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“…impossible to replicate the ease…”

See “Dr. Sims’s young medical students struggled…,” above.

“…the rising and falling of Lucy’s cervix…”

This description comes from Sims’s later colleague at Woman’s Hospital, Gaillard Thomas. It would apply just as well to what Sims would have seen in the 1840s.

Thomas, T. G. (1869). A Practical treatise on the diseases of women, by T. Gaillard Thomas ... 2nd edition ... enlarged. Philadelphia: H.C. Lea., p. 55.

“…sole credit as innovator…”

This is how Sims described it in 1852. I have substituted in the sponge catheter for the sigmoid catheter, as in 1846 he tried the sponge first (and can be supposed to have thought it would work—see “…would insert a long thin sponge…,” above).

“On the Treatment of Vesico-Vaginal Fistula,” J. Marion Sims, The American Journal of the Medical Sciences, Vol. XXIII, 1852, pp. 74-75.

“…the quill suture long in use…”

Bozeman, N. (1884). History of the clamp suture of the late Dr. J. Marion Sims, and why it was abandoned by the profession, p. 19.

“…had to be yanked out of her…”

See “…he laid hold of the string…,” above.

“…urinary salts…”

See “…it was stuck,” above.

“…with the sponge once again…”

See “…Betsey bled but not as much…,” and “…a stick of gum elastic…,” above.

“From there, he began experimenting…”

Surprisingly, Bozeman accepted Sims’s claim that Anarcha, Lucy, and Betsey were cured—although his judgement on this predated the publication of Sims’s autobiography, so it’s unknown whether he would have stood by the claims he made in 1884, given that some of them were quite at odd with Sims’s account. In any event, it’s here—and elsewhere—that Bozeman notes that Sims never made a detailed account of the Alabama fistula experiments. That said, the various adjustments I assign to Sims here are highly likely, if not absolutely certain, given the description of the difficulties he anticipated and later claimed to have surmounted.

Bozeman, N. (1884). History of the clamp suture of the late Dr. J. Marion Sims, and why it was abandoned by the profession, p. 19.

“…some having leaked urine for years…”

Sims offered a quite detailed account of Anarcha’s condition (See “…the smell of gas and waste…,” above), and scant details on Betsey and Lucy. Of the others, he said nothing. My account here is an approximation of what I saw and learned in Africa, and of an unnamed young woman who died in Nigeria shortly before I arrived, as is described in the afterword to the printed book.

“…emerging as a leader…”

This is inference. Documents reveal that later in life Anarcha worked as a midwife, and certainly she learned a great deal during the three-and-a-half years of experiments in Sims’s hospital. As later documents also reveal that she had few other skills, I have suggested that she was recruited to work as a nurse even as a young girl. (See “…Anarcha became a helper…,” above.) Given that she had a fair amount of experience as a nurse already, it makes sense that she would have distinguished herself among the women Sims experimented on.