Gynecology

Preface

Gynecology is to-day so broad a subject that in order to deal with it exhaustively a series of monographs would be required. While monographs undoubtedly enrich the literature and are invaluable, they do not altogether

!meet the needs of either the student or the practitioner of medicine, for in order to cover the necessary ground the student must of necessity be a voluminous reader, and he would be unusually discerning indeed if he were capable of selecting the pertinent from the unessential or the immaterial. The monograph, moreover, does not furnish the needed information in such a form as to enable the practitioner to gather his facts with a reasonable expenditure of time.

There would seem to be, therefore, a distinct place for the text-book which presents the subject in a systematic form, giving all the necessary information, and omitting such details as are not immediately required for practical purposes. A thorough acquaintance with the subject presented in this way will provide the student with a fund of information that clinical teaching and clinical experience will tend to crystallize and render applicable. In the library of the busy general practitioner the comprehensive text-book stands as a ready guide to the accurate diagnosis and the successful treatment of the gynecologic conditions most frequently encountered.

A logical plan for studying the pathology of any organ or group of organs and of the methods of treatment may be formulated to include : (i) A description of the normal structures and of the normal functions ; (2) a review of the causes that produce the abnormal; and (3) a summary of the manifestations of the abnormal and of the methods of treatment. Believing this to be a rational sequence, the author has arranged and discussed the subject matter in the following order: (1) Normal anatomy and physiology; (2) morbid anatomy and physiologic abnormalities that are dependent upon developmental defects; (3) the acquired causes of disease of the reproductive organs; (4) the general symptomatology, both subjective and objective, of diseases peculiar to the pelvic organs, together with the approved methods of investigation; and finally (5) a systematic arrangement and description of the diseases affecting the organs and structures of the entire generative tract — their morbid anatomy, symptomatology, diagnosis and treatment.

In addition to affections of the generative organs proper, such diseases of the intestinal and urinary tract as are most frequently encountered in women have been considered. Static backache, sacroiliac sprain, toxic arthritis, gonorrhoea, tuberculosis, syphilis, menstrual disorders, sterility, the selection and preparation of operative cases, operative technic, post-operative treatment, and the management of post-operative complications, local therapeutic measures, radium and Rontgen ray therapy, and the use of vaccines, have been dealt with under separate heads.

Although seemingly superfluous in a work of this nature, the chapters on anatomy and physiology have been included in the belief that they will vi PREFACE

serve to refresh the memory of the student and of the practitioner regarding the details of anatomy and physiology of the generative organs, a knowledge of which is so essential to a full understanding of gynecologic symptoms and operative treatment, and which will render unnecessary a search through the more exhaustive treatises devoted exclusively to these subjects.

The author has drawn freely from the literature, and has aimed to give full credit for these quotations in the bibliographic references at the end of each chapter. The bibliography is intended to serve the student as a guide for more extended reading. Some of the earlier writings of the author have also been included. The majority of the illustrations have been made from original photographs or drawings.

The author wishes to acknowledge his indebtedness to Dr. John G. Clark for the clinical and teaching experience that facilitated the preparation of this volume. He is under especial obligations also to Dr. Philip F. Williams, who has reviewed the entire manuscript, criticising, correcting, and adding to the text, and assisting in many ways too numerous to mention. The suggestions of Dr. Charles C. Norris in the chapter on tuberculosis, of Dr. Frank Crozier Knowles in the chapter dealing with cutaneous lesions of the external genitalia, and of Dr. Floyd E. Keene in the chapter on examination of the urinary tract, have been most acceptable ; Dr. Wm. J. Merrill and Dr. Frank Dickson have given assistance in the preparation of the chapter on backache ; Dr. Leon Jonas, in the section on acidosis ; and Dr. Henry Pancoast, in the chapter on radium treatment and Rontgen ray therapy.

The author's thanks are also due to the artists, particularly Mr. Aitken, for the excellence of their work ; to the publishers, for their unfailing courtesy; to Miss Lilian B. Mendel, for careful editorial work; and to Miss Lydia Stieglitz, for her painstaking efforts in typing the manuscript.

The Author.

January, 192 i.