J. Marion Sims, the Father of Gynecology: Hero or Villain?

Jeffrey S. Sartin, MD

Disclosures

South Med J. 2004;97(5) 

In This Article

Struggle, Accomplishment, and Controversy

J. Marion Sims was born in 1813 in Lancaster County, SC, to a father of modest means and a mother from a somewhat more respectable family. Education was for him, like so many other Americans of his background, a ticket out of a hardscrabble and uncertain life. His early college career was undistinguished: I never was remarkable for anything while I was in college, except good behavior, Sims later wrote.[2] At age 20 he had to choose a professional course of study, and he chose medicine by default. I would not be a lawyer; I could not be a minister; and there was nothing left for me to do but to be a doctor.[2] Sims found medicine very stimulating, and worked hard in medical school. Upon graduation in 1835, however, he went back to Lancaster County to establish a practice with more than a little trepidation because of his lack of practical knowledge and experience.

Figure 1.

J. Marion Sims, MD. (Courtesy of National Library of Medicine.)

This anxiety was soon borne out by events, as he lost his first two patients, infant children afflicted by persistent diarrhea. Deciding his luck might be better out West, he moved to Alabama in October 1835 and hung out his shingle. He mostly floundered that first year, finding himself compelled to treat grave conditions with the inadequate medical armamentarium of the times. The possibilities of aggressive empiricism were, however, suggested by an early experience in which a patient developed abdominal pain, with certain signs pointing equivocally toward a liver abscess. Sims convinced the reluctant patient to undergo surgery without anesthesia, and later recorded: I think it was one of the happiest moments of my life when I saw the matter [pus] flow and come welling up opposite that bistoury [scalpel].[2]

Sims had an active but uneventful career in Mount Meigs, AL, until 1840, at which time he moved with his young family to Montgomery. We had no money, and always lived from hand to mouth, Sims later recalled of his arrival in the city.[2] In Montgomery he began to make a name for himself as a respectable physician. He boasted of being the first doctor in the South to successfully treat club-foot and cross-eyes.

In the latter part of 1845, Sims' fortune took a decided turn for the better. According to his autobiography, Sims had been referred a young female slave named Anarcha, who suffered from a vesicovaginal fistula as a consequence of protracted labor. Sims pronounced her incurable, and was on the verge of sending her away, when an incident of pivotal importance occurred. A middle-aged woman was thrown from a horse, sustaining a pelvic injury. The young physician, then 32 years old, was called to examine her. His initial examination suggested uterine malposition as the cause of her pain, and in the attempt to examine her more thoroughly he had her squat on her knees and elbows in bed. He then introduced both his forefinger and middle finger into the vagina, and immediately the pelvic organs relaxed and the woman experienced relief.

This experience led Sims to an epiphany: he could use the same unconventional position to examine and treat his patient with the vesicovaginal fistula. That same day he bent a pewter spoon into a crude instrument and introduced it into the vagina of another slave patient named Betsey, and, according to his account, I saw everything, as no man had ever seen before.[6]

This was a literal as well as a metaphorical statement, for Sims was resolved to approach the examination and treatment of diseases of women in a new way. He modified his improvised speculum and began to design instruments for the surgical repair of this condition. Within three months he was ready to try the new techniques on his first slave patient, Anarcha, as well as another half-dozen female slaves with similar fistulae. He set them up in a special hospital building adjacent to his family home, making arrangements with their masters for their upkeep while under his care.

The next 3 years were trying for Sims, as he operated again and again in an attempt to solve the problem of persistent fistulae. He came to realize that closure of the surgical wounds with the standard, unsterilized silk or gut sutures was the cause of the operation's failure. He read of a Virginia surgeon's use of lead sutures and had a local jeweller make sutures of silver wire. This innovation prevented the wound infection which would predictably result in breakdown of the suture line.

When Sims examined Anarcha one week after her thirtieth surgery for fistula repair, he found "no inflammation, . . . no tumefaction . . ., and a very perfect union of the little fistula."[2] In fact, more than that, he knew he was revolutionizing medicine, not just in the form of an innovative surgical technique, but in terms of the approach of physicians to diseases in women.

At the time of this success Sims became chronically ill with a diarrheal illness. He traveled extensively to find the right combination of climate, water, and food to improve his health, and eventually decided to move to New York City in 1853. One year earlier he had published his account of the fistula repair in the Journal of the American Medical Sciences.[8] This article, while well received, was not quite enough to provide Dr. Sims with a suitable medical practice in New York, and he and his family (including now six children) struggled for several years until a fortuitous series of events culminated in the establishment in 1855 of the Woman's Hospital, a publicly and privately funded charity hospital exclusively for the treatment of female disorders (Fig. 2). By that time Sims' health had improved, and he was up to the task of moving forward as a charismatic teacher and the leading surgeon on the hospital's staff.

Figure 2.

The first Woman's Hospital in New York City. (Courtesy of New York Academy of Medicine.)

