J. Marion Sims
James Marion Sims, hailed as ‘The Father of American Gynecology’, is one of the most prolific innovators in early MUSC history. He was born in 1813 in Hanging Rock, South Carolina and graduated from the South Carolina College in 1832. He then settled on a career in medicine and attended the Medical College of South Carolina in Charleston for one semester before completing his education at Jefferson Medical College in Philadelphia. After graduation he returned to the South, initially practicing in rural Alabama. Sims there made his name as a surgeon by practicing techniques and inventing instruments aimed at repairing vesico-vaginal fistulae. He later moved to New York City, in part for health reasons, and soon established his practice there. He was instrumental in the establishment of the nation's first hospital for women in 1853. In addition to the diseases of women, Sims was interested in cancer and worked to establish the New York Cancer Hospital (now the Memorial Sloan-Kettering Hospital). Sims died in New York on November 13, 1883.
Despite the fact that his career would eventually focus exclusively on surgical gynecology, Sims openly admitted that he studiously avoided women’s medicine for many years of his medical practice:
“For the first ten years of my professional life the treatment of any disease peculiar to woman was ignored as far as possible.’”
What changed this aversion? According to most sources, Sims was called out to treat a local woman who had fallen from her horse and who had ‘dislocated’ her womb. Dr. Sims manually maneuvered the womb back into place, through the vagina. The success of this procedure not only changed Sims’ attitude towards women’s medicine, but also in part led to his innovations in the treatment of vesico-vaginal fistulae.
Vesico-vaginal fistula is an abnormal fistulous tract extending between the bladder (or rectum) and the vagina, causing the constant, involuntary discharge of urine (or feces) into the vaginal vault. In the past, this condition was most often caused by long, difficult labors. The unborn child exerted pressure on the pelvis, cutting off blood flow and causing tissue to die.
In Sims’ time, there was neither cure nor treatment for the affliction, which carried great social stigma.
Sims’ procedure for repairing VVF relied on the use of Silver Sutures. To Sims, the secret of his success (which was first achieved in 1852) rested almost entirely on the use of silver sutures.
“You who are familiar with the experience of that noble charity, the Woman’s Hospital, will not be surprised, when I declare it as my honest and heart-felt conviction, that the use of SILVER AS A SUTURE IS THE GREAT SURGICAL ACHIEVEMENT OF THE NINETEENTH CENTURY.
For my country I claim the honor of this imperishable discovery…’”
In the repair of vesico-vaginal fistulae this was indeed a significant discovery. It also, unfortunately, somewhat obscures the fact that experimentation was an important factor in Sims’ success. The initial procedures to cure vesico-vaginal fistula were performed on slave women, sometimes resulting in dozens of surgeries on a single patient.
Sims, J. Marion, Silver Sutures in Surgery, Samuel S. & William Wood, New York, 1858, p. 8.
Sims writes of the illustration, “Figure 9 is intended to show the relations of the fistula in the seventh case, which was the only successful one of the series. It was just at the neck of the bladder, the tissue was deficient, and the edges inverted, or turned towards the pubic arch. Here the sutures were passed close to the edges of the fistula, as shown in the figure; but when the button was to be applied, I found that it had to be convex instead of concave, [author’s emphasis] as so particularly recommended by Dr. B [Bozeman of Montgomery, Alabama]. Notwithstanding this, union took place. If the button had been made with a concavity, and thus applied, forcing the edges of the fistula up into it whether or not, the wires would have cut out before union could have been effected.”, pp. 19-20.
Today, vesico-vaginal fistulae are most often found in geographic areas where gynecological care is scarce, and/or violent rape is common. See both: http://www.endfistula.com/index.htm and http://www.healafrica.org/.
Sims’ treatment of slaves remains a controversial, ethical topic. For a more in-depth discussion, see: Wall, L. L. , ‘The Medical Ethics of Dr. J Marion Sims: A Fresh Look at the Historical Record’, Journal of Medical Ethics, Vol. 32, No. 6, June 2006, pp. 346-350.
Sims Speculum and the Sims Position
Along with the usage of silver sutures and the availability of patients to experiment on, Sims’ successes can also be attributed to several of his other innovations. Mainly, the Sims Position and the Sims Speculum. Indeed, Sims’ combination of technique, position and instrumentation was a tremendously successful one. In as late as 1956, several physicians reported that only small changes had been made to Sims’ original procedure for the repair of fistula.
The Sims Position was a gynecological examination position that granted the physician a more unobstructed view of the vagina and cervix than had previously been observed.
“In this position the thighs are to be flexed at about right angles with the pelvis, the right a little more than the left. The left are is thrown behind, and the chest rotated forwards, bringing the sternum quite closely in contact with the table, while the spine is fully extended, with the head resting on the parietal bone.’”
The Sims Speculum is a ‘U-shaped’ instrument that, when used in tandem with the Sims Position, allowed the physician a clear view of the surgical site. The patient lay on their side with one leg pulled towards the abdomen and the speculum is inserted from behind. Aside from the surgical uses of the Sims Speculum, it was significant because it required an assistant to hold the speculum in place for the physician. In Sims’ case, these assistants were almost exclusively women. Sims was insistent on the presence of female assistants in gynaecological procedures, as well as preventative visits. He believed that women would not attend routine check-ups if there was not another woman present in the room.
Heaton, Claude E., ‘The Influence of J. Marion Sims on Gynecolocy [sic]’, Reprinted from Bulletin of the New York Academy of Medicine, Sept. 1956, Vol. 32 No. 9. P. 687, PAMPHLET.
Sims, J. Marion, Silver Sutures in Surgery, Samuel S. & William Wood, New York, 1858, pp. 29-31.
Sims Sigmoid (self-retaining) Catheter
Sims’ final innovation, with regards to the repair of VVF, was the Sims Sigmoid (self-retaining) Catheter. This catheter was designed to remain in place throughout the patient’s 4-6 week recovery from vesico-vaginal repair surgery.
Aside from his work with VVF, Sims also founded the first women’s hospital in the United States. The Woman’s Hospital was founded in 1852, in NYC, and was the first hospital in the US to exclusively treat the diseases of women. Sims was also one of the fore-runners in the field of sterility treatment and performed one of the earliest successful artificial inseminations.
Illustration from: Sims, J. Marion, Silver Sutures in Surgery, Samuel S. & William Wood, New York, 1858, p. 29.
Sims was heavily criticized for his studies on fertility. Heaton, Claude E., ‘The Influence of J. Marion Sims on Gynecolocy [sic]’, Reprinted from Bulletin of the New York Academy of Medicine, Sept. 1956, Vol. 32 No. 9. P. 688, PAMPHLET; Sims, J. Marion, Clinical Notes on Uterine Surgery, With Special Reference to the Management of the Sterile Condition, William Wood & Co. New York, 1871, pp. 365-369.
Sims, J. Marion, Silver Sutures in Surgery, Samuel S. & William Wood, New York, 1858, p. 47.
For example, see: Harris, Seale, Woman’s Surgeon: The Life Story of J. Marion Sims, The MacMillan Company, New York, 1950, pp. 84-85; Sims, J. Marion, Clinical Notes on Uterine Surgery, With Special Reference to the Management of the Sterile Condition, William Wood & Co. New York, 1871, pp. 12-20, 23