J. Marion Sims
James Marion Sims (January 25, 1813 – November 13, 1883) was an American physician and a pioneer in the field of surgery, known as the "father of modern gynecology". His most significant work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth. He is also remembered for inventing Sims' speculum, Sims' sigmoid catheter, and the Sims' position. However, "one would be hard pressed to find a more controversial figure in the history of medicine."
J. Marion Sims
|Born||January 25, 1813|
|Died||November 13, 1883 (aged 70)|
|Alma mater||Jefferson Medical College|
Sims perfected his surgical techniques by operating without anesthesia on enslaved black women. In the 20th century, this was condemned as an improper use of human experimental subjects and Sims was described as "a prime example of progress in the medical profession made at the expense of a vulnerable population".
But Sims' medical ethics have also been defended by modern commentators. For instance, physician and anthropologist L. Lewis Wall, founder of the Worldwide Fistula Fund, has argued that Sims conformed to the accepted medical practices of the time. His operations on slave women provided effective relief from a previously untreatable condition that was catastrophic to their health and quality of life. It appears the subjects were willing; they had no other, better option. According to Sims, the slave women were "clamorous" for the operation.
Sims was a voluminous writer and his published reports on his medical experiments, together with his own 471-page autobiography (summarized by Wylie), have been the main sources of knowledge about him and his career. His positive self-presentation has, in the late 20th and early 21st centuries, been subject to revision. Aside from his treatment of slave women, Sims was not an appealing figure. "Many called him a braggart."
Early life, education and careerEdit
J. Marion Sims (called Marion) was born in Lancaster County, South Carolina, the son of John and Mahala (Mackey) Sims. For his first 12 years, Sims's family lived in Lancaster Village north of Hanging Rock Creek, where his father owned a store. Sims later wrote of his early school days there.:4–5
After his father was elected as sheriff of Lancaster County, he sent Sims in 1825 to the newly established Franklin Academy, in Lancaster (for white boys only). In 1832, after two years of study at the predecessor of the University of South Carolina, South Carolina College, where he was a member of the Euphradian Society, Sims worked with Dr. Churchill Jones in Lancaster, South Carolina. He took a three-month course at the Medical College of Charleston (predecessor of the Medical University of South Carolina).
He moved to Philadelphia, Pennsylvania, in 1834 and enrolled at the Jefferson Medical College, where he graduated in 1835, "a lackluster student who showed little ambition after receiving his medical degree". As he put it,
"I felt no particular interest in my profession at the beginning of it apart from making a living.... I was really ready at any time and at any moment to take up anything that offered, or that held out any inducement of fortune, because I knew that I could never make a fortune out of the practice of medicine.":8
He returned to Lancaster to practice. After his first two patients died, Sims left and set up a practice in Mount Meigs, near Montgomery, Alabama.:7 He described the settlement in a letter to his future wife Theresa Jones as "nothing but a pile of gin-houses, stables, blacksmith-shops, grog-shops, taverns and stores, thrown together in one promiscuous huddle".:374 He was in Mount Meigs from 1835 to 1837.:6 Sims visited Lancaster in 1836 to marry Theresa, whom he had met many years earlier, when a student in Lancaster. She was the niece of Churchill Jones, and had studied at the South Carolina Female Collegiate Institute.:177–178
In 1837 Sims and his wife moved to Macon County, Alabama, where they remained until 1840.:6 He was a "plantation physician", who had "a partnership in a large practice among rich plantations.":7 "Sims became known for operations on clubfeet, cleft palates and crossed eyes." This was his first experience treating slaves, who were brought to him by their owners.
In 1840 the couple moved to Montgomery, Alabama,:7–8 where they lived until 1853.:10 There Sims had what he described as the "most memorable time" of his career. Within a few years he "had the largest surgical practice in the State", the largest practice that any doctor in Montgomery had ever had, up to that time.:7 "He was immensely popular, and greatly beloved.":8
Medical experimentation on enslaved African-American womenEdit
Repair of vesicovaginal fistulaEdit
In Montgomery he continued treating slaves (who made up two thirds of the city's population:34). He built a hospital for them on his property.:9; at the time it was the only such facility in the state. It has been called "the first woman's hospital in history". In 1845 he was brought a woman with a condition he had not seen before: vesicovaginal fistula.
