J. Marion Sims - Repair of Vesicovaginal Fistula

Repair of Vesicovaginal Fistula

Women with vesicovaginal fistulas – usually the result of traumatic labor – were, in those days, social outcasts. No cure was available. In Montgomery, Alabama, Sims experimented on three Alabamian women who were held captive as slaves – Anarcha, Betsy, and Lucy – who were suffering from fistula problems, to develop new techniques to repair this condition or be used as experiments for medical research. From 1845 to 1849 he experimented on them, operating on Anarcha 30 times (it remains unclear if this was necessary due to stitching failure, or if Sims did it deliberately). Although anesthesia had recently become available, Sims did not use any anesthetic during his procedures on Anarcha, Betsy, and Lucy. After the extensive experiments and difficulties, Sims finally perfected his technique and repaired the fistulas successfully in Anarcha. He then "repaired" several other slave women. It was only after the success of the early experiments on the slaves that Sims attempted the procedure on Caucasian women with fistulas, this time with anesthesia.

These experiments set the stage for modern vaginal surgery. Sims devised instruments including the Sims' speculum to gain proper exposure. A rectal examination position where a patient is on the left side with the right knee flexed against the abdomen and the left knee slightly flexed is also named after him as Sim's position. He insisted on cleanliness. His technique using silver-wire sutures led to successful repair of a fistula, and this was reported in 1852.