This post was inspired by Doc Gurley’s call for submissions to this week’s Grand Rounds, the theme of which is Improvisation.
Sims was a family doctor practicing in Montgomery, Alabama in the mid 1800’s. Although he had no expertise in or desire to treat “women’s disorders”, he was referred, in quick succession, three young African slaves suffering from vesicovaginal fistula – a hole between the vagina and the bladder that develops as a result of prolonged obstructed labor. No one had yet developed an operation that could cure the condition, and Sims had declared the women inoperable.
But just before he was about to send the third young women back to her owner’s plantation to live forever with her debilitating condition, something happened that changed both Sim’s mind and the field of medicine forever.
Sims was called upon to care emergently for a white woman who fell from her horse and who was in great pelvic pain. Assuming that her pain was from acute malposition of the uterus, and remembering a trick taught to him by one of his former professors, Sims asked the woman to get on her knees and elbows. He then inserted two fingers into the vagina, vigorously pumping up and down to reposition the uterus. As he did this, the woman’s uterus fell back into position, relieving her pain. At that moment, a large amount of air burst from the vagina. Although this embarrassed the woman, it gave Sims an idea of how he might help the African slave languishing untreated in his backyard hospital.
If depressing the vaginal walls allowed air to get into the vaginal cavity, could he somehow create an instrument to do the same thing and allow access to the area of the fistula?
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 genupectoral position, inserted the improvised speculum and atmospheric pressure accomplished the rest. The fistulous opening was clearly seen.
“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 walls of the vagina could be seen closing in every direction. The neck of the uterus was distinct and well defined and even the secretions from the neck could be seen as a tear glistening in the eye clear even and distinct and as plain as could be. I said at once “Why can not these things be cured?”
Sims operated using his speculum, but the operation failed. The fistula persisted, albeit smaller than before. It would be years, and many more operations on these same women and others, before he perfected a surgical technique using silver wire suture that resolved the fistulae completely.
Over time, Sims would come under increasing scrutiny and criticism for what some said was unethical experimentation on his patients, who were all female slaves, and whose operations were performed without anesthesia. Sims did give post operative pain relief, in the form of large amounts of opium – another practice that put him under suspicion. Reportedly, Sim’s patients themselves remained faithful to him in their desperate hope to resolve their plight – faithful to the point of serving as his surgical assistants when his medical colleagues abandoned him to his experiments.
Some say Sims used the African slaves to experiment on surgical techniques he would someday use with white women under anesthesia, and condemn Sims as a racist monster. Others say he was just a man of his time who gave away service for free to slaves suffering from what had been heretofore an incurable condition.
Whatever you think of Sims, it is important that we remember and honor the three slave women who served as his patients, and known only by their first names – Anarcha, Lucy and Betsey.
It is also important to remember that even today, over two million women in sub-Saharan Africa and Asia suffer from vaginal fistula, as a result of unattended childbirth and violent rape. International efforts are being directed at treatment for these women, but prevention demands that all women have access to skilled birth attendance and access to emergency obstetrical care.
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Sources –
Sims, JM. The Story of My Life. New York, D Appleton & Co, 1894. via Google Books.
Harris, Seale, MD. Women’s Surgeon – The Life Story of Marion Sims. New York, The MacMillan Company, 1950.
Sartin, JS. J Marion Sims, the Father of Gynecology – Hero or Villain?
Ojunaga, D. The Medical Ethics of the Father of Gynecology“. Journal of Medical Ethics 1993; 19: 28-31.
Sims Speculum image from Wikipedia. Surgery Image from National Library of Medicine.
Indeed, it is a sad comment about the world in which we live that most women in the so called ‘Third World” do not have access to even the most rudimentary gynaecological or obstetric healthcare and that vaginal fistulae are so common. In my profession as a paramedic, I once ran to a job, on my own, and my patient was a young Somali / Sudanese woman who was in the final stage of labour. What made it a total Holy Cow / jaw hit floor moment for me was that this woman had been subject to an infibulation, something I had only heard about. Shocked as I was at the mutilation I saw as I delivered the baby, one has to realize that one is dealing with a different culture and must not be judgmental. It is difficult to understand a world where the culture is so alien to our own and where poverty is a way of life, or usully, death. Even to this day I think of that poor, young woman. It still makes me shudder and wonder if I misread the textbooks! Visiting the US I found out that most women there have access to their own gynaecologist… Which I find remarkable. Living in England, in my 53 years I have never seen a gynaecologist!
Love this medical history lesson. I hope you submit this one to SurgeXperiences.
Hi,
Great post. My father, a physician, recently wrote a paper on Dr. Marion Sims. I thought I would comment on a few things. First of all, it is a wonderful paper. However, Dr. Sims actually used the local jeweler to make the instument as the Hardware store was unable to create the needed object. As to the slave controversy, Dr. Sims did own many slaves and was known for his stance against secession. He actually went to Europe for the duration of the civil war and returned to to practice in the Northeast after the war. I know that his contribution to medicine is significant and is still used today.
I apologize if I sound critical or in any way offended you. I have also forwarded the post to my father.
Thanks and great job,
Sailing M.
M Sailing –
Thanks for your comments, and no offense taken.
Sims did initially use spoons from the hardware store as described, if one is to believe his autobiography and the biography I quoted by Seale.
Once it was clear the spoons worked, he then had a jeweler forge a speculum that mimicked the tool he improvised, just as you desribe.
You can read Sims’ autobiography on google docs – just follow the link I gave (The internet is amazing, isn’t it?).
If your dad’s article is on the internet, give me the link and I’ll add it to the end of my post for others to read.
Peace,
TBTAM
So typical of white people too belittle the evils of their ancestors so they can uplift themselves and call it accomplishment. The man was a doctor and those slaves he owned were never his property they were kidnapped victims that till this day people refuse to see a human. You will call the, slaves before you call them human. You will call them property before kidnap victims. You sick people.
How to show you how offensive it is is saying “some say he ….. ” we consider this some say that Hitler killed a lot of Jewish people. But it is ok to wash away the wrongs done to my people because we are just apes you know non humans who need to get over it. Screw you. Some say. The man was a white monster.
Horrendous as it was, those women were not KIDNAPPED. Wrong term. Not making light of their suffering at all but kidnapped is the wrong term.
They were never able to go back to the horrendous owners again and the woman stayed with Sims and helped him with his research. I am sure they had no choice though.
Karen,
Monique is referring to the fact that all slaves are kidnapped victims because they are being held against their will. The fact that you mentioned “owners” solidifies this.