In the 19th century, vesicovaginal fistulas, though not fatal, were a common, socially destructive, and "catastrophic complication of childbirth", that affected many women. There was no effective cure or treatment. Lacking adequate birth control, women generally had a high rate of childbirth, which increased their rate of complications. Vesicovaginal fistulas occur when the woman's bladder, cervix, and vagina become trapped between the fetal skull and the woman's pelvis, cutting off blood flow and leading to tissue death. The necrotic tissue later sloughs off, leaving a hole. Following this injury, as urine forms, it leaks out of the vaginal opening, leading to a form of incontinence. Because a continuous stream of urine leaks from the vagina, it is difficult to care for. The victim suffers personal hygiene issues that may lead to marginalization from society, and vaginal irritation, scarring, and loss of vaginal function. Sims also worked to repair rectovaginal fistulas, a related condition in which flatulence and feces escape through a torn vagina, leading to fecal incontinence.
In the mid-19th century, gynecology was not a well-developed field: "the practice of examining the female organs was considered repugnant by doctors." In medical school, doctors were often trained on dummies to deliver babies. They did not see their first clinical cases of women until beginning their practices.:28 Sims had had no formal background in gynecology prior to beginning his practice in Alabama. He remarked in his autobiography that "if there was anything I hated, it was investigatng the organs of the female pelvis".:34
When a woman came to him with an injured pelvis and retroverted uterus from a fall from a horse, he placed her in a knee-chest position and inserted his finger into the vagina; this triggered a full distention of the vagina with air, allowing Sims to see the vagina clearly. The distention inspired him to investigate fistula treatment. Soon after, he developed a precursor to the modern speculum, using a pewter spoon and strategically placed mirrors.
From 1845 to 1849, Sims started doing experiments on slave women to treat vaginal problems. He added a second story to his hospital, for a total of eight beds.:10 He developed techniques that have been the basis of modern vaginal surgery. A key component was silver wire, which he had a jeweler prepare. The Sims' vaginal speculum aided in vaginal examination and surgery. The rectal examination position, in which the patient is on the left side with the right knee flexed against the abdomen and the left knee slightly flexed, is also named for him.
In Montgomery, between 1845 and 1849, Sims conducted experimental surgery on 12 enslaved women with fistulas in his backyard hospital. They were brought to him by their owners. Sims asked for patients with this fistula, and "succeeded in finding six or seven women".:9 Sims took responsibility for their care on the condition that the owners provide clothing and pay any taxes; Sims provided food. One he purchased "expressly for the purpose of experimentation when her master resisted Sims' solicitations.":35
He named three enslaved women in his records: Anarcha, Betsy, and Lucy. Each suffered from fistula, and all were subjects of his surgical experimentation. From 1845 to 1849 he conducted experimental surgery on each of them several times, operating on Anarcha 13 times before the repair of her fistulas was declared a success. She had both vesicovaginal and rectovaginal fistulas, which he struggled to repair. "Notwithstanding repeated failures during four years' time, he kept his six patients and operated until he tired out his doctor assistants, and finally had to rely upon his patients to assist him to operate.":10
Although anesthesia had very recently become available, Sims did not use any anesthetic during his procedures on these three women. According to Sims, anesthesia was not yet fully accepted into surgical practice, and he was unaware of the use of diethyl ether. Ether as an anesthetic was available as early as the beginning of 1842.
A 2006 review of Sims' work in the Journal of Medical Ethics said that ether anesthesia was first publicly demonstrated in Boston in 1846, a year after Sims began his experimental surgery. The article notes that, while ether's use as an anesthetic spread rapidly, it was not universally accepted at the time of Sims' experimental surgery.
In addition, a common belief at the time was that black people did not feel as much pain as white people. One patient, named Lucy, nearly died from septicemia. He had operated on her without anesthetics in the presence of twelve doctors, following the experimental use of a sponge to wipe urine from the bladder during the procedure. She contracted septicemia because he left this sponge in her urethra and bladder. He did administer opium to the women after their surgery, which was accepted therapeutic practice of the day.
