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THE IDEA that health problems peculiar to women deserve separate and distinct medical
and surgical attention simply had not been conceived before the middle of the nineteenth
century. Some physicians even refused to examine women or to treat them for other
than ordinary afflictions. Their reasons ranged from realization of their own shortcomings
to ludicrous pseudo modesty. Meanwhile, sick women suffered in silence and in seclusion.
In maintaining this attitude, New World doctors of the early 1800’s followed
the practice of European physicians, to whom they looked for leadership in medicine.
They were importers of ideas; seldom exporters. However, there were a few, but important,
exceptions. Rugged physicians, faced with the myriad medical problems of the new
American frontiers, and without consultants or publications to fall back upon, were
forced to improvise, to invent, to experiment, to take chances. Out of their experiences,
when they could find time to write them down, came some remarkable contributions
to medical knowledge; and medical communication across the Atlantic began to acquire
a two-way flow.
Near the frontier village of Danville, Kentucky, Dr. Ephraim McDowell (1771-1830)
performed the first of a series of ovariotomies in 1809, about which he published
a report in 1816. These intra-abdominal operations, eight of thirteen of which were
successful, were performed without benefit either of anesthesia or of antisepsis.
Although John Light Atlee (1799-1885) of Lancaster, Pennsylvania, performed ovariotomy
successfully in 1843, as did his younger brother, Washington Lemuel Atlee (1808-1878)
in Philadelphia, no European physician followed McDowell’s lead for several
decades.
In 1833, Army Surgeon William Beaumont (1785-1853) published reports of his remarkable
studies on secretion of gastric juice in his famous patient, Alexis St. Martin,
which he began while stationed at a frontier fort on Mackinac Island, now a part
of Michigan.
On the Georgia frontier, Dr. Crawford W. Long used ether to anesthetize patients
undergoing surgical procedures, as early as 1842; but reports from surgeons at Massachusetts
General Hospital in Boston of demonstrations by Dr. William T.G. Morton in 1846
gave basic principles of surgical anesthesia to the world.
During early decades of the nineteenth century, a penniless South Carolina country
boy was growing up. In his youth and early manhood he showed little promise beyond
the ordinary-but he was destined to launch a new medical specialty, gynecology,
land not only to take the lead in surgery for women in the United States, but to
become an accepted leaders and teacher abroad. His name was James Marion Sims.
Eldest of eight children fathered by a tavern keeper and local politician, James
Marion Sims was born January 25, 1813, near Hanging Rock Greek, Lancaster County,
South Carolina. He grew to manhood in Lancaster. His mother wished him to become
a minister; his father, a lawyer, Having no enthusiasm for either of these callings,
Marion Sims decided upon medicine. Perhaps the fact that the father of Eliza Theresa
Jones, the girl he loved who lived “on the other side of town,” had
been a physician, helped him make his decision. Sims began study in the office of
Theresa’s uncle, Dr. B.C. Jones, then registered for a course of lectures
in the Medical College at Charleston, from which he graduated in 1834, at the age
of twenty one. The following year Sims attended Jefferson Medical College In Philadelphia,
receiving his M.D. degree in 1835.
Nothing pointing to future greatness was evident either to Dr. Sims or to his home
town neighbors when he returned to Lancaster, South Carolina, to practice. Of himself,
Dr. Sims wrote: “When I graduated, I felt absolutely incompetent to assume
the duties of a practitioner…I had had no clinical advantages, no hospital
experience, and had seen nothing at all of sickness. I had been able to buy a full
set of instruments for surgical operations, land I laid in a full stock of medicines
in Philadelphia. My father rented me a office on Main Street, I had a sign painted
on tin…”To detract further from the young physician’s confidence,
his first two patients, infants, died under his care. Had he not been completely
without means, Sims would have given up medicine then and there; he did decide to
leave Lancaster, and proceeded by horseback to the frontier town of Mount Meigs,
Alabama, a trip requiring three weeks of difficult travel. In Mount Meigs, his fortune
changed; most of his surgical patients recovered; most of his medical patients got
well; his practice thrived.
