral and social feelings blunted, there it will be oftener found.

When Sims addressed the American Medical Association in 1858 on the topic "Treatment of the results of obstructed labor", the "charts" which illustrated it "caused the lady auditors to vacate the gallery.

From there, he went to London, and performed a second fistula repair with several colleagues on hand to observe, including Dr. Thomas Spencer Wells (soon to be appointed Queen Victoria's household surgeon).

These surgeries greatly enhanced Sims's reputation, and he planned on traveling to Vienna to demonstrate the procedure there, when another case from a colleague arrived in the French capital and eventually caused him to cancel his trip to Austria.

[13][22]: 46 Sims returned to the US in January 1862 aboard the Great Eastern, and back in New York he favorably reported on the pavilion plan and convinced the board of the Woman's Hospital to adopt it.

However, Sims discovered that a remunerative practice to support his family working on fistula patients in Paris was possible, and so he decided to remain in Europe until the cessation of hostilities in the USA.

He published Clinical Notes on Uterine Surgery simultaneously in English, French, and German (London, Paris, and Berlin) in 1865; this work described novel methods of treatment which were not readily adopted by the profession, but which in a few years would revolutionize the practice of gynecology.

"[68] Two years later, offering a toast on board the steamer Atlantic, returning to Europe, he said that in the aftermath of the war, the South had been degraded "beyond the level of the meanest slave that ever wore a shackle.

Sims' experimental surgeries without anesthesia on enslaved women, who could not consent, have been described since the late twentieth century as an example of systemic racism in the medical profession.

Dr. Sims, "the father of gynecology", was the first doctor to perfect a successful technique for the cure of vesicovaginal fistula, yet despite his accolades, in his quest for fame and recognition, he manipulated the social institution of slavery to perform human experimentation, which by any standard is unacceptable.

Sims used the surgical opportunities presented by long neglected chronic–and often incurable–cases of illness and injuries among the enslaved to sharpen his skills and stake a claim for professional celebrity—all in the context of the profits to be made from human trafficking one of the South's busiest slave markets.

[11] Wall notes that legal consent was granted by the slaves' owners; enslaved black women, he acknowledges, were a "vulnerable population" with respect to medical experimentation.

However, Wall also suggests that Sims obtained consent from the women themselves, citing an 1855 passage from the New York Medical Gazette and Journal of Health, where Sims wrote: For this purpose [...] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not.

According to the Australian gynecologist and author Caroline M. de Costa, Hideous as the accounts of his surgery may appear to sensitive 20th century eyes, undoubtedly Sims was at least partly motivated by a desire to improve the lot of his enslaved patients.