A digital examination revealed a retroversion of the uterus. He placed the patient in the knee-elbow position, inserting two fingers into the vagina in the effort to push the womb into place. To his great surprise there was an inrush of air which dilated the vagina and exercised pressure enough to carry the displaced organ into position. The ballooning of the vagina by atmospheric pressure brought all parts of this hitherto inaccessible surgical region into full view. Forgetting everything for the moment except the value of this important revelation, he jumped into his buggy, and drove hurriedly to a hardware store in Montgomery, where he bought a set of pewter spoons of different sizes. Bending the bowl and part of the handle of one of these at a right angle, he placed one of his patients suffering from vesico-vaginal fistula in the genupectoral position, inserted the improvised speculum, and atmospheric pressure accomplished the rest. The fistulous opening was clearly seen. He says:
"Introducing the bent handle of the spoon, I saw everything as no man had ever seen before. The fistula was as plain as the nose on a man's face; the edges were clear and well defined, and the opening could be measured as accurately as if it had been cut out of a piece of plain paper. The speculum was perfectly clear from the very begnning. I soon operated upon the fistula, closing it in about an hours' time, but the operation failed."
He did not then know the cause of failure, but later discovered that it was due to infection from the use of silk ligatures". Not long after this, in walking from his home to his office, he noticed upon the ground a bit of spiral wire, such as was used to give elasticity to suspenders before the days of India rubber. He picked up the wire, uncoiled it and it came over him at once that he had found a suture which, if made of a pure metal, would not only hold, but be less apt to induce infection. He carried the wire immediately to a silversmith in Montgomery, gave him a half-dollar silver piece, and asked him to beat that into a wire of the size of the brass wire he presented. This was skillfully done by the smith, and with this wire and the speculum was done the first successful operation for vesico-vaginal fistula, and Marion Sims had taken the first great step towards the immortality which awaited him. Of this instrument the illustrious Thomas Addis Emmett said:
"From the beginning of time to the present, I believe that the human race has not been benefited to the same extent and in a like period by the introduction of any other surgical instrument. Those who did not fully appreciate the value of the speculum itself have been benefited indirectly to an extent they little realize, for the instrument in the hands of others has probably advanced the knowledge of the diseases of women to an extent which could not have been done for a hundred years or more without it."
But it was not alone in this particular line that he achieved distinction, but also in other departments of surgery.
In 1835 he performed a successful operation for abscess of the liver; in 1837 one for removal of the lower jaw without external mutilation, the operation of excision being done entirely from within the mouth, and a successful removal of the superior maxilla for tumor of the antrum. He performed originally the operation of cholecystotomy, without the knowledge of the fact that Dr. Bobbs, of Indiana, to whom he always accorded full credit, had preceded him by a few months.
To him it may well be said that mankind is indebted for the surgical invasion of the peritoneal cavity. In his great paper entitled: "The Careful Aseptic Invasion of the Peritoneal Cavity" for the Arrest of Hemorrhage, the Suture of Intestinal Wounds and the Cleansing of the Peritoneal Cavity, and for all Intraperitoneal Conditions," before the New York Academy of Medicine, on October 6, 1881, quoting from his own experience
