A REVIEW 
OP 
AN ANNIVERSARY DISCOURSE 
BEFORE THE NEWYORK ACADEMY OF MEDICINE. 
BY 
J. MARION SIMS, Ml)., 
ox 
SILVER SUTURES IN SURGERY. 
[Republished from the North American Medico-Chirurgical Review for July, 1858.] 
PHILADELPHIA: 
J. B. -LIPPINCOTT AND CO. 
1858. A REVIEW 
OF 
SILVER SUTURES IN SURGERY: 
AN ANNIVERSARY DISCOURSE BEFORE THE 
NEW YORK ACADEMY OF MEDICINE. 
BY 
J. MARION SIMS, M.D. 
[Republished from the North American Medico-Chirurgical Review for July, 1858.] 
PHILADELPHIA; 
J. B. LIPPINCOTT AND CO. 
1858. A REVIEW 
OF 
SIMS’S SILVER SUTURES IN SURGERY. 
The name of the orator here presented, and the theme exhibited in his 
title-page, naturally arouse more practical attention than is usually ac- 
corded to an ephemeral address. The reader, however, who expects to 
find in this extravagant and absurdly egotistical discourse a scientific 
study of the advantages and use of pure silver as a material for sutures, 
will be sadly disappointed. 
A mere special plea for personal aggrandizement, with a tirade against 
competitors and the most cursory allusion to the original labors of his 
predecessors, are not the demonstrations to be looked for in a contribu- 
tion to the progress of operative surgery, formally invited, as the author 
intimates, by the members of the New York Academy of Medicine. 
The manifesto of Dr. Sims, in answer to that call, is certainly a very 
different conclusion from what was confidently expected in the first fruits 
of the rare opportunities of the Surgeon to the Woman’s Hospital, and 
which might have been offered to the Academy as an honorable tribute to 
the humanity and wisdom of the founders of that charity. 
Were it not before us, in the black and white of a printed pamphlet, 
published “by order,” etc., and with all its ad captandum paraphernalia 
of pictures and staring capitals, wre should try to regard its various pecu- 
liarities as the harmless frothiness of an after-dinner effusion, easily ac- 
counted for and as readily forgotten. As it is, however, there is so much 
which demands explicit contradiction, that we find it impossible to con- 
fine our notice within the brief space to which such emanations are alone 
entitled. 
We have no inclination for the discussion involved in the examination 
of its remarkable pages, nor have we any desire to increase the already 
industriously extended notoriety of what has, doubtless, ere this, proved 
a source of mortification, as it is of discredit, to all concerned in its publi- 
cation. We should gladly pass it by, along with the periodical issues of 
a very different but not less enthusiastic order of seekers for popular 
eclat, and would have little but surprise and regret to express in relation 4 
Sims on Silver Sutures. 
to its misrepresentations and assumptions, were it not for the previous 
distinction of its author, and the authoritative auspices under which it is 
put forth. 
Under these circumstances we are compelled, in defence of a grossly 
assaulted contributor to this journal, and for the credit of American Sur- 
gery, so far as our position as journalists involves us, to deny the shadow 
of a foundation for the charge of bad faith so piteously urged against Dr. 
Bozeman, and to repudiate the bombastic pretensions of Dr. Sims as to 
the importance and reality of his alleged “discovery” of the silver suture. 
We need hardly stop here to explain the position of this journal in re- 
gard to genuine American improvement in medical science, especially in 
practical surgery. It is not our intention to underrate the value of me- 
tallic sutures, or to dispute the merit, which belongs to Dr. Sims, of 
having introduced their more general employment in the management of 
wounds and plastic operations. Still less do we wish to detract from the 
honor due to him for the material advance in methodizing and improving 
the details of the particular operation to which he owes his professional 
success. It will not be difficult to show that, in these matters, Dr. Sims 
himself, in his anniversary oration, has proved his worst enemy, and the 
first one to attack the laurels which have hitherto been generally awarded 
to him, and by none more fairly and frankly than Dr. Bozeman. He 
does this so gratuitously, and in a temper so evidently the effect of 
jealousy, that we heartily lament his misfortune in having had no thought- 
ful friend to suggest to him, or his academy admirers, the maxim ad- 
dressed to the cobbler of old. 
Ne sutor ultra crepidam was never more applicable than to the course 
of the self-gratulating laureate of the “ Silver Suture.” His achievements, 
with the vaunted stitch and its accompaniments, were willingly accepted 
as a material accession to the triumphs of surgery, in behalf of suffering 
womankind under one of her heaviest and most disheartening afflictions; 
and the champion of the suture was hailed as a master, and requited 
in fair proportion to the good he had effected by his perseverance, inge- 
nuity, and skill. 
Not satisfied, however, with the brilliant reputation obtained through 
the legitimate account of his investigations and their then unparalleled 
results, he was tempted, by a dread of divided honors, to stoop to trumpet 
his “discoveries” and rail at his “followers,” before a mixed audience, 
which must have been much more amused and disgusted than it could 
have been instructed. 
In the midst of his success he had found a Mordecai at the palace-gate, 
whose humble but decided merit in the same field offended him. He 
waxed eloquent, not only in sounding his own praises “from the house- Sims on Silver Sutures. 
5 
tops,” as he says, but in denouncing the troublesome competitor who had 
dared to improve upon his instruments and mode of operating. He 
strove to suspend this too fortunate rival on a gallows of professional dis- 
grace by accusing him, without proof, and in direct contradiction to the 
published evidence, of ingratitude and plagiarism. In the effort to dis- 
parage the single but important step in advance, established by Dr. Boze- 
man, he perpetrates the folly of stripping his own operation of its cha- 
racteristic features, by destroying the admirable combination of other 
men’s methods, in which the superior advantage of his former plan con- 
sists ; while he commits the very crime he would fasten on his quondam 
associate, by ignoring the inventions of his predecessors and clamoring 
for the sole credit of what he certainly did not originate. 