After the extensive experimental surgery, and complications, Sims finally perfected his technique. He repaired the fistulas successfully in Anarcha. The silver-wire sutures, developed in 1849,:10 helped him make the first completely successful repair of a fistula. Sims published an account of this in his surgical reports of 1852. He proceeded to repair fistulas in several other enslaved women. According to Durrenda Ojanuga from the University of Alabama, "Many white women came to Sims for treatment of vesicovaginal fistula after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation." The Journal of Medical Ethics reports a case study of one white woman, whose fistula was repaired by Sims without the use of anesthesia, in a series of three operations carried out in 1849.
Sims later moved to New York to found a Woman's Hospital, where he performed the operation on white women. According to Ojanuga, Sims used anesthesia when conducting fistula repair on white women. But L. L. Wall, also writing for the Journal of Medical Ethics, states that as of 1857, Sims did not use anesthesia to perform fistula surgery on white women, citing a public lecture where Sims spoke to the New York Academy of Medicine on November 18, 1857. During this lecture, Sims said that he never used anesthesia for fistula surgery "because they are not painful enough to justify the trouble and risk attending their administration". While acknowledging this as shocking to modern sensibilities, Wall noted that Sims was expressing the contemporary sensibilities of the mid-1800s, particularly among surgeons who began their practice in the pre-anesthetic era. In 1874 Sims addressed the New York State Medical Society on "The Discovery of Anaesthesia", and in 1880 read to the New York Academy of Medicine a paper, soon published, about a death from anesthesia.:22
During his early medical years, Sims also became interested in "trismus nascentium", also known as neonatal tetanus. It is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from the mother having been immunised are at risk for this disease. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. In the 21st century, neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.
Trismus nascentium is now recognized to be the result of unsanitary practices and nutritional deficiencies. In the 19th century its cause was unknown, and many African slave children contracted this disease. Medical historians believe that the conditions of the slave quarters were the cause. Sims alluded to the idea that sanitation and living conditions played a role in contraction.
Whenever there are poverty, and filth, and laziness, or where the intellectual capacity is cramped, the moral and social feelings blunted, there it will be oftener found. Wealth, a cultivated intellect, a refined mind, an affectionate heart, are comparatively exempt from the ravages of this unmercifully fatal malady. But expose this class to the same physical causes, and they become equal sufferers with the first.
Sims also thought trismus nascentium developed from skull bone movement during protracted births. To test this, Sims used a shoemaker's awl to pry the skull bones of enslaved women's babies into alignment. These experiments had a 100% fatality rate. Sims often performed autopsies on the corpses, which he kept for further research on the condition. He blamed these fatalities on "the sloth and ignorance of their mothers and the black midwives who attended them", as opposed to the extensive experimental surgeries that he conducted upon the babies.
Critiques of experimentationEdit
Sims' experimental surgeries without anesthesia on enslaved African-American women, who could not consent, have been described since the late 20th century as an example of racism in the medical profession. This is seen as part of the historical oppression of blacks and vulnerable populations in the United States. Patients of Sims' fistula and trismus nascentium operations were not given available anesthetics. He caused the deaths of babies on whom he operated for the trismus nascentium condition.
In regards to Sims' discoveries, Durrenda Ojenunga wrote in 1993:
His fame and fortune were a result of unethical experimentation with powerless Black women. Dr Sims, 'the father of gynaecology', was the first doctor to perfect a successful technique for the cure of vesico-vaginal fistula, yet despite his accolades, in his quest for fame and recognition, he manipulated the social institution of slavery to perform human experimentation, which by any standard is unacceptable.
Terri Kapsalis writes in Mastering the Female Pelvis, "Sims' fame and wealth are as indebted to slavery and racism as they are to innovation, insight, and persistence, and he has left behind a frightening legacy of medical attitudes toward and treatments of women, particularly women of color."
Author Harriet Washington, in her 2007 book Medical Apartheid, writes of Sims' experiments: "Each naked, unanesthetized slave woman had to be forcibly restrained by other physicians through her shrieks of agony as Sims determinedly sliced, then sutured her genitalia." Facing South, a publication of The Institute for Southern Studies, wrote that enslaved women were forced to hold each other down during surgery.
