Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

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But he had no t the procedure. edical school lec- .md accordingllk 1 her liI1695 and probe her pelvis ddenly, 5115 was was more SUI' ' P pwfeioutl 1l'0rem0Ved hls .may he dorm was an fm' I Sims realllfd expllkion of an . g the pfmel it WHS amos' .d restored the Placer He f aPPlican0n 0 uld be usedto . ' al Cam 5 vaglgi to the hr it 511nmU0n'aed sith fhe.dI?geC IU 51 to im. aeallr' began plan an operation to cure the girl- and the others he had seen. He never considered the possibility of failure. His career, to this point-except for an early setback when he attempted to establish a medical practice in his native Lancaster, S.C. - had been marked by repeated success. He gained confidence after mov- ing to Alabama and had begun to tackle some very complicated cases. His first contribution to the literature was a description of the surgical repair of a cleft lip and the cleft palate in an adult woman. Others included a revo- lutionary procedure for removing osteo- sarcoma of the jaw that did not require disfiguring incision of the face. Clearly, when Sims began to plan his vaginal operation he was riding the crest of a successful medical practice, based mostly on his achievements in surgery for which he was gaining reknown throughout the South. - His first requirement was the de- sign of the necessary instruments. On his way home to reexamine the slave girl he stopped to purchase a pewter spoon, which he was able to bend into varying configurations. His improvised instrument became the basis of the famous duck-billed CSimsD speculum. It brought the fistulous tract clearly into View and confirmed Sims' decision to operate. He faced four years of frustration, doubt, loss of confidence by his colleagues and financial sacrifice before he would see success. He oper- ated on one of the slave girls 30 times -leading to charges by his critics in Montgomery that he was conducting human experimentation. However, de- spite the fact that anesthesia had not been adopted generally in surgery in the 1840's, Sims' patients never com- plained. This was due in part, no doubt, to the docility bred by years of slavery, but was in no small measure due to their confidence in Sims, plus the knowledge his operation was their only hope of being restored to a normal life. Sims became obsessed with the operation. He built an addition to the small hospital behand his home and assumed the obligation of feeding and clothing his patients while he worked to perfect his procedure. It was not until 1849-five years after his first unsuccessful attempt-that he effected a cure. The ingredients of success were five: the Sims position and Sims speculum, of course, a catheter to keep the bladder empty while the fistula healed, silver wire sutures and a new method for drawing them together. The last two were the most important, for without them success eluded the surgeon for years, with them he suc- ceeded in his first attempt. - After this, Sims turned much of his attention to the field he originally disdained-diseases of women. He was described even in his day as the father of gynecology, though he continued to be a gifted general surgeon. Sims be- gan to build a national and later a worldwide reputation after he moved from the South to New York, where he was able to find relief from chronic debilitating diarrhea. He left Alabama in 1853 and two years later was the primary force behind establishment of the Womanis Hospital of the State of New York. Here he collaborated with Thomas Addis Emmet, also a Jefferson graduate, and other gynecological pio- neers. With the approach of the Civil War, Sims' expression of Southern sympathies made New York increas- ingly inhospitable. So he Went to Europe, where he was called on to demonstrate his operation before lead- ing surgeons. He remained abroad longer than he had anticipated and engaged in private practice in both France and England. A biographer notes that his acceptance by European aristocracy allowed him to transform the tradi- tional role of the American physician abroad from that of humble student to that of honored teacher. His reputa- tion assured him an extensive practice in whatever country he chose to visit. While he commanded large fees from those who could afford them, Sims al- ways had an active charity practice. Biographers agree he practiced medi- cine for the sheer satisfaction of it- not financial reward. While in England in 1866 he published a textbook, Clinical Notes of Uterine Surgery, which stirred up a great deal of controversy because of its frank consideration of what were con- sidered indelicate topics at that time. His discussion of the treatment of sterility aroused the most criticism, es- pecially his advocation of postcoital microscopic examination of sperm. His proposal that artificial insemination could be an answer to sterility brought this retort from the Medical Times and Gazette of London: Better let ancient families become extinct than keep up the succession by such means. Soon, however, many of Sims' in- novations began to be widely accepted and on his return to New York in 1858 he was acknowledged as the world's foremost gynecologist. He returned to Woman's Hospital as senior consulting surgeon and accepted a position on the board of governors. Six years later, however, when his worldwide reputa- tion was at its peak, he became embroiled in a dispute with the super- visors of the hospital and resigned. So, as 1875 dawned, the foremost Ameri- can gynecologist was barred from the institution he was responsible for founding and forced to practice in a small ofiice in his home. As always, he continued to see charity patients, even on Sundays. His prestige outside of New York did not suffer, and the year he left the Woman's Hospital he was elected president of the American Med- ical Association. A year later he was a charter member of the American Cy- necological Society, which elected him president in 1880 Cthe year Woman's Hospital reinstated him as consulting surgeonl -The final task to which Sims turned his attention was an autobiog- raphy, Story of My Life, which he never completed. lt was published in unrefined form after his death in 1883 and has provided much of the source material for subsequent biographers. Seale Harris' version, W0man's Sur- geon, published 1950, includes this assessment of the man: Marion Sims was one of a few out- standing 19th century pioneers who added more to the basic knowledge of medicine and surgery in three or four decades than had been accumu- lated in all the thousands of years preceding. Chiefly, however, he was the physician who brought new hope and new life to women. Today at Jefferson, where he re- ceived his medical degree in 1835, a society bearing his name and founded in his honor, serves as the nidus for young men who hope to practice the specialty he developed. They, as he, may be aided by good fortune. But they will have to supplement it with keen minds and hard work.