Dr. Sims married Theresa Jones in 1836. For the next three years Dr. Sims practiced
successfully – then he and his family were struck down by a series of attacks
of malarial fever. These so reduced Sims’ ability to practice that his savings
were exhausted. He determined to seek a healthier climate and relocated in Montgomery,
Alabama.
In addition to regaining his health, Sims, who previously had had little interest
in medicine except as a means of making a living began to mature professionally.
He developed a successful general practice, and increased his reputation as a skillful
surgeon. At the rear of his home he built a one-story frame building that would
accommodate eight beds, to serve as a hospital. He also began training young men
in medicine and surgery.
In Montgomery, too, Dr. Sims performed a clever, difficult operation for harelip
and missing upper jaw, the report of which became his first paper published in a
major journal. There, too, he believed he had discovered the cause of trismus nascentium,
a condition of tetanus in infants. Sims ordered infants showing signs of this condition
removed from their strait-jacket-like cradles, where they lay on their backs virtually
immobilized, and saw to it that they were placed on their sides and their positions
changed frequently to relieve pressure on the point where the spine joins the skull.
Until 1845, Dr. Sims had taken little interest in women patients beyond caring for
ordinary ailments. Until June of that year, he had never encountered a patient suffering
with vesicovaginal fistula-an opening resulting from tears in tissues between vagina
and bladder, or rectum, from difficult childbirth, permitting drainage either from
the bladder or from the rectum, or sometimes from both, into the vagina. Continuous
uncontrollable leakage of urine or feces from the vaginal caused both physical and
mental agony to unfortunate victims, who not only were shunned by family and by
friends, but hated themselves while doomed to an almost intolerable lifetime of
discomfort and of seclusion. However, in the course of two months, Dr. Sims was
called upon by owners of three young female slaves. Anarcha, Betsey, and Lucy, who
suffered from such fistulas, and he was requested to do something to relieve them.
Sims, finding no published report of successful surgical treatment for vesicovaginal
fistula, pronounced them incurable. However, the owner of Lucy insisted upon sending
her to Dr. Sims office for examination. The doctor was regretfully about to send
Lucy back home when a set of circumstances altered the young surgeon’s life
– and Lucy’s life, as well.
Dr. Sims was called that morning from his routine rounds to care for a woman who,
thrown from a horse, had injured her pelvis and was in great pain. Sims, having
determined that there were no fractures, was faced with the problem of relieving
her intense pain. According to his own report: “If there was anything I hated,
it was investigating the organs of the female pelvis. But this poor woman was in
such a condition that I was obliged to find out what was the matter with her. It
was by a digital examination, and I had sense enough to discover that there was
retroversion of the uterus…” A long forgotten aphorism of one of his
former teachers came to mind: he placed the patient in the knee-chest position,
and with further digital manipulation, air was admitted to the vagina, pressure
restored the uterus to its normal position, and the patient was relieved of her
pain almost instantly.
The thought flashed through Dr. Sims’ mind could he not put Lucy in a similar
position and see the relationship of the fistula to surrounding tissues: “Fired
with this idea,” wrote Sims, “I forgot that I had twenty patients waiting
to see me…I jumped into my buggy and hurried home. Passing by the…store,
I bought a pewter spoon…”
Calling his two assistants, Dr. Sims went to the hospital and told his patient he
wished to re-examine her. Placing her on a table, he directed her to assume the
knee-chest position. As Sims inserted the bent handle of the spoon into the patient’s
vagina, he reported: “I saw everything, as no man had ever seen before. The
fistula was a plain as the nose on a man’s face…I said at once, “Why
can not these things be cured?” I immediately went to work to invent instruments
for performing the operation…”He was so confident that he not only
kept Lucy at the hospital, but he sent also for Anarcha and Betsey, telling their
masters he would them up at his own expense until they were well.