Physician L.L. Wall, writing in the Journal of Medical Ethics, says fistula surgery on non-anesthetized patients would require cooperation from the patient, and would not be possible if there were any active resistance from the patient. Wall writes that surviving documentation from the time says the women were trained to assist in their own surgical procedures. Wall also argues the documentation suggests the women consented to the surgeries, as the women were motivated to have their fistulas repaired, due to the serious medical and social nature of vesicovaginal and rectovaginal fistulas. According to gynaecologist Caroline M. de Costa, writing in The Medical Journal of Australia:
Hideous as the accounts of his surgery may appear to sensitive 20th century eyes, undoubtedly Sims was at least partly motivated by a desire to improve the lot of his slave patients. In this, he was no different from many 19th century surgeons experimenting with the techniques that are the foundation of current surgical practice, gynaecological and otherwise. The lives of the slave women on whom Sims experimented would have been even more miserable without their subsequent cures, and the knowledge gained has been applied to fistula repair for thousands of women since.
In his autobiography, J. Marion Sims said he was indebted to the enslaved women. After multiple failed operations he was discouraged, and the enslaved women encouraged him to proceed, because they were determined to have their medical afflictions cured. Shortly after Sims' successful repair of Anarcha's vesicovaginal and rectovaginal fistulas in 1849, he successfully repaired the fistulas of the other enslaved women. They returned to their plantations.
Sims has been criticized for operating on the enslaved women without their consent. Wall writes in the Journal of Medical Ethics, that legally, consent was granted by the slave's owners. He noted that enslaved persons were a "vulnerable population" with respect to medical experimentation. Wall also writes that Sims obtained consent from the enslaved women themselves.
He cites an 1855 passage from New York Medical Gazette and Journal of Health, where Sims wrote:
For this purpose [therapeutic surgical experimentation] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not.
Deirdre Cooper Owens wrote: "Sims has been painted as either a monstrous butcher or a benign figure who, despite his slaveowning status, wanted to cure all women from their distinctly gendered suffering." She describes these opposing views as overly reductionist, saying his history is more nuanced. He lived in a slave-holding society and expressed the racism and sexism that were considered normal during his time. He contributed significantly to the field of gynecological surgery. Sims' suture technique developed in the 1840s for fistula surgery is still in use by modern-day physicians.
New York and EuropeEdit
In 1855 he founded Woman's Hospital, the first hospital for women in the United States. His project met with "universal opposition" from the New York medical community;:11 it was due to prominent women that he established it. They were visited by "prominent doctors, who endeavored to convince them that they were making a mistake, that they had been deceived, that no such hospital was needed, etc.":12–13 "I was called a quack and a humbug, and the hospital was pronounced a fraud. Still it went on with its work.":13 In the Woman's Hospital, he performed operations on indigent women, often in an operating theatre so that medical students and other doctors could view it, as was considered fundamental to medical education at the time. Patients remained in the hospital indefinitely and underwent repeated procedures.
Sims and the ConfederacyEdit
In 1861, during the American Civil War, Sims, a "loyal Southerner",:46 moved to Europe, where he toured hospitals and worked on fistula patients in London, Paris, Edinburgh, Dublin, and Brussels. However, according to J.C. Hallman, he was there as one of several government agents of the Confederacy, who were seeking money (loans), diplomatic recognition of their new government (no country ever recognized it), and supplies and ships. An intercepted letter informed Lincoln's Secretary of State, William Seward, that Sims was "secessionist in sentiment", and that his "purpose in going abroad at this time is believed to be hostile to the government", as Seward reported to U.S. diplomats in Europe. According to the U.S. Minister in Brussels Henry Shelton Sanford, Sims was a "violent secessionist", and his "movements in Europe had 'given color to (the) opinion' that he was a spy".
The most celebrated episode in Sims' life was his summons, in 1863, to treat Empress Eugénie for a fistula. This widely reported episode helped Sims to solidify his worldwide reputation as a surgeon. But according to Hallman, no source confirms that Eugénie had any medical problem at all. Simms' visits to the palace were semi-diplomatic Confederate visits, and the illness an invention to escape the vigilance of the U.S. diplomats, who had their eyes on Sims. Eugénie became an "ardent disciple" of the Confederacy.
Expressing the views of many Southern whites, Sims later said that "the dreadful mistake it was to give the negro the franchise." Two years later, offering a toast on board the steamer Atlantic, returning to Europe, he claimed that in the aftermath of the war, the South had been degraded “beyond the level of the meanest slave that ever wore a shackle.”
At the same time, Sims argued that it was puerile for the South to sulk in its loss. He called for an acceptance of the issues of the war, including the 15th amendment. “It is folly to talk of the lost cause,” he said.
