First published in 1863 this is the second edition with the text re-written and greatly extended with five additional plates, with illustrations of the operations on vesico-vaginal fistula, ovariotomy, and perineal operations. ”From the earliest days of recorded medical history physicians have struggled with the problem of vesicovaginal fistula, exhausting their ingenuity in an effort to reclaim these social outcasts. . . . Until the middle of the nineteenth century progress in surgery was greatly hampered by ignorance of asepsis and the absence of anesthesia. Attempts to repair vesicovaginal fistulas were further impeded by difficulties of exposure, inadequate instruments, and faulty suture materials. In 1845 J. Marion Sims, a young American surgeon, who insisted on washing his hands thoroughly before operating, began his experiments on the now legendary negro slaves, Anarcha, Betsy, and Lucy, victims of vesicovaginal fistulas. After repeated, fruitless attempts, about 40 in number, to cure these wretched creatures, Sims ultimately succeeded with the aid of silver sutures . . . and a vaginal speculum now named for him.” (Speert) – The peculiar lateral posture (Sim’s position) and the invention of the special curved speculum (Sims’ speculum), were the particular factors of his success in operating vesico-vaginal fisula. Before Sims’ invention that horrible disease was incurable. To the Sims’ position ”as no man had ever seen it before”, he added a special suture of silver wire, to avoid sepsis, and a catheter for emptying the bladder while the fistula was healing. With these four coefficients, Sims perfected his operation for repairing this almost irremidiable condition and initiated a new era in gynaecology. An excellent portrayal of Sims' instruments and of Sims sitting while operating on a patient for vesico-vaginal fistula appeared in this second edition of Savage’s book. The drawing was made by the celebrated anatomic artist, J.B. Léveillé. The lateral position was also very convenient for the patient. Sims himself, then in London, supervised the execution of these pictures. . Collation: Pp (8), (72), with 16 hand-coloured lithographed plates. Binding: Publisher’s brown cloth with gilt title on front cover. References: For James Marion Sims: Garrison-Morton 6057; Medical Classics, Volume II, 1937-38, pp 663-712; Speert, Harold, Obstetric and Gynecologic Milestones (1958), Chapter 52, pp 442-54; Graham [pseud. for J. H. Flack], Eternal Eve (1950), pp 442-53; Ricci, James V. The Development of Gynaecological Surgery and Instruments,( 1990), pp 360-65.