Dr. Sims’ confidence that he could cure vesicovaginal fistula surgically was
to be sorely tried. His first operations proved failures; while the fistulas might
be greatly reduced, infections resulted around silk sutures, and small opening remained
– small opening that leaked as much as large ones. Three years of trial and
error and discouragement followed. Finally, in 1849, Dr. Sims determined to use
thin pure silver wires as sutures, securing them with pieces of lead. Anarcha became
subject of the experiment; it was her thirtieth operation. The operation was successful;
there was no infection about the silver wire sutures; the fistula was closed. In
the next two weeks, Lucy and Betsey were cured by similar operations.
Dr. Sims was amazed at the number of women suffering from vesicovaginal fistula
who came out of seclusion to seek his help, when word of his success got around.
The Sims position, a more comfortable adaptation of the knee-chest position, and
the Sims speculum, bear the doctor’s name even today.
Just when Sims seemed to be on the road to success, fate dealt him more blows. His
second son died; and Sims himself became victim of a chronic intestinal infection
– a disease that was proving fatal to many persons in the Southern states.
After trying for three years to regain his health, the discouraged doctor, believing
death was near, decided to publish his manuscript on operations for vesicovaginal
fistula. It appeared in the January, 1852, issue of the American Journal of Medical
Sciences. Needless to say, it met with more skepticism than enthusiasm.. .
In a desperate effort to regain his health, Dr. Sims finally decided in 1853 a move
permanently to New York City. This was quite an undertaking for the family rooted
for generations the South. He struggled to gain a foothold; but poor health, irritability,
poverty, and jealousy on the part of his colleagues in the city, held him back.
Though he had opportunities to demonstrate his operation, surgeons frequently adopted
his techniques and sent no more referrals to Sims.
Out of meditation during idle time came his conviction that women deserved greater
consideration by the medical profession. Gradually in Sims’ mind a new idea
developed; a special hospital for care of women and for performance of the operation
at which he had become so adept. Dr. Sims gained little support or interest until
by chance he struck up a friendship with Henri Luther Stuart, former newspaper-man
and free lance writer with many contacts. With Stuart’s aid and introductions,
Dr. Sims met a number of New York’s wealth philanthropic leaders. With the
help of an active group of influential women, Dr. Sims was able to overcome almost
insuperable obstacles of finance, of prejudice, and; of opposition from medical
men. On May 4, 1855, Woman’s Hospital – the first gynecologic hospital
in the United States – opened its doors. At first it had but 30 beds and Dr.
Sims was its only surgeon. Constant charitable activity and much ingenuity on the
part of the Lady Managers’ committee were required to keep its doors open.
Gradually, however, the hospital grew. Other gynecologic operations were undertaken;
the staff was increased; doctors from near and far were welcome to visit the operating
room to observe Dr. Sims’ methods. Eventually, land for expansion was secured
between Forty-ninth and Fiftieth streets (now the site of the Waldorf-Astoria Hotel)
and foundations were laid in 1863 for a new and expanded state-chartered hospital
– The Woman’s Hospital in the State of New York. Dr. Sims continued
as titular head of its surgical staff.
Meantime, however, other events were developing that were to influence Dr. Sims’
life. The War between the States put him in an embarrassing position; he and his
family could not put out of mind their Southern ties, and such beliefs were highly
unpopular in New York. Sims decided to take a vacation trip to Europe – a
sort of “postman’s holiday” – for European surgeons had
heard of him, and he was invited to demonstrate his vesicovaginal fistula operations
in leading continental medical centers. Dr. Sims then became an international commuter,
he moved his family to Paris for the duration of the war. He became physician to
queens and empresses, as well as to charity patients. In 1870 and 1871, he served
as military surgeon in the Anglo-American Ambulance Corps during the France-Prussian
war. For his impartial services to sounded soldiers, he was decorated both by French
and by German governments.