We purpose to show that he acts very differently from Dr. Bozeman in 
his treatment of Mettauer and Levert, of this country, and of Dieffenbach, 
Yelpeau, and others, abroad, by the magniloquent exaltation of his own 
genius at the expense of their rights; and that he even deigns to appro- 
priate a hint from the arch offender, Dr. Bozeman, himself. 
Let us not be misunderstood as to our view of the right of property in 
scientific inventions and their application. We acknowledge little interest 
in the vain and petty quarrels for precedence in the honor of inventing 
new instruments and modes of treatment, or even in the discovery of 
scientific truths. After all, he is the greatest benefactor who succeeds in 
teaching his fellow-men the actual use and value of a new step in art or 
science, whether or not his happens to be the first glimmer published or 
put on record, much less imagined, of its existence or availability. Tins 
is virtually the world’s verdict, in spite of the often-repeated reclamations 
for theoretical priority which are so vehemently asserted at the eleventh 
hour; and we believe it is the just one. But the true leader of humanity, 
whose intelligence and energy have enabled him, by outstripping others, 
to win the prize, can well afford to acknowledge the advance already pro- 
posed by his less active predecessors, and the aid he may have derived 
from their suggestions; nor has he anything to gain from an attempt to 
stultify his own advance, and bar further progress, by resisting improve- 
ments on himself, although those improvements may throw his “into the 
background.” 
“Silver Sutures in Surgery,” gays Dr. Sims, “is a subject that necessarily 
involves frequent and constant reference to my own labors and their results; 
indeed, it has been the theme of my life for the last twelve years. In selecting it, 
I am not ignorant of the delicacy of my position, and of my liability to be mis- 
interpreted, and to be criticised by some who do not know me as you do. 
Nevertheless, I shall speak as an American—plainly, frankly, and fearlessly, 
feeling that you and the great mass of the profession will understand and fully 6 
Sims on Silver Sutures. 
sustain me. So far as it concerns my experience, personal narrative, claims as 
a discoverer, or defence against aggression, I have a right to declare them 
openly ‘from the house-tops;’ and for this, in the abstract, I hold myself re- 
sponsible. But whether the subject-matter will be considered quite appropriate 
for the occasion, is a question only for the fastidiously censorious; and I shall 
dismiss that very summarily, by shifting its responsibility to the broad shoulders 
of the gentlemen just named, at whose solicitation I stand here to-night.”—pp. 7,8. 
We should be very loathe to believe that the distinguished members of 
the Academy of Medicine, here alluded to, would knowingly subject them- 
selves to such a burden as Dr. Sims has cast upon them, in return for 
their good-natured confidence in his sense of propriety as well as pro- 
fessional experience. We shall not question their opinion as to the fit- 
ness of the “subject-matter” for an audience containing many men and 
women incapable of understanding anything about it, except the revolting 
and once hopeless nature of an infirmity to which one sex is liable in its 
most important functions, and the vast debt of gratitude "which both sexes 
owe to the individual before them for the “ only genuine cure.” But we 
do not believe that these officers of the Academy can contentedly accept 
the compliment which thus compels them to indorse the self-glorifying 
appeal, over their shoulders, to a miscellaneous assembly. It is far too 
likely to remind them of the large-lettered exhibitions which are sus- 
pended from the backs of a much humbler class of peripatetics in their 
public streets. 
Not having the fear of the speaker or his sponsors before our eyes, we 
do not hesitate to range ourselves among the “fastidiously censorious ;” 
and we venture to express the hope that the hitherto interesting series of 
annual mementoes, which began so well with Dr. Francis and had reached 
a climax not easily surpassed in the scholarly address of Dr. Watson, may 
cease altogether, rather than that such perversions as this of Dr. Sims 
should be allowed to threaten the well-earned fame of the Academy. 
“You who are familiar,” continues our author, “with the experience of that 
noble charity, the Woman’s Hospital, will not be surprised, when I declare it as 
my honest and heartfelt conviction, that the use of silver as a suture is the 
GREAT SURGICAL ACHIEVEMENT OF THE NINETEENTH CENTURY. 
“For my country I claim the honor of this imperishable discovery, and seize 
this auspicious occasion to place permanently upon record a history of its ori- 
gin and progress. 
“Many of you already know that it was not the result of mere accident, but 
of long, laborious, and persevering effort, based upon the immutable principles 
of science, and forming one of the most beautiful examples of inductive phi- 
losophy. 
“Wishing to impress upon the profession its importance and value in general 
surgery, as well as in injuries from protracted parturition, I shall necessarily be Sims on Silver Sutures. 
7 
compelled to draw largely and somewhat minutely upon my past experience. 
But this will be readily tolerated by a liberal profession ; for, while I labor to 
establish principles, it will be legitimate to refer to dates, and times, and places, 
and persons, and circumstances, all of which are necessary, to place forever 
beyond cavil my claims and agency in this discovery. 
“ In 1845 I conceived the idea of curing vesico-vaginal fistula, and entered 
upon the broad field of experiment with all the ardor and enthusiasm of a de- 
votee. After nearly four years of fruitless labor, silver wire was fortunately 
substituted for silk as a suture, and lo! a new era dawns upon surgery. 
“This was on the 21st of June, 1849, since which time I have used no other 
suture in any department of surgery.”—pp. 8, 9. 
In another part of the pamphlet, after assuring us that every case of 
vesico-vaginal fistula “is easily and perfectly curable that has tissue 
enough to render any operation whatever practicable, while a failure is 
the exception to the rule,” and that there is in these operations “ not the 
least risk to life,” he raves on in the following strain ; 
“ I am not claiming too much for this suture when I say that the same rela- 
tive result must be attained in all other surgical operations requiring sutures, 
if the same method be adopted. 
“My language is in nowise extravagant; and I shall yet live to see the day 
when the whole profession of the civilized world will accord to this simple dis- 
covery the high position of being the most important contribution as yet made 
to the surgery of the present century. 