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e transformed the tra- ditional role of the American physician abroad from that of humble student to that of honored teacher t is popular to credit chance-or what Sir Walter Scott described as the happy combination of fortuitous cir- cumstances -for significant discoveries in medicine, as well as other fields. Thus, many writers have been over- impressed by the elements of fortune underlying the contributions of Cfor lamesl Marion Sims to medicine and particularly to gynecology. The barest research reveals, however, that years of hard work and frustration underlay Sims' initial-and probably his most important-Contribution in this field, the first successful surgical procedure for repair of a vesicovaginal fistula. The importance of his discovery is un- contested. Prior to Sims' operation, wo- men with this condition were classified as incurable and became outcasts, for- saken by the families as well as society. Many of them wished for death, some died by their own hand. For two cen- turies before Sims, leading surgeons of Europe had been unsuccessful in de- vising a successful operation for the condition. That there was some element of chance in Sims' achievement is unde- niable, especially in view of the fact that in the early days of his practice he referred all patients with female problems to doctors specializing in this field-known derisively at the time among physicians as male midwifery. In 1845 Sims had been practicing 10 years but had not seen a single case of vesicovaginal fistula. Then in three months while practicing at Montgom- ery, Ala., he saw three female slaves with the condition and was forced to report to their masters that their plight was not correctable and they would never return to the fields. The proximity of the three cases was the first element of chance, the second was the accidental discovery of the lateral kneechest position for good visualization of the pelvic organs. Sims had been called to see a woman who had fallen from a horse and was com- plaining of back pain and pressure on her bladder and rectum. He decided after physical examination that the woman's uterus had been displaced by the fall and should be returned to its normal position. But he had no idea how to go about the procedure. He tried to recall a medical school lec- ture 'll years before and, accordingly, placed the woman on her knees and elbows and began to probe her pelvis with two fingers. Suddenly, she WHS relieved-and no one was more sur- prised than Sims. Maintaining his air of professional omniscience, he calmly removed h1S hand and said, You may lie down now. As she did there was an em' barrassing rush of air. Sims realized quickly it was merely expulsion of alr he had introduced during the proce- dure and he concluded it was atm0S- pheric pressure that had restored the uterus to its proper place. He 1m- mediately saw clinical application Of this phenomenon. lt could be used'tO make the walls of the vaginal C3Vlty visible. His thoughts turned to the young slave girl waiting at his home for a train back to her plantation. She was the third patient with the dreaded fistula whom he had seen in three months. He enthusiastically began to plan an and the c0Il5ldeI His Cafe' eaIlY se establish native I marked He ing I0 tackle S0 first C09 3 dCSCUl 3 Cleft . adult W' lutiollall sarcoma disfiguri when 52 operatioi successh mostly C for whi throught I His sign of I his way girl he s spoon, vl varyingl instrume famous l It hroug into viev to Opera fruslratir his Colle heforeh ated on . -leading MOIilg01 humane SPire the been Sidi fhe 184i Plalnedi dolllli, tl slavery, dlle fri t lbs linoi onli' llc Ilormal 3 Sin Opefalioi ini i. 3SSl1med Clothing to Peffe Until 15 llhg H CUIS- uCCef fill