Having treated royalty, after his return to the United States, Sims raised his charges in his private practice. He effectively limited it to wealthy women, although "he always had a long roll of charity patients".[clarification needed]:25 He became known for the Battey surgery, which contributed to his "honorable reputation"[clarification needed]. This involved the removal of both ovaries. It became a popular treatment to relieve insanity, epilepsy, hysteria, and other "disorders of the nerves"[clarification needed] of women. At the time, these were believed to be caused by disorders of the female reproductive system.
Sims received honors and medals for his successful operations in many countries. Since the 20th century, the necessity of many of these surgeries has been questioned. He performed surgery for what were considered gynecological issues: such as clitoridectomies, then believed to control hysteria or improper behavior related to sexuality. These were done at the requests of the women's husbands or fathers, who were permitted under the law to commit the women to surgery involuntarily.
Break with the Woman's HospitalEdit
In 1871, Sims returned to New York. He got into a conflict with the other doctors of the Woman's Hospital, with whom he carried on a dialogue by means of published pamphlets. One issue was whether the hospital would treat women with uterine cancer, because the hospital was founded to treat diseases of women, and cancer was not a disease peculiar to women. In addition, cancer was feared as contagious. The second issue was how many outsiders (doctors or medical students) could observe any given operation, as was common at the time. This meant they could observe the sexual organs of white women patients; there were no African-American patients. The Board of the hospital set a limit of 15; previously there had been as many as 60.
After quarreling with the board of the Woman's Hospital over the admission of cancer patients, Sims became instrumental in establishing America's first cancer institute, New York Cancer Hospital. Hallman says that "Sims was thrown out of his own hospital in New York in 1874, in part because his fellow doctors had determined that his work was reckless and lethal".
In 1880, Sims contracted a severe case of typhoid fever. W.Gill Wylie, an early 20th-century biographer, said that although Sims suffered delirium, he was "constantly contriving instruments and conducting operations". After several months and a move to Charleston to aid his convalescence, Sims recovered in June 1881. He traveled to France. After his return to the United States in September 1881, he began to complain of an increase in heart problems. He had suffered two angina attacks in 1877.
According to Wylie, Sims consulted with doctors for his unknown cardiac condition both in the United States and in Europe. He was "positive that he had a serious disease of the heart and it caused deep mental depression". He was halfway through writing his autobiography and planning a return visit to Europe when he died of a heart attack on November 13, 1883 in Manhattan, New York City. He had just visited a patient with his son, H. Marion Sims. He is buried at Green-Wood Cemetery in Brooklyn, New York.
Legacy and honorsEdit
- On the title page of the reprint of an article, "History of the Discovery of Anesthesia", first published in the May 1877 number of the Virginia Medical Monthly, Sims listed his honors as:
Author of "Silver Sutures in Surgery," "The Sims Operation for Vesico-Vaginal Fistula," "Uterine Diseases," "History of the Discovery of Anaesthesia", Etc., Etc.; Member of the Historical Society of New York; Surgeon to the Empress Eugenie; Delegate to Annual Conference of the Association for the Reform and Codification of the Law of Nations, 1879; Founder of the Woman's Hospital of the State of New York, and formerly Surgeon to the Same; Centennial President of the American Medical Association, Philadelphia, 1876; President of the International Medical Congress at Berne, 1877; Fellow of the American Medical Association; Permanent Member of the New York State Medical Society; Fellow of the Academy of Sciences, of the Academy of Medicine, of the Pathological Society, of the Neurological Society, of the County Medical Society, and of the Obstetrical Society of New York; Fellow of the American Gynaecological Association; Honorary Fellow of the State Medical Societies of Connecticut, Virginia, South Carolina, Alabama and Texas; Honorary Fellow of the Royal Academy of Medicine of Brussels; Honorary Fellow of the Obstetrical Societies of London, Dublin and Berlin, and of the Medical Society of Christiana [Oslo]; Knight of the Legion of Honor (France); Commander of Orders of Belgium, Germany, Austria, Russia, Spain, Portugal and Italy, Etc., Etc., Etc.
