The Sims speculum is a U-shaped piece of plastic or metal used to examine the walls of the vagina. The patient is normally placed lying on her left side with her knees drawn up to her chest - the Sims position. One arm of the speculum is inserted into the vagina and the operator pulls back on the other arm. The anterior (front) aspect of the vaginal canal can be retracted to visualise the posterior (back) wall and vice versa.

This type of speculum is particularly useful for visualising fistulae (abnormal holes or connections) and prolapse (protrusion) of the rectum or bladder into the vagina. Such occurences may be complications of multiple childbirth or very protracted labour.

The speculum is named after James Marion Sims (1813-1883), known as the "Father of Gynecology". In 1845, while examining a patient he decided the orthodox 2-pronged ('duck-bill' or Cusco) specula were inappropriate. He purchased a pewter spoon from a nearby hardware store and bent it into a U-shape. He later wrote, in his slightly purple autobiography The Story of My Life :

I saw everything, as no man had ever seen before... I felt I was on the eve of one of the greatest discoveries of the day.

Sims went on to invent brilliant new surgical techniques for the repair of fistula and prolapse, relieving the suffering of untold numbers of women.

In recent years, Sims has fallen from grace somewhat as his research methodology has become public knowledge. From 1845-1849 he developed his surgical technique by operating on Black slave women without consent or anaesthesia. Ether and chloroform were available and were used in surgery from at least 1846. Such techniques may not have been widely available however; defenders of Sims maintain that surgical anaesthesia was not routinely used until the 1850s.

On some occasions, a mild opiate was given but Sims wrote that it was largely "the stoicism of the Negro" that served for anaesthesia. It is reported that one slave girl, Anarcha, was operated on over 30 times. Early procedures were particularly agonising as catheters for bladder drainage were not used. Sutures and sponges left in place quickly became infected, encrusted and impossible to remove.

Having perfected his techniques, Sims demonstrated them around the world. He treated royalty including Empress Eugenie, the wife of Napoleon III of France. The stoicism of the Empress was not so called upon as she was etherised.

On his return to the US, Sims was appointed President of the American Medical Association in 1876 and was founder and president of the American Gynecological Association. There are notable statues of him in Central Park, New York and Montgomery, Alabama and his portrait hangs at a number of prestigious medical schools.

 


Caroline M de Costa, James Marion Sims: some speculations and a new position, Medical Journal of Australia 2003; 178 (12): 660-663 (available online)
Thanks to rootbeer277 for suggesting some improvements.

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