American Medical Biographies/Sims, James Marion

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Sims, James Marion (1813–1883)

J. Marion Sims was on his father's side English, on his mother's of Scotch-Irish descent. His paternal grandfather, John Sims, was born December 27, 1790, and married Mahala Mackey in 1812. Of the father, his distinguished son left a record that "he was one of the best of men and best of husbands." He was sheriff of Lancaster County, South Carolina, from 1830–1834. His mother was the daughter of that Lydia Mackey, wife of Charles Mackey, a revolutionary soldier, who having been taken within the British lines, was tried by court-martial and sentenced to death as a spy by Col. Tarleton, and she successfully interceded with this British officer for the commutation of the death sentence, and ultimately obtained her husband's liberty.

Marion Sims was born in Lancaster District, South Carolina, January 25, 1813. He attended the common schools there, entered the Franklin Academy in 1825, and later was sent to the South Carolina College at Columbia, from which he graduated in December, 1832. Speaking of himself at this time he says:

"I never was remarkable for anything while I was in college except good behavior. Nobody ever expected anything of me, and I never expected anything of myself." What a mistake of the youth concerning the man who was to achieve the greatest reputation ever accorded to an American surgeon.

On the twelfth of November, 1833, he matriculated at the Charleston Medical School, where he attended lectures for one year, and in 1834 became a student at Jefferson Medical College, Philadelphia, from which he graduated in 1835. In May of that year he settled as a practitioner in Lancaster, but after a short period of discouragement removed in the fall of 1835 to Mount Meigs, Montgomery County, Alabama, where he was soon recognized as a clever doctor. While living here he volunteered in the Seminole War and in an expedition against the Creek Indians. Returning from this public service, and ambitious for a larger field, he established himself in Montgomery, the capital of the State, in December, 1840.

The boldness and success of his operations in general surgery soon attracted a large clientele, which encouraged him to establish a private hospital, and within a few years he startled the professional world by the announcement of the cure, by an original method, of a series of cases of vesico-vaginal fistula. Up to that time there was not an authenticated successful treatment for this important surgical lesion, and when the science of obstetrics was in its infancy there were thousands of women who, as a result of unskilful attendance in childbirth, were left in the most deplorable and loathsome condition by reason of injuries to the bladder; they were, in fact, among the most wretched and pitiable of human beings, and attracted the sympathy and attention of the enterprising young surgeon. He sought out a number of these helpless women, gave them shelter and free treatment in his hospital, and after several years of patient, anxious and persistent effort, finally succeeded in curing them. In the evolution of this operation he invented the silver-wire suture and the duck-bill speculum, the announcement of these successful cases attracting world-wide attention, and in many quarters being received with incredulity.

The invention of the speculum came about in this way: Early one morning in 1845 a countrywoman riding on horseback into Montgomery was thrown from her horse and suffered a displacement of the uterus. Sims was called to see her, and found her in bed complaining of great pain in her back and a sense of tenesmus in both bladder and rectum.

A digital examination revealed a retroversion of the uterus. He placed the patient in the knee-elbow position, inserting two fingers into the vagina in the effort to push the womb into place. To his great surprise there was an inrush of air which dilated the vagina and exercised pressure enough to carry the displaced organ into position. The ballooning of the vagina by atmospheric pressure brought all parts of this hitherto inaccessible surgical region into full view. Forgetting everything for the moment except the value of this important revelation, he jumped into his buggy, and drove hurriedly to a hardware store in Montgomery, where he bought a set of pewter spoons of different sizes. Bending the bowl and part of the handle of one of these at a right angle, he placed one of his patients suffering from vesico-vaginal fistula in the genu-pectoral position, inserted the improvised speculum, and atmospheric pressure accomplished the rest. The fistulous opening was clearly seen. He says:

"Introducing the bent handle of the spoon, I saw everything as no man had ever seen before. The fistula was as plain as the nose on a man's face; the edges were clear and well defined, and the opening could be measured as accurately as if it had been cut out of a piece of plain paper. The speculum made it perfectly clear from the very beginning. I soon operated upon the fistula, closing it in about an hour's time, but the operation failed."