“ The only thing at all comparable to it is Etherization ; and in practical re- 
sults of permanent benefit it is absolutely contemptible, when compared with 
those from the universal use of silver sutures in the broad domain of general 
surgery.”—p. 46. 
In the foregoing extracts Dr. Sims has the benefit of a sufficiently full 
statement, verbatim et literatim, of his position on the suture question. 
Let us see what is his idea of the right of ownership in the grand in- 
vention. 
“As concentrated efforts have been made in various quarters to rob me of 
full credit for my labors, I have thought it due to truth, to justice, to posterity, 
and to myself, to place permanently upon record a history of the circumstances 
attending this discovery.”—p. 46. 
These various moral, personal, and prospective interests are then duly 
sustained in a long and extremely characteristic “ personal narrative,” 
which cannot fail to divert and astonish the reader as much as it interests 
him. For the present we pass over the details of the early efforts, the 
gradual but laborious unfolding of new plans, the numerous discourage- 
ments but steady progress toward improvement, and the crowning triumph 
to the years of toil, which do him so much honor. Some excitement may 8 
Sims on Silver Sutures. 
be well excused in one who chronicles the checkered fortunes of a struggle 
fraught with so much that is laudable in its conception and career. But 
the vain-boasting and unfairness of our hero provoke a sifting of his 
story, and lead us to seek human agency for the sources of inspiration 
which he describes as “Providential.” This agency maybe fairly attri- 
buted to Wurtzer, Chelius, Velpeau, Dieffenbach, and Churchill, and to 
Hayward, Mettauer, and Pancoast, whose different suggestions and ex- 
pedients afforded the needful hints to choose from, without the neces- 
sity for higher revelation. The real heroism is to be found in the all- 
trusting women who went on with never-failing fortitude, enduring 
trial after trial, to enable this one man to work out upon their lacer- 
ated bodies an almost hopeless problem which was to determine the life- 
long happiness or misery of multitudes of their sex. Theirs was the 
great act; and, much as they have gained in the escape from suffering, 
let them still share the praise. This share is graciously allowed them by 
Dr. Sims in the following strain : 
“To the indomitable courage of these long-suffering women, more than to 
any one other single circumstance, is the world indebted for the results of these 
persevering efforts. Had they faltered, then would woman have continued to 
suffer from the dreadful injuries produced by protracted parturition, and then 
should the broad domain of surgery not have known one of the most useful im- 
provements that shall forever hereafter grace its annals.”—p. 55. 
To return to our “narrative;” after years of fruitless experiment he 
finally Imagined that the only remaining obstacle was in the irritating 
action of the material of the suture. 
“Now, the question arose, was there a substitute for silk that would answer 
the same purpose, and yet not poison the animal tissue ? Why, lead remains in- 
definitely in the body, becomes sacculated, and produces no poisonous or sup- 
purative effect; Dr. Levert, of Mobile, [Am. Jour. Med. Set., No. YIL, May, 
1829,) had demonstrated the innocuousness and efficiency of leaden ligatures 
on the arteries in the lower animals, and Mettauer and Dieffenbach had actu- 
ally used leaden sutures in these very cases; and I had in my various experi- 
ments tried them in two cases of vesical, and one of rectal fistula, but, fortu- 
nately for science, the clumsy leaden wire was unsuccessful in my hands. Was 
there any other metal that could be substituted for lead, possessing its valuable 
property of harmlessness ? 
“ In the train of inquiry what would be more readily suggested to the reason- 
ing mind than silver, gold, and platinum ?”■—pp. 59, 60. 
He tells us he has used all of them, but adopts the silver, “ because it 
is as good as gold, and cheaper.” Just at this crisis he happens “to pick 
up a piece of brass wire that had been used in a pair of old-fashioned 
suspenders made before the clays of India rubber; it was fine as ordinary Sims on Silver Sutures. 
9 
sewing thread.” He got a jeweller to imitate this in silver ; and, on the 
21st of June, it was applied, with leaden bars and the perforated shot, to 
a young colored woman, who “had never murmured at the preceding 
failures,” and was “placed on the operating table for the thirtieth time.” 
“In all previous operations the urethra, in a day or two, would become red 
and tender, and the urine loaded with thick tenacious mucus, thus showing the 
inflammatory process, which was adverse to union ; but after this operation, the 
urine remained perfectly limpid all the time, and on the eighth day the parts 
were perfectly healed; the suture apparatus remaining just as it was placed, 
with the cross-bars somewhat burrowed in the vaginal tissue.” At last he had 
attained what he had “ worked for for nearly four years ; and it was but a few 
weeks before all the cases were cured that had been the subject of experiment 
for so long time.”—pp. 60, 61. 
This termination of his gropings was happy enough, one might suppose, 
to admit of some little gratitude to the few investigators whose previous 
inklings and recorded experience were entitled to at least as much 
notice as the old suspender wire. He mentions Levert, as having experi- 
mented on arteries with leaden ligatures, but neglects to tell us that 
Levert experimented with silver, gold, and platinum wires, as well as 
lead. He might have remembered, too, that silver wire was long ago ad- 
vised and used by a member of the New York Academy, (Dr. J. Kearney 
Rodgers,) as a suture between fragments of bone, and has ever since been 
familiar to American surgeons. Whether or not it is new as a suture 
for soft parts, its employment as a means of retaining fragments of bone 
in apposition dates at least as far back as the eighteenth century. 
This question, however, is of trivial importance; we should not have 
mooted it with one less grasping in his demands, and more liberal to his 
neighbors in minor matters, than the author of this address. Dr. Sims 
deserves and receives the usual credit for developing the advantages of 
the metallic suture, and for urging its application in many cases in 
which he was, doubtless, the first to resort to it and demonstrate its 
value. An ingenious modifier and manipulator, untiring in the pursuit 
of the required expedient, and able to appreciate its application, he cer- 
tainly is; but, with all this inventive capacity, he has yet to establish a 
foothold in the field of independent scientific “discovery.” 