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he nation was at war. lt was barely two months after Pearl Harbor. Wives and sweethearts feared for their loved ones. No one knew but everyone feared what lay ahead . . . death . . . destruction . . . pain and- most of all-horrible maiming injuries. During these dark days, Time, the weekly news magazine, reassured its readers that American soldiers would go into battle with the benefit of an elaborate medical evacuation system to remove the wounded from the battlefield and provide necessary care immediately. The magazine chose to illustrate the article with an idealized drawing of Maj. jonathan Letterman riding in a Civil War ambulance. It was the major-a career medical officer -who masterminded an effective evac- uation system during the Civil War. In modified form, the system re- mains in effect even today, and is still saving lives in Vietnam. Maj. Cen. Paul Pr. Hawley, Cen. Eisenhower's chief surgeon for the European The- ater, has said: There was not a day during VVorld War ll that 1 did not thank Cod for jonathan Letterman. Time reassured its anxious readers in February 1942: The lives and suffer- ing saved by this brilliant and humane he lives and suffering saved by this brilliant and humane U.S. Army medical man can never be measured U.S. Army medical man can never be measured. Yet, despite the importance of his contribution, few Cls ever heard of Letterman. Those who did probably were treated at the Army's Letterman General Hospital in San Francisco. Modern medical officers have come to expect-and take for granted- prompt, efiicient evacuation of casual- ties. lt's almost unthinkable that wars were not always fought in this manner. But barely 100 years ago, wounded lay on the battlefield for a week or more. This was the situation during the Cri- mean War in Europe, which preceded the American Civil War by a few years. Early Civil War battles followed the same script. Letterman saw the problem and submitted a plan for an ambulance corps to the War Depart- ment, it was rejected. Letterman then submitted the plan to Cen Ceorge B. McClellan-whose father founded jef- ferson-and it was approved. - This was only the beginning, how- ever, Letterman got his ambulances, but line oflicers often preempted them for other uses. He had to fight military politics continually to recruit and train litter bearers and ambulance attendants -the forerunners of the modem medic The ambulance corps was bloodied at Antietam in September of 1862, and acquitted itself superbly. Antietam ranks among the bloodiest battles of our history, but the field was cleared of casualties within 24 hours. The famous photo by Matthew Brady of Lincoln at McC1el1an's headquarters after the battle shows the President with a smile. Since Dr. Letterman is in the group, it may be assumed that the humane President was doubly pleased with his military victory and medical triumph. Letterman kept improving his sys- tem throughout the war and set up a network of hospitals where wounded taken from the battlefield by ambu- lance could get treatment. According to Cen. Hawley, it is the same system as is in use today, with some slight modifications, perhaps, to adjust to the airplane and to take advantage of the great advances in surgery since the Civil War. - The brilliant success of Letter- man's system sparked the interest of the many European military observers sent to evaluate new tactics developed during the Civil War. Military men eventually saw the value of salvaging wounded men-many of whom would return to fight another day. Letterman's principles were applied in the develop- ment of similar services for the world's armies. Marion Sims, another jeffer- son immortal, used the system in direct- ing an ambulance corps for France in the War of 1870. It was probably the first use of the Letterman system by a foreign army. The system reached far beyond the battlefield. It was the inspiration for what is claimed to be the nation's first city ambulance service-that of Bellevue Hospital in New York. Dr. Edward B. Dalton, who developed the service, served in the Army Of the Potomac under Letterman. The Armyis first permanent gen- eral hospital was erected in San Pran- cisco in 1911. Fittingly, it was named for Letterman, who had died in that city in 1872-a mere 10 years after his plan was tested in battle. A new com- plex was dedicated last year. The plaque contains this observation: Maj. Lettermanis principles Of organization stand today, influencing the medical evacuation service of every modern army. ,. ,111 .5 ij f any ol Weir l paramounl and succel men in ar C0mplaintf force of hi WSIS H1011 Iliff heart Vltlion th, Hlliltl Wag Miithellg HSPCCK of h lies him 3 pslycliliilrig hlU1SClf 3 Ernest Ea flassifies 6 . 0552? P . UW In PSYClii: Prom his Wi, hi aimed hi lifetime . 1 . can SlIlQe rrsil genius!!! E f0Ilte 38 mP0r