He did not then know the cause of failure, but later discovered that it was due to infection from the use of silk ligatures. Not long after this, in walking from his home to his office, he noticed upon the ground a bit of spiral wire, such as was used to give elasticity to suspenders before the days of India rubber. He picked up the wire, uncoiled it and it came over him at once that he had found a suture which, if made of a pure metal, would not only hold, but be less apt to induce infection. He carried the wire immediately to a silversmith in Montgomery, gave him a half-dollar silver piece, and asked him to beat that into a wire of the size of the brass wire he presented. This was skilfully done by the smith, and with this wire and the speculum was done the first successful operation for vesico-vaginal fistula, and Marion Sims had taken the first great step towards the immortality which awaited him. Of this instrument the illustrious Thomas Addis Emmett said:

"From the beginning of time to the present, I believe that the human race has not been benefited to the same extent and in a like period by the introduction of any other surgical instrument. Those who did not fully appreciate the value of the speculum itself have been benefited indirectly to an extent they little realize, for the instrument in the hands of others has probably advanced the knowledge of the diseases of women to an extent which could not have been done for a hundred years or more without it."

But it was not alone in this particular line that he achieved distinction, but also in other departments of surgery.

In 1835 he performed a successful operation for abscess of the liver; in 1837 one for removal of the lower jaw without external mutilation, the operation of excision being done entirely from within the mouth, and a successful removal of the superior maxilla for tumor of the antrum. He performed originally the operation of Cholecystotomy, without the knowledge of the fact that Dr. Bobbs (q. v.), of Indiana, to whom he always accorded full credit, had preceded him by a few months.

To him it may well be said that mankind is indebted for the surgical invasion of the peritoneal cavity. In his great paper entitled: "The Careful Aseptic Invasion of the Peritoneal Cavity for the Arrest of Hemorrhage, the Suture of Intestinal Wounds and the Cleansing of the Peritoneal Cavity, and for all Intraperitoneal Conditions," before the New York Academy of Medicine, on October 6, 1881, quoting from his own experience as surgeon-in-chief of the Anglo-American Ambulance Corps in the Franco-Prussian War, Dr. Sims courageously promulgated these rules:

1. The wound of entrance should be enlarged sufficiently to ascertain the whole extent of the injuries inflicted.

2. These should be remedied by suturing the wounded intestine and ligating bleeding vessels.

3. Diligent search should be made for extravasated matter, and the peritoneal cavity should be thoroughly cleansed of all foreign matter before closing the external wound.

4. The surgeon must judge whether the case requires drainage or not.

In 1853 he established himself in New York City, and in February, 1855, organized the "Woman's Hospital in the State of New York," with this becoming the founder of the great science of gynecology. From the temporary structure at 83 Madison Avenue, the hospital was removed to the block of ground donated to it by the city on 50th Street and Lexington Avenue, whence after nearly a half century it was removed to the magnificent new building at 110th Street and Morningside Heights.

In 1861 Dr. Sims for the first time visited Europe, and on the eighteenth of October of that year, at the Hotel Voltaire, successfully demonstrated his operation for vesico-vaginal fistula. Among those who witnessed this operation were some of the greatest surgeons of that age, Nélaton, Velpeau, Civiale, Baron Larrey, Sir Joseph Olliffe, Huguier and others. By this and other cases his presence in Paris created a furore in medical circles. So great was the reputation achieved that he was called to all parts of Europe, not only to operate, but in consultation, and to treat various maladies in the department of gynecology; in fact, a short time saw him enjoying a most lucrative practice among the best people in European capitals. Upon one occasion, in attendance upon an important case, he became for several weeks the guest of the Emperor Napoleon at St. Cloud.

After the close of the Civil War in America Dr. Sims returned to New York, but upon the outbreak of the Franco-Prussian War in 1870, he sailed for Europe, and there organized and became surgeon-in-chief of the Anglo-American Ambulance Corps. He rendered such distinguished professional services, especially at and after the battle of Sedan, that the French Republic conferred upon him the order of Commander of the Legion of Honor. From this time until his death, November 13, 1883, he lived alternately in Europe and America, busily engaged in practice of his profession wherever he found himself.

Dr. Sims contributed extensively to professional literature, not only as it related to obstetrics and gynecology, but to medical and surgical science in general. His most important professional work was entitled "Clinical Notes on Uterine Surgery."

Among the many official positions which he occupied was that of the president of the American Medical Association, in 1876.