Admitting, then, his position as the author of silver suture surgery, we 
still want to know what mysterious virtue there is in virgin silver to make 
it the sine qua non in keeping wounds in proper order. How has it 
been shown that cheaper, more pliable and stronger metals are not 
equally available, or cannot easily be made so by coating with silver or 
with other unirritating material ? Galvanic action might interfere, but 
who has shown this ? If it be true that metallic ligatures or sutures are 10 
Sims on Silver Sutures. 
in all cases preferable to animal or vegetable—which we beg leave to 
doubt exceedingly—then let iron, the cheapest, strongest and most pliable 
when finely drawn, be fairly tested, with and without a covering. We 
have tried electro-plated iron wire and found it more delicate and con- 
venient than the silver wire which had been provided for the case. We 
doubt the necessity, however, of plating the iron wire at all; it might be 
tinned, but would probably do just as well uncovered, since the common 
twisted suture needle has been long enough in use, in hundreds of deli- 
cate plastic operations, to prove its unirritating qualities and freedom from 
injurious oxidation. Copper, (the best for plating,) tin, and aluminum, 
also demand a trial, as well as iron and lead. 
Dr. Sims refers to lead as having been employed by Mettauer and 
Dieffenbach; but, although unwilling to say anything of the labors of 
these operators, he quotes his own failures with their suture only to 
disparage it, and dismisses it as “clumsy.” These negative results 
and the cavalier dismissal can hardly counteract the authority of 
Mettauer and Dieffenbach. (See Mettauer’s cases in American Journ. 
Med. Sci., January, 1833, and April, 1837 ; also Dieffenbach in same 
Journal, Nov. 1838.) Nor does the idle epithet indulged in affect the 
applicability of the vulgar metal, when properly prepared and handled, 
to all the legitimate functions of the more stylish substitute of Dr. Sims; 
still less does it deprive the leaden thread in the hands of Mettauer and 
Dieffenbach, of the post of honor, such as it is, in the van of the metallic 
sutures. 
We have neither time nor space to follow Dr. Sims in his harangue 
upon the vastly superior action of his silver suture in various surgical 
cases, or to examine into the need of any kind of suture in many of the 
dressings for. which he recommends it; nor do we wish to reopen the 
very old debate upon the good and bad effects of silken sutures, which 
has been going on, with frequent fluctuations but no material practical 
conclusion, ever since the time of Pibrac and Louis, of John Hunter and 
John Bell. The new turn and impulse to the discussion, given by the 
fancy of Dr. Sims, is of less importance to the management of external 
wounds in these days of collodion and isinglass adhesive strips; and yet 
suggests a good deal of experimental inquiry which ought to be pursued, 
and which would have added greatly to the value of his paper. 
So much for the first object of the anniversary address. The second 
seems to be to demolish Dr. Bozeman and his “button suture,” which 
latter had become a stumbling-block to Dr. Sims. 
This branch of the argument begins, directly after the grand announce- 
ment of the dawn of the “new era,”—the silver age of surgery,—with a 
reference to the speaker’s article, in the American Journal of the Medi- Sims on Silver Sutures. 
11 
cal Sciences, on “The Treatment of Yesico-Vaginal Fistula,” as con- 
taining the first revelation, in the shape of “full and specific directions 
for every stage of the operation.” “The silver suture as then used,” he 
says, “I called the 'clamp-suture,’ on account of its method of action in 
forcing or ‘clamping’ firmly together the surfaces to be united.” He then 
describes the component parts and the action of this quondam clamp 
arrangement, and gives a wood-cut in illustration, “merely for its histo- 
rical value, and to show the progress of improvement.” 
Everybody understands that the new surname of clamp, thus given to 
an old form of suture, was very generally received, because it does convey 
a better idea of the well-known action of the quills, and because it repre- 
sents a neat improvement of the primitive cylinders, which the author 
of the name had unquestionably contrived. We are sorry to see the 
Doctor thus casting off what, in spite of his own protest, will continue 
to be regarded as an inseparable feature of his particular method. Whe- 
ther superseded or not by other appliances, in addition to the metallic 
suture, it cannot be replaced, either in name or function, by the suture in 
itself as the only essential part. The clamp, although applicable only to 
listuhe of Velpeau’s second and third classes, and utterly unfit for his first 
and for the fourth and fifth of Bozeman, has done too much good service in 
other hands, as well as those of Dr. Sims, to be altogether set aside at this 
stage of its history. Yet Dr. Sims assures us (p. 21) that “the great success 
of these operations” [including Bozeman’s,] “is due entirely to the silver 
wire. I had long ago demonstrated, over and over again, that the clamps 
or leaden bars and perforated shot were totally worthless, if used with 
silk as a suture; in other words, that the silver wire was the essential 
part, the sine qua non of success.” After adverting to some disparaging- 
experience with Dr. Bozeman’s suture, in which he appears to have been 
strangely awkward and unfortunate, he informs us that “seeing thus 
that the much vaunted button was obnoxious in some cases, and nugatory 
in others, I now began a series of experiments with the wire as an inter- 
rupted suture, without ‘clamps’or ‘buttons,’so-called.” He had found 
it excellent in general surgery; and he saw no good reason why it 
should not answer equally well in the management of the fistulge on 
which he was then engaged. It was accordingly applied on the 24th of 
June, 1856. 
This was about six weeks after the intruding “ button” was presented 
to the profession, and betrays an awakening sense of weakness in the 
clamp, which, until the entrance of the new light, its cautious advocate 
had not ventured to indulge. Similar experiments, however, had been 
long ago performed with promising success by Dieffenbach and Mettauer, 
the only difference being that they used lead, which we believe to be better 
than silver as an interrupted suture. 12 
Sims on Silver Sutures. 
