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“…additional complications.”

Sims’s inner monologue here is largely speculative. The various difficulties he imagines here are the difficulties he will, in fact, encounter later in the book. It’s presumptuous to suggest that he anticipated all of them in this moment, so I’m compressing time, to a degree, in order to speak to his motives. Additionally, I’m beginning to speak here to one of the core disputes in the Sims’s legacy—the extent to which Anarcha, Lucy, Betsey and the others became willing participants in the experiments. To be clear, enslaved persons cannot provide informed consent (and Sims would not have needed consent to adhere to the ethical standard of the time), and Sims had only recently performed an experiment explicitly for the purpose of demonstrating that consent was not necessary for major surgery (See “…regardless of whether a patient was willing,” above.) This passage is laying the groundwork for Sims’s true motives in coercing the women he collected to enable the Alabama fistula experiments—this, in and of itself, may amount to a form of psychological torture.