PREFACE
THE plan of this work was laid down and many of the Articles were actually written when the European War broke out in August 1914. The difficulty of completing our task amid the many preoccupations of these times has been very great, alike for the Editors, the Contributing Authors, and the Publishers, although we have never wavered in our determination to carry out our project.
The work was originally contemplated because in the opinion of the Editors the time had arrived when it was necessary to put into concrete form the great changes through which Gynaecological Practice in this country has passed during the last ten years. The change may be briefly summarized by saying that Gynaecology has become definitely a special branch of surgery, in close touch with abdominal surgery generally, and the old view that the gynaecologist is a physician not a surgeon is no longer tenable. In consequence of this development the interests of the gynaecologist have necessarily broadened. Pelvic disease in women is frequently associated, in the relation of cause or of effect, with diseases of the gastro-intestinal and urinary canals; the gynaecologist has accordingly realized that he must be prepared to deal with whatever condition he may find on opening the abdomen for the relief of disease apparently of pelvic origin. And further, he must be familiar with the special methods which are employed in the investigation of such diseases as those of the kidney, the bladder, and the rectum. Diseases of the female breast fall so obviously into the province of the gynaecologist that no explanation of the inclusion of this subject is called for. The vermiform appendix possesses relationships of unique intimacy with the pelvic organs, and there is no doubt that cases of appendicitis in women very frequently come under the care of the gynaecologist. During pelvic operations, injury to the intestines necessitating enterorrhaphy or enterectomy frequently occur, with which it is quite obvious that he must be prepared to deal. And further, during convalescence from abdominal operations, intestinal complications may arise which call for a sound knowledge of intestinal surgery.
In order to embody these developments it was necessary to extend the scope of the