Curiously enough, and very unhappily for his own way of thinking from 
the suum cuique stand-point, the first steps of his revised plan of opera- 
tion are precisely those of Dr. Bozeman; while the twisting of the wires 
which completes the union, as also the method of withdrawing them, are 
the processes of Mettauer; except that the wires are cut off by Dr. Sims, 
whereas Mettauer, although he cuts them off in staphylorraphy, more 
wisely leaves them long enough to reach the entrance of the canal. The 
wires are drawn together by an instrument shaped and cleft like the broad 
end of a French director, which is evidently a modification of Bozeman’s 
adjuster. In short, the new “operation” is another very pretty illustra- 
tion of the adaptive power of our enterprising but too captious orator. 
We acknowledge that these are very little matters of dispute;—as unbe- 
coming to the pages of a respectable review as they are to those of a 
scientific essay or annual address. Our object, in dwelling on such ques- 
tions, is simply to suggest to Dr. Sims, in future discussion of other 
men’s labors in a field, which is still open to all, an application of the 
golden rule. 
“In my own hands,” he continues, “this method of using the silver wire” [be. 
with clamps and shot,] “in vesico-vaginal fistula, was uniformly successful, be- 
cause I always took good care to make a broad and free scarification of the 
edges of the fistula, and to pass the sutures so far from them that the cross-bars 
or clamps would burrow in the vaginal tissue, there to remain till the case was 
permanently cured. But my followers were not so successful, simply because 
these two important points were not fully appreciated. They complained that 
the sutures would cut out; a thing that never happened with me in but three 
or four cases, and they were among my first experiments, before learning tho- 
roughly the art of applying them.” 
To return to the story of our amiable and modest author:— 
Dr. Sims here forgets his own experience, especially as recorded in his 
former article, (Am. Jour. Med. Sci., Jan., 1852, p. 10,) in which, in ad- 
dition to the cutting out and other “difficulties” requiring “great judg- 
ment, which experience alone can give, to counteract,” he speaks of hav- 
ing witnessed “in two or three instances, a still more serious accident 
from an undue pressure of the clamps, viz. a strangulation of the inclosed 
fistulous edges, which unfortunately resulted in a sloughing of the tume- 
fied parts, and a consequent enlarging of the opening.” 
The charge against his “ followers,” of ignorance, is an unsustained 
assertion, in relation to which, Bozeman and the now comparatively nu- 
merous operators are entitled to an equal footing with himself. It is well 
contradicted by one of his ablest and most experienced commentators 
(Dr. Kolloch) in the following remarks : 
“The wires will cut themselves out in certain cases, however much attention 
may be bestowed on their introduction at a sufficient distance from the edge of Sims on Silver Sutures. 
13 
the raw surface, and sufficient depth into the submucous tissue; the lips in- 
cluded between the clamps will slough, however much judgment may be exer- 
cised in drawing them together, and irregularities on the vaginal surface, 
rigidity from cicatrices, and the situation of either a part or the whole of the 
fistulous opening, may prevent the clamps from being evenly applied, and with 
sufficient parallelism to secure their regular and efficient action. In conse- 
quence of these occurrences the patient has to be subjected to a greater or less 
number of repetitions of the operation; and, perhaps, other means have to be 
employed for the perfection of the cure.” (Report on the History and Treat- 
ment of Yesico-Yaginal Fistula, read before the Georgia State Med. Soc., p. 17 ; 
published in the Savannah Jour, of Med., and in the Southern Med. and Surg. 
Jour., Augusta, Georgia; see also a Review by H. R. S., in Am. Jour. Med. 
Sci., Oct., 1857, p. 392.) 
The same authority, in a recent review of this pamphlet of Dr. Sims, 
adds some further testimony to his previous evidence in favor of the supe- 
riority of Bozeman’s plan. 
“The attempt of Dr. Sims to disparage ‘the button’ will not readily succeed 
in producing conviction in the minds of those who have had an opportunity of 
comparing the two methods. We have not the pleasure of the personal ac- 
quaintance of either Dr. S. or Dr. 8., and have, therefore, no personal predilec- 
tion to bias our judgment. 
“Before we were acquainted with Dr.Bozeman’s Modification of the Silver 
Wire Suture, we had operated several times unsuccessfully with Dr. Sims’s 
clamps; but as we knew of no more perfect method, as we were blessed with a 
pretty good stock of patience and perseverance, as we found that the fistulas 
(although not cured) were very much contracted by each operation; above all, 
as we had, like Dr. Sims, willing patients at our control, we were determined to 
go on, yea, even to the thirtieth or fortieth repetition. Before, however, our 
long-suffering patients were subjected to this severe ordeal, we were furnished 
by Dr. Bozeman with his pamphlet, and lo! success crowned our very first 
trial. 
“With such evidence as this before our eyes, could we refuse to acknowledge 
the superiority of the button over the clamps ?” (Savannah Jour, of Med., May, 
1858, p. 59.) 
Dr. Mettauer, who has “ treated and cured twenty-seven cases with the 
leaden interrupted suture alone, and without the least difficulty,” in an in- 
structive paper, (published June, 1855, before the appearance of Dr. Boze- 
man’s article,) after stating that the “ quilled suture, as improved by Dr. 
Sims, had not succeeded in his hands,” holds the following language ; 
“In each case, three in number, the operation failed from ulceration of the 
denuded borders, both at the margins and where the metallic clamp rested on 
them, and by the premature cutting out of the silver wire. 
“In one case the clamp induced sufficient ulceration to form a new opening 
into the bladder so early as the fifth day after the operation. Possibly I may 
have used undue force in the approximation of the denuded borders in these 14 
Sims on Silver Sutures. 
cases; but it seemed to me that I only carried it to the extent of placing them 
in complete and firm contact. 
“ This suture, however useful it may have been in the hands of Dr. Sims, is 
liable to important objections. If applied with two much force it will almost 
certainly cause ulceration or actual sloughing of the denuded borders ; and it 
will be very difficult, in most cases in which it is used, to determine the degree 
of force which should be used in applying it.” ( Virginia Med. and Surg. Jour., 
June, 1855, pp. 451, 452.) 
One more testimonial may be offered here, (from the review of Dr. H. 