Near the close of his long and eminent career as a practitioner and teacher of gynecology, Prof. T. Gaillard Thomas (q. v.), in an address to the graduating class of the medical department of Cornell University, delivered at Carnegie Hall, said:

"If I were called upon to name the three men who in the history of all times had done most for their fellow men, I would say George Washington, William Jenner and Marion Sims."

Immediately after his death a movement for the erection of a statue in his memory was inaugurated in Europe and in his native country, and in 1894 there was unveiled in Bryant Park, New York City, a statue in bronze, a life-like image of the great teacher, the spontaneous gift from his brothers in the profession throughout the civilized world, and from many of the unfortunate beings his genius and skill had benefited. In brief yet comprehensive phraseology, the inscription tells the story of his career:

J. MARION SIMS. M. D., LL. D.
BORN IN SOUTH CAROLINA, 1813. DIED IN NEW YORK CITY IN 1883.
SURGEON AND PHILANTHROPIST.
FOUNDER OF THE WOMAN'S HOSPITAL OF THE STATE OF NEW YORK.
HIS BRILLIANT ACHIEVEMENTS CARRIED THE FAME OF AMERICAN SURGERY THROUGHOUT THE CIVILIZED WORLD.
IN RECOGNITION OF HIS SERVICES IN THE CAUSE OF SCIENCE AND MANKIND
HE RECEIVED THE HIGHEST HONORS IN THE GIFT OF HIS COUNTRYMEN
AND DECORATIONS FROM THE GOVERNMENTS OF FRANCE, PORTUGAL. SPAIN, BELGIUM, AND ITALY.

On the reverse:

PRESENTED
TO THE CITY OF NEW YORK
BY
HIS PROFESSIONAL FRIENDS,
LOVING PATIENTS,
AND
MANY ADMIRERS
THROUGHOUT THE WORLD.

Marion Sims possessed a striking personality. With all his long and bitter struggle with poverty and for professional recognition, and in his early days for health and life itself, time had dealt gently with his form and face, whereon nature had set in unmistakable lines the stamp of greatness. Although he had rounded well the years allotted by the psalmist, his step was still quick and firm, his carriage erect, dignified and graceful. The frosts of age had not tinged the rich abundance of his dark-brown hair, which fell straight back from off the massive forehead, for the ever-active brain and the deep-seated, searching eyes of brown, asked always for the light! The brows were arched and unusually heavy and prominent; the nose beautifully proportioned and of Grecian type; the mouth well shaped, lips usually compressed, which, with the prominent chin, bespoke courage and firmness of purpose. His face was oval, clean-shaven and smooth, and the usual expression was of almost womanly sweetness, yet it was quick to vary in harmony with whatever emotion was predominant. Away from excitement and in the home-life, his expression and actions were almost boyish. He never seemed to have forgotten that he was once a boy, and he would throw himself into a household frolic with all the abandon of his early days. He was courageous to a degree, and, although he rarely lost control of his temper, yet he was at times imperious and aggressive. When occasion demanded he was a good fighter, and fought his enemies with right good will; but he was quick to forgive, and just before his death he said one day, "I have forgiven all who ever did me wrong, with one exception." As said of him by a gifted orator, he possessed qualities ideal in the make-up of a truly great surgeon, "the brain of an Apollo, the heart of a lion, the eye of an eagle, and the hand of a woman."

A full list of his writings may be seen at the end of "The Story of My Life," New York, 1884; they include: "On the Treatment of Vesico-vaginal Fistula," Philadelphia, 1853; "Silver Sutures in Surgery," New York, 1858; "Clinical Notes on Uterine Surgery," New York, 1866.

Tribute to Janies Marion Sims, W. O. Baldwin, 1884.
In Memoriam, Austin Flint, James Marion Sims W. M. Carpenter, 1886.
Amer. Jour. Obstet., N. Y., 1884, vol. xvii, P. F. Munde.
Boston Med. and Surg. Jour., 1883. vol. cix.
Galliard's Med. Jour., N. Y., 1883, vol. xxxvi, autobiography.
New York Med. Rec., V., 1883, vol. xxiv.
Trans. Amer. Gyn. Soc., 1884, N. Y., 1885, vol. ix.
Trans. Amer. Surg. Assoc., 1884, Phila., 1885, vol. ii.
Portrait in the Surg.-Gen's. Lib., Wash., D. C.