Sims developed his technique through years of surgical experimentation performed exclusively on a dozen enslaved women, without the use of anesthesia. Their owners brought these women to Sims, only three of whom—Anarcha, Betsey, and Lucy—were named in his records. Slaves were considered property and, as such, the women were never paid for their participation. Only after mastering his technique (he operated on Anarcha thirteen times) did Sims repair the fistulas of white women, all with anesthesia.6