R. Storer, in the Am. Jour. Med. Set., loc. citat.,) which we quote in full 
because it presents an excellent and appreciative summary of Dr. Boze- 
man’s labors, and because it is free from the suspicion of undue influences 
to which our own remarks may be subjected. 
“ It is to Dr. Bozeman, of Alabama, to whom it accidentally suggested itself, 
that we are indebted for the long-looked-for discovery, now known as the button 
suture. His first paper was published in the spring of 1856, and he has lately 
made known the results of a more extended experience, by diagrams, accurate 
descriptions, an elaborate classification of all possible varieties of fistula, and 
directions for perfectly adapting his apparatus to each and every one of them. 
“ The early stages of his operation are identical with those already described. 
Silver ligatures are used, but are introduced directly and without the aid of any 
other thread. Instead of being fastened to metal quills, the extremities of the 
wires, brought together like Mettauer’s before twisting, are passed through 
minute perforations in a shield of lead, which is found to answer much better 
than the silver at first proposed, and, as by Sims, clamped securely with shot. 
“It is claimed that the metal shield will—better than Sims’s cross-bars—l. 
Act the part of a splint in keeping the approximated edges in close contact, 
and at rest; 2. Prevent the wires from cutting out; and 3. Protect the edges of 
the wound against irritation by the urine, vaginal discharges, or atmosphere. 
“ The button suture has been fairly tried. Successful cases have been re- 
ported, besides the fifteen [now twenty-four] or more of Bozeman, in this 
country, by Gaston, T. Wood, Kolloch, Williams, and others; and in Great 
Britain, by Spencer Wells and Baker Brown ; all of whom corroborate its ex- 
cellence. Kolloch’s report, indeed, prepared evidently with care, and well and 
candidly written, is mainly occupied by cases from his own practice, show the 
relative merits of the clamp and button. Dr. Bozeman has found that the more 
difficult cases of ordinary fistula can be easily cured, but there are tAvo lesions 
he has mastered which have hitherto been entirely beyond surgical aid. 
“ The first of these is a longitudinal laceration of the edge of the meatus, 
[termed ‘ rent of the urethraby Dr. B.] ‘ the most unfavorable form of all the 
urethral injuries,’ for which no treatment had ever been proposed. 
“The other victory alluded to is in those cases where the cervix uteri is 
directly involved in the fistula. Nothing had been done unless by Yidal’s 
method of closing the vagina, save by Jobert, who, until lately, by extensively 
dissecting away the attachments of the cervix, whether or not accompanying Sims on Silver Sutures, 
15 
this by the insertion of a flap from a distant part, managed to close the fistula 
but lost his patients by peritonitis. 
“ Bozeman, on the other hand, claims better fortune. By his method the 
uterus itself is dragged down, the edges of the cervix are passed, just as with 
any part of the vesico-vaginal septum, and stiches inserted into its substance. 
“ The idea of this bold procedure, as novel as it is successful, had undoubtedly 
presented itself to the mind of Yelpeau, (Operative Surgery, v01.i., p. 627 ; see 
also his Clinique Chirurgicale, vol. ii., p. 267,) who speaks of the possibility of 
dragging down the cervix and making it subservient to closing the fistula, but 
remarks, ‘ all these suggestions want a foundation to rest upon ; none of them 
can yet adduce any success in their favor;’ and Jobert, improving upon him- 
self, relates, at the close of the year, a case in which sutures were passed through 
the cervix; (Union Medicale, Nov., 1856 ;) but the credit of having independ- 
ently conceived the operation in all its completeness, and of having put it into 
actual practice, is undoubtedly Bozeman’s.” 
This review also mentions a unique and invaluable application of the 
button, which deserves especial notice. Speaking in praise of Sims’s 
catheter, as indispensable, he says:— 
“ In those lacerations of the meatus already referred to, this instrument can- 
not be borne; but by an ingenious arrangement of his button-shield, Bozeman 
has compelled it, though designed for an entirely different purpose, successfully 
to take the place by affording the necessary support to a male elastic.” 
The reader is now prepared to appreciate the wisdom and delicacy as 
well as justness of the attack of Dr. Sims upon the unwitting offender 
who had left him so far behind in the study of their common theme. 
In 1853, being obliged by ill health to leave Montgomery, Alabama, Dr. S. 
“ gave Dr. Bozeman of that place a partnership in business,* and indoctrinated 
him in my peculiar method of operating for vesico-vaginal fistula, instructing 
him in ray various modes of using silver wire as a suture, not only in this class 
of affections, but in general surgery. Not understanding its principle of action, 
and, therefore, failing in its practical application, he was quite disheartened 
with his ill success, when by mere accident he fell upon a plan of fastening the 
wire, and so modifying my method, that in awkward or inexperienced hands it 
became easier of application. Instead of passing the wires through the leaden 
bars on each side of the fistula, he passed them through a concave disc or ‘ but- 
ton’ which rests upon the surface of the parts to be united.” 
In the marvellous history of his own discoveries he stumbles on the 
best mode of looking into the vagina, by a “Providential incident;” and 
announces (p. 51) that “there are no accidents in the providence of 
* [The partnership referred to, we understand from Dr. 8., was only nominal, and 
was formed, at the earnest solicitation of Dr. Sims, for a special purpose and con- 
sideration, just as he was making his arrangements to come to the North, and not 
longer than two months before his departure.—Eds.] 16 
Sims on Silver Sutures. 
God.” It seems, however, that the device of Dr. Bozeman is not to be 
thus canonized, although it had neither precedent nor incident to bring it 
into active being By mere accident only did he fall upon a plan, which 
could not be respectable because it so modified his master’s method as to 
make this “ easier of application,” and thus bring it within the unhallowed 
reach of “ awkward and inexperienced hands!” 
