1 INTRODUCTION
Sims, almost with a magic wand, changed the whole subject from one succession of dismal failures to nearly a uniform success by new methods graphically described and clearly illustrated in a paper on "The Treat- ment of Vesico- vaginal Fistula" ("American Journal of Medical Sciences," vol. xxiii, 1852).
In 1853 he removed to New York City and in 1857 he delivered his memorable address on "Silver Sutures in Surgery." ("Transactions of New York Academy of Medicine," November, 1857.)
He visited Europe in 1861, teaching and honored, and awarded medals wherever he went; he returned to America in 1862, revisited Europe in the same year and remained there until 1868. For Sims' numerous contributions to surgery see "The Story of my Life," edited by his son, H. Marion Sims, New York, 1885, where in a brief biography by J. M. Toner, we have a list of his more important contributions on page 459.
In the dramatic rise of gynecological surgery in the fifties and sixties, the American surgeon deserves an unusual share of the credit of the evolution of the treatment of fistulas. A yet greater share of credit, for the working out rational operations for the treatment of the rup- tured vaginal outlet, including complete tear dividing the sphincter, is due to Thomas Addis Emmet. Emmet with the remarkable insight of genius caught Sims's idea at once, acquired his methods, and improved upon them and did more than any other surgeon to teach the members of the profession in this country how to do these operations at the Woman's Hospital in New York City. Emmet's book " A Treatise on Vesico-vaginal and Recto-vaginal Fistula," 1868, describes more graph- ically than anything written before or since, the methods of dealing with difficult cases.
Nathan Bozeman (1825-1905), another remarkable surgeon hailing from Alabama, also took up Sims' work and with some variations in the methods did many successful operations and became widely recog- nized as a teacher. (See "Remarks on Vesico-vaginal Fistula," Louis- ville, 1856.) (See also " Urethro-vaginal and Vesico-vaginal Fistula," "North American and Surgical Review," Philadelphia, 1851.)
Bozeman's merit is further enhanced by his treatment of pyelitis by irrigation of the kidney by means of a catheter introduced up the ureter through a vesico-vaginal opening. (See "New York Journal," vol. xlvi, 1887; also "American Journal of Medical Sciences," vol. xcv, 1888.)
The greatest inheritor of the skill of Sims and Emmet in the fields of plastic work appears to be E. C. Dudley of Chicago.
Alexander H. Ferguson describes a method of closure of a fistula by cutting deeply around its periphery through the vaginal walls down to the bladder. The circular flap made in this way is inverted into the