- A bronze statue by Ferdinand Freiherr von Miller (the younger), depicting Sims in surgical wear, was erected in Bryant Park, New York, in 1894, taken down in the 1920s amid subway construction, and moved to the northeastern corner of Central Park, at 103rd Street, in 1934, opposite the New York Academy of Medicine. The address delivered at its rededication was published in the Bulletin of the New York Academy of Medicine. This is the first statue erected in the United States in honor of any physician. The statue became the center of protests in 2017 due to Sims' operations on enslaved black women. Vandals defaced the statue with the word RACIST and painted the eyes red. In April 2018, the New York City Public Design Commission voted unanimously to have the statue removed from Central Park and installed in Green-Wood Cemetery, near where Sims is buried.
- Another memorial was installed on the grounds of his alma mater, Jefferson Medical College.
- There is a statue on the grounds of the Alabama State Capitol in Montgomery (dedicated in 1939). In April 2018, when Silent Sam was doused with red ink and blood, the statue had ketchup thrown on it while a skit about Sims was performed. "An alternative statue of Sims's 'first cure', the young woman known as Anarcha, was erected in protest only to be stolen in the night."
- Another statue of Sims, installed in 1929, is at the South Carolina State House in Columbia; the mayor of Columbia, Stephen K. Benjamin, in 2017 called for its removal, as have other protestors.
- A painting by Marshall Bouldin III entitled 'Medical Giants of Alabama', that depicted Sims and other white men standing over a partially clothed black patient, was commissioned for $20,000 in 1982 (paid for by donors). It was on display at the University of Alabama at Birmingham's Center for Advanced Medical Studies, but was removed in late 2005 or early 2006 because of complaints from people offended by it, and the ethical questions associated with Sims.
- The Medical University of South Carolina, whose predecessor Sims attended, set up around 1980 an endowed chair in his honor. In February, 2018, the chair was quietly renamed. However, a "J. Marion Sims Chair" in obstetrics and gynecology still appears in a March 2018, program. A J. Marion Sims Society, a student organization, existed there from 1923 to 1945.
- A Sims Memorial Address on Gynecology, delivered before the South Carolina Medical Society at Charleston, is documented from 1927.
- In 1950, a historical marker was erected near the site of his parents' farmhouse, where he was born. Present at the dedication ceremony were Congressman James P. Richards and representatives of the American Medical Association, the Medical College of South Carolina, the University of South Carolina, the chairman of Lancaster's Marion Sims Memorial Hospital board, the state archivist of South Carolina, and four of Sims' children. Dr. Roderick McDonald, president of the South Carolina Medical Association, introduced the speaker, Dr. Seale Harris, past president of the Southern Medical Association and former editor of the Southern Medical Journal, whose biography of Sims, Woman's Surgeon: the Life Story of J. Marion Sims, had just been published.
- A cartoon of Sims appeared on the cover of the November, 2017, issue of The Nation.
- A J. Marion Sims Foundation was founded in 1995 in his home town of Lancaster, South Carolina. It has dispensed almost $50,000,000 in grants.
- The Marion Sims Memorial Hospital is located in Lancaster.
- In Dublin, Ireland, in 1999 there was founded the J. Marion Sims Clinic, or Sims Fertility Clinic, which quoted from Sims' autobiography: "Here I am again in my beloved Dublin". In 2018 it has become Sims IVF, with no reference to Dr. Sims on the site.
- In Montgomery, Alabama, a historical marker at 37 South Perry St. marks the location of Sims' house and backyard hospital or infirmary. The building on the site is from the early 20th century.
- In 1953, Sims was elected to the Alabama Hall of Fame.
- Vaginal surgery: fistula repair. Invented silver wire as a suture.
- Instrumentation: Sims' speculum; Sims' sigmoid catheter.
- Exam and surgical positioning: Sims' position.
- Fertility treatment: Insemination and postcoital test.
- Cancer care: Sims argued for the admission of cancer patients to the Woman's Hospital, despite contemporary beliefs that the disease was contagious.
- Abdominal surgery: Sims advocated a laparotomy to stop bleeding from bullet wounds to this area, repair the damage and drain the wound. His opinion was sought when President James Garfield was shot in an assassination attempt; Sims responded from Paris by telegram. Sims' recommendations later gained acceptance.
- Gallbladder surgery: In 1878, Sims drained a distended gallbladder and removed its stones. He published the case believing it was the first of its kind; however, a similar case had already been reported in Indianapolis in 1867.
- Sims 1889, p. 32.
- Sims 1889, p. 23.
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