The balloon experiment of the kneeling patient, so graphically re- 
corded, (p. 50,) in which the whole vaginal expanse displayed itself for 
the first time to the admiring eyes of Dr. Sims, was one which, although 
not thus explained, was well known to surgeons of any reading, long be- 
fore it thus occurred to the practical mind of our historian. The position 
on the elbows and knees suggested by it was years ago recommended by 
Wurtzer, Chelius, Yelpeau, and Churchill, and is quoted by Pancoast in 
his Operative Surgery, published in 1844. Like the unlucky clamp, 
however, this other once prominent feature in the process of the Doctor 
is withdrawn from its place of honor by the immortal stitch. A position, 
partly prone and partly on the side, much less constrained for the patient, 
and, as we believe, from one trial of it, sufficiently convenient for the ope- 
rator, is now recommended. It is illustrated with a full-length picture 
which is not equal to many of the others, either in design or execution. 
Our orator claims to have “ had a mission, if not of a Divine character, 
at least but little short of it,—of Divine origin and to be engaged in 
“ a labor of love under Divine guidance for the furtherance of a truly 
benevolent purpose.” In a season of discouragement, too, something told 
him “ that the work had to be done, and that if I should fall, God in his 
wisdom would raise up some one as an instrument to carry it forward to 
a glorious consummation.”—pp. 54, 55. 
Better times have not increased his Christian humility or charity. 
He evidently wishes to remain alone in his solemn glory, and will brook 
no son of Jesse near the throne. 
“Notwithstanding the fact that the Doctor lived in Montgomery for years, 
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 him- 
self every step of the operation that resulted from my own individual and un- 
aided efforts,—even my silver wire and perforated shot, the only things of any 
real value whatever, and publishes it as his operation by a ‘new mode of suture,’ 
making strenuous efforts to place my labors in the background. 
“ I do not complain of modifications, but I do complain of a disingenuousness 
that would be dishonorable even under widely different circumstances.” 
* [Dr. Bozeman had the prospects of any other young practitioner of his age and 
acquirements. The only professional position granted, that we have heard of, was 
the dwelling-house and office of Dr. Sims, for which the latter received what was 
considered, at the time, an extravagantly high price.—Eds.] Sims on Silver Sutures. 
17 
The pathetic earnestness with which, like the Israelite of Yenice, he 
thus bewails his daughter and his ducats, would only rouse a smile, if 
the outcry w'ere not burdened with a serious personal charge. 
In order to contradict this charge at once, we have only to cite a pas- 
sage from Dr. Bozeman’s first paper. In objecting to the clamp suture 
he expressly states that,— 
“I do not wish to be understood as attempting to detract from the great 
credit due, from the profession and the public, to Dr. Sims for his untiring 
perseverance in bringing his method to its present high state of perfection; I 
consider that this gentleman is fully entitled to all the praise that has been be- 
stowed upon him, both in America and Europe. To the honor of his professional 
brethren in this country, it may be stated that no one has been found who has 
not gladly accorded to him the high distinction that he at present occupies. I 
am sorry that the same cannot be said of European surgeons in general; for, 
with the exception of Mr. Erichsen, Mr. Brown and Mr. Druitt, of London, no 
one on the other side of the Atlantic has proved sufficiently frank to do full 
justice to Dr. Sims’s claims. Eully impressed, therefore, with the importance 
of the position I assume in attempting to show that the clamp suture is objec- 
tionable, I proceed to the task, actuated, as every inquirer after truth should 
be, by no other motives than a desire to make facts and principles subservient 
to the great ends of science.” 
Dr. Bozeman does not claim originality, as lie might well have done, 
for his button, but offers it only as a modification of the twisted suture. 
In our view it is altogether unlike and superior to the twisted suture, 
being capable of greater variation and serving more completely as splint, 
shield and director, all in one. The only thing that approaches it is the 
brad suture; but that is only a convenient species of quill or clamp 
suture, with few of the mechanical advantages of the various forms of 
button. As for the outcry about the non-acknowledgment of “even the 
silver and the shot,” it is sheer nonsense to suppose that Dr. Bozeman 
was bound to say, in so many definite words, what had long been a matter 
of notoriety among professional men. His general tribute to Dr. Sims’s 
pre-emption rights was ample, and, of course, included all matters not 
expressly mentioned. But Dr. Bozeman can easily do without the shot 
as well as the silver; for he only needs a furrowed ridge upon the 
outer face of the shield along the line through which the holes are to 
pass, to secure a fixed and ready means of clinching the wire, which is bet- 
ter than the “clumsy” and slippery contrivance of Dr. Sims. 
Dr. Sims, in narrating a hare-lip case, describes an arrangement of 
softened ivory, or a softened and flattened piece of quill, to be applied as 
a shield and a support under the wires, which is clearly suggested by 
Bozeman’s disc; which indeed had actually been proposed as such, in 
private practice, by two different surgeons of our acquaintance. Although 18 
Sims on Silver Sutures. 
engaged at the time in exalting the silver suture at the expense of the 
shield, he thus impliedly admits the advantage of the latter, but utters not 
a word as to the source of his suggestion. 
This very attempt, perhaps unconscious, on the part of Dr. Sims, 
to avail himself of the principle of mechanical support and retention to 
which the broad disc is so well adapted, shows the necessity, which he 
perceives, for something more than the barren and negative quality of 
non-irritation, which alone distinguishes the metallic suture from other 
sutures, as a bond of union. Beyond the absence of superficial irritation, 
its ordinary use involves no “principle” whatever that is not common to 
silk and flax, and that is not surpassed in rational attributes by other 
modes of retentive dressing. 
On the other hand, the button shield, as already shown in part by Dr. 
Storer, is really philosophical, and is capable of application to an abundant 
variety of solutions of continuity. This very capability would lead an in- 
telligent and earnest practitioner to classify the forms of injury to which 
it may be adapted. That this has been done in fistulse with great care 
and clearness by Dr, Bozeman, is much to his honor, since he has thus 
effected more scientific progress than with any other portion of his 
labors. 
In the course of his investigations he has ascertained the relative fre- 
quency of certain fistulas, and has learned that the most prevalent (about 
thirty per cent.) are those involving the neck of the uterus, his fifth class, 
and one in which the clamp is altogether unavailable. 
