PREFACE TO THE SECOND EDITION.

THE first edition of this work met with a most appreciative reception by the medical press and profession both in this country and abroad, and a large number of colleges in the United States and Canada have recommended the book to their students.

If I have enjoyed the praise bestowed upon the book, I have paid no less attention to just criticisms, and have embraced the opportunity afforded by this revision to bring the work up to date.

In this second edition old-fashioned patterns of instruments have been replaced by new ones, defective original illustrations have been artistically redrawn, and many new figures have been added.

Aseptic surgery, which was in its infancy when the first edition was written, has been more carefully considered, still retaining its forerunner, antisepsis, which in many respects, by the nature of things, is indispensable, and often is all