Over the next several decades, Sims' reputation grew. His hospital attracted a core of physicians–Drs. Thomas Emmet, Edmond Peaslee and T. Gaillard Thomas–who may be fairly said to be the progenitors of gynecology as a respected medical specialty in America. Sims, at first the most reticent of men, began to draw crowds of students in the surgical amphitheater, to write prolifically on all manner of diseases, and to lecture far and wide. His fame preceded him to Europe, and he moved there semipermanently during the American Civil War. In 1863 he ministered to the health of Empress Eugenie, wife of French Emperor Napoleon III. That year he began writing his innovative work Clinical Notes on Uterine Surgery,[4] which was controversial but widely read. All over the world doctors read Sims' casual, chatty text and promptly revolutionized their treatment of women's ailments according to its precepts.[5] Its straightforward approach to female diseases was refreshing, and its emphasis on treatment of sterility, including artificial insemination, was ahead of its time.

In the latter part of Sims' career he remained a forceful presence in gynecology. Perhaps his chief mark of distinction was a willful empiricism, the belief that no medical problem was insoluble, given enough thought and effort. He became an expert on pelvic and abdominal surgery, performing the first documented gallbladder surgery in 1878[6] and helping to usher in the new era of therapeutics made possible through the use of general anesthesia. He authored a highly influential pamphlet heralding the role of Crawford Long of Georgia in discovering ether and helped cement Long's role in the medical history books.[7] He was a forceful advocate for the use of Lister's antiseptic principles in surgery, leading the vanguard for this then-controversial theory.[5,8] His reputation is only slightly tarnished by his promotion of certain now-discredited techniques, such as cervicotomy for sterility and dysmenorrhea[8] and ovarian removal (ovariotomy, or Battey's procedure) for various physical and psychosomatic conditions then termed hysterical diseases.[8] He was an enthusiastic practitioner of these techniques, but hardly as evangelical as many of his colleagues at the Woman's Hospital, who reflected peculiarly Victorian notions regarding sexuality, organic disease, and mental illness.[8]

After Sims was comfortably ensconced in his New York practice at Woman's Hospital, he began to display a habit of occasional intemperate outbursts which provoked conflict and alienated many of his colleagues. In 1857 he used the occasion of a prestigious address before the New York Academy of Medicine (reprinted as Silver Sutures[9]) to criticize his former protégé Nathaniel Bozeman, who revised Sims' vesicovaginal procedure and had the temerity (from Sims' point of view) to try to claim some of the glory for himself.[10] Notwithstanding the fact that [Bozeman was] without any professional position till I gave it to him, that he is indebted to me for what he could never have obtained without my aid, he appropriates to himself every step of the operation that resulted from my own individual and unaided efforts..., Sims complained in the introduction to his honorary address.[9] He made a lifelong enemy of Dr. Bozeman, a result which would vex Sims again and again over the next 20 years.

In 1870 Sims published a newspaper account of his treatment of a famous actress, Charlotte Cushman, and found himself accused of ethical charges before the New York Academy of Medicine. He received a reprimand for resorting to paid advertising, and betraying the secrets of a patient.[5] This did not have a material effect on his practice, embarrassing though it was. In 1871 Sims was involved with helping to develop emergency medical services for the French during their conflict with Prussia. During a meeting of the American Sanitary Committee in Paris, he engaged in a heated quarrel with an American dentist named Evans. Sims grabbed him by the neck and punched him in the face before being forcibly restrained. Sims left Paris before charges were filed.[8]

In 1874 Sims committed a more critical error. For at least 2 years a great deal of personal animosity had simmered between Sims and the other eminent surgeons at Woman's Hospital, Drs. Emmet, Peaslee and Thomas. A large portion of this was professional jealousy, fueled in no small part by Sims' egotism, which led him to regard Woman's Hospital as his own personal fiefdom. The other board members voted to ban cancer surgery from the hospital and to limit the number of spectators at surgeries. Sims saw these restrictions as aimed directly at him, but kept quiet initially. At the hospital's anniversary party in November (normally a staid affair of good cheer) he let loose. I have never heeded your edict and never will; and if you are aggrieved at this you can have my resignation at your next meeting if you wish it.[5] To his surprise and regret, the hospital board took him up on his offer, and Sims was unceremoniously relieved of his association with the preeminent women's hospital in the country, which he was instrumental in founding 20 years earlier.

In 1875 he was elected president of the American Medical Association, partly based on the efforts of partisans who were upset at his treatment during the Woman's Hospital affair. His tenure was energetic, if not eventful. He continued to spend much time abroad, while managing a small boutique practice in New York. In 1877 he plunged into a reopening of the Woman's Hospital controversy by responding to a pamphlet written by Drs. Emmet, Peaslee and Thomas, and which was highly critical of his behavior. As biographer Seale Harris points out, It was one of the unwisest things he ever did.[5] The resulting publication[11] ensured that J. Marion Sims would continue to nurture enmity for many years until a belated reconciliation with his erstwhile friends and colleagues.

As the accolades accumulated in the latter part of his career, Sims' health declined. He suffered from recurrent episodes of diarrhea throughout his adult life, and in later years was troubled by the angina of ischemic heart disease. In 1883 an ailing Sims dictated The Story of My Life to a young secretary, covering his career up through the Civil War years. It would remain unfinished, cut short by his sudden death due to myocardial infarction on November 13, 1884, less than one day after performing a complicated operation upon a woman of some prominence.[5]

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