It was not our expectation, however, to consider Dr. Bozeman’s plans 
and principles of treatment. They are fully given in his several papers, 
especially the last, already published in this journal. Our sole desire has 
been to expose the folly and injustice of the attack upon his honor as a 
man and a physician, by the one who should have cherished him the most, 
not as a rival but as a worthy coadjutor. Nor need we follow the aggressor 
in his feeble and inconsistent strictures on the “principle” of the button 
suture, and in his misconstruction of its application; still less in his 
ill-judged and inconclusive trials of it, as exhibited in his discourse. 
Of the six cases subjected to the pretended test and found wanting, 
three were cases of operation for occlusion of the vagina, in which the 
button is not recommended, and in which a different operation should 
have been performed; while not one of the operations in the other three 
was performed in accordance with the precepts of the inventor. 
Before parting with Dr. Sims we would humbly ask his leave, and, if 
need be, that of Drs. Bozeman and Mettauer, to propose another “modi- 
fication.” From what we have seen of leaden ligatures, and of these 
vesico-vaginal operations, we are strongly prepossessed in favor of Met- Sims on Silver Sutures. 
19 
tauer’s suture. Dr. M. thus describes his method of using this, after 
having introduced the several threads, directly opposite each other, 
through all the coats of the bladder and vagina, “fully an inch from the 
denuded margins on the vaginal surface”:— 
“I next proceeded to approximate the divided borders, by making traction 
on the metallic threads, and then carefully confining them in close and exact 
contact, by twisting their free ends together, until the loops were sufficiently 
abridged to enable them both to support and moderately to compress the struc- 
tures embraced by them; and for the purpose of twisting the wires I employed 
a light pair of self-closing forceps, without ring-handles, having found that in- 
strument far more handy than the ordinary dressing forceps, or forceps with 
ring-handles. After securing the first suture so as to bring the denuded bor- 
ders well together, I tightened the second, and was gratified in finding that the 
fistulous opening was perfectly closed, and that not a drop of urine escaped 
between the borders. I was careful, in twisting the wires, not to employ undue 
force, but sufficient to bring the opposing surfaces into complete and firm con- 
tact, without injuriously compressing the unlooped structure ; and I invariably 
twisted from left to right, to prevent confusion. 
“After many trials in determining the extent to which the tension should be 
carried, I finally adopted, as a safe rule, the fixed and erected state of the 
twisted extremities of the wires, and their bristle-like spring when touched with 
the probe; and the tightening of the loops should be executed with extreme 
caution and gradually, testing it, as we proceed, from time to time, by touching 
the wires with a probe or the extremity of the forceps.”—(Virginia Med. and 
Surg. Journal, June, 1855, p. 449.) 
According to his experience, it is necessary to tighten the ligatures on 
the second or third day after the operation; which can be most readily 
done by simply twisting the wire a few turns, until the approximating 
force is once more steadily exerted, as shown by the spring-like tension 
of the twisted wires above described. The ability thus to graduate the 
approximating force, and subsequently to renew this approximation, if 
necessary, constitutes, in Dr. Mettauer’s view, a very weighty source, 
among others, of superiority in the interrupted leaden suture over the 
clamp. The leaden suture has this advantage, to some extent, over the 
simple interrupted silver suture also, because of its greater pliability; but the 
twisting manoeuvre is very easily adapted to the shield of Bozeman, and ren- 
ders this latter especially desirable for the purpose. All that we need is 
a double row of holes parallel to each other, instead of a single one as 
heretofore. Passing the two ends of each ligature through their corre- 
sponding pair of holes, we would then twist their ends together gradually 
and cautiously, as directed by Mettauer, and we would repeat this twist- 
ing, or release the wires by untwisting, according to circumstances in each 
case. 20 
Sims on Silver Sutures. 
In order the better to watch the condition and relative positions of the 
sutured parts, we would prefer a transparent horn or tortoise-shell shield 
to the lead at present used. This transparent shield, with parallel lines of 
perforations, and a series of slender leaden or iron or tin wires properly ap- 
plied, and to be twisted, retwisted or untwisted, pro re nata, might be 
made to answer every indication in hare-lip and other plastic operations; 
at least, as well as the flattened quill and silver suture plan proposed by 
Dr. Sims. We again beg permission to submit our horn-button and 
lead, iron or tin suture, for his especial and candid consideration. 
The contrast between the combination of vile things in our “invention” 
and the simplex mundiciis of their lordly rival is, doubtless, painful to 
eyes and ears polite; but, until we are convinced that silver is entitled 
to monopolize the position as a connecting medium in wounds which it 
holds as a circulating one in trade, we must continue to adhere to the 
more serviceable iron and lead, or, peradventure, tin. 
In conclusion, we again regret that the New York Academy of Medi- 
cine has permitted this publication to go forth under the sanction of its 
seal and the formal action of a committee composed of some of its best 
men. It was bad enough, in all conscience, to oblige these gentlemen 
and their fellows to listen even to its delivery, not omitting the exordium 
to the “presidential galaxy” with which the orator apologizes for the 
intrusion of his private griefs. But to involve any public body, through 
an annual address, in the endorsement of such a tissue of adulation and 
self-glorification, is an imposition on its character for taste, judgment, 
dignity, and ethics, which ought not to go unwhipped of justice,—least 
of all by a society which ranks among its members many of the brightest 
ornaments of the American profession. 
In regard to the author himself, we are satisfied that, whatever he may 
think of our-own remarks—which have been indited in no recriminating 
spirit, as we have no personal interest in either party—he must deeply 
lament the occasion which has thus brought him so unpleasantly before 
his brethren and the public. Our task has been a thankless one, as un- 
palatable to ourselves as it may be to him; and we heartily wish that he 
and his reviewers could have been spared the necessity of its infliction. 
To our readers we have to say, in excuse for troubling them, that in the 
performance of the censor’s duty we have striven to respect the adage,— 
“If offence come out of truth, it were better that the offence come than 
that the truth be concealed.”