Dr. Sims returned to New York in 1872, and again took part in activities of the
expanding Woman’s Hospital. His staff and patient load had grown rapidly.
In 1874, however, the Board of Lady Supervisors passed bylaws limiting the number
of visitors who could witness operations and refusing admission to cancer patients.
Dr. Sims’ ire was aroused; he arose and vehemently, perhaps undiplomatically,
voiced his opposition. He announced that unless the two rules were repealed at the
next meeting, he would leave the hospital. Dr. Sims’ resignation was accepted,
December 22, 1874. This was a great blow to the aging surgeon; but if his popularity
was at a low ebb in New York, the condition did not prevail elsewhere. The following
year, 1875, he was elected president of The American Medical Association.
Dr. Sims’ work was not limited to gynecologic surgery; he also did basic work
on control of dysmenorrheal, on overcoming sterility, and on artificial insemination.
In 1878, he initiated an operation for removal of gallstones and gave it the name
cholecystotomy. In 1880, Dr. Sims was named president of the American Gynecological
Society, an organization which he had helped to found. In the same year, he was
reinstated as consulting surgeon to Woman’s Hospital. Dr. Sims, by then, however,
was spending much of his time in Europe, where his reputation was a great as it
was in the United States. In 1881, he was made honorary president of the International
Medical Congress at Geneva.
About to return to Rome, where he had built a successful practice, Dr. Sims, in
his seventy-first year, seemingly in good health, while sitting in bed working on
his autobiography early in the morning of November, 13, 1883, had a seizure of dyspnea.
His son, Dr. Harry Marion Sims, rushed to his side, but the father died without
a word.
Dr. Marion Sims, to whom so many women owed lifelong debts of gratitude, indeed
had a fruitful, inspiring career. His first operations on suffering women were performed
without benefit either of anesthesia or of antisepsis; yet, within his lifetime
he was to add both these booms to mankind – and to womankind – to his
operating techniques. Not only are the surgical feats he performed still outstanding;
he led pioneers in gynecology to respectability and to recognition on a high plane.
He invented new instruments to meet new requirements. He brought to medicine a new
concept; hospitals devoted to the special surgical and medical needs of women. Equally
important, he carried these bold, brilliant ideas, pioneered in America, back to
Europe, and taught Old World physicians how to use them for relief of countless
thousands of women world-wide.
THE PICTURE
Little did James Marion Sims, M.D., (1813-1883) dream, that summer day in 1845,
as he prepared to examine the slave girl, Lucy, that he was launching himself on
an international career as a gynecologic surgeon; or that he was to raise gynecology
from virtually an unknown to a respected medical specialty. Nor did he realize that
his crude back-yard hospital in Montgomery, Alabama, would be the forerunner of
the nation’s first Woman’s Hospital, which Sims helped to establish
in New York in 1855. Dr. Sims, who became a leader in gynecology in Europe as well
as in the United States, also served as president of The American Medical Association
in 1875-1876.
REFERENCES:
Ackerknecht, E.H.: unpublished monograph.
Ackerknecht, E.H.: American Gynecology Around 1850. Reprint from the Wisconsin Medical
Journal, March, 1952.
A Century of Service. The Times – News of the Woman’s Hospital, Division
of St. Luke’s Hospital, New York, Vol.7, No.2, May 1955.
Harris, Seale, Woman’s Surgeon. New York, Macmillan Company, 1950.
Heaton, Claude E: The Influence of J. Marion Sims on Gynecology. Reprint from the
Bulletin of the New York Academy of Medicine, Second series, Vol.32, No.9, September,
1956.
Marr, James Pratt, James Marion Sims, New York, 1949.
Marr, James Pratt, Pioneer Surgeons of the Woman’s Hospital, Philadelphia,
F.A. Davis Company, 1957.
Delphia, F.A. Davis Company, 1957.
Sims, J. Marion: The Story of My Life. New York, D. Appleton & Co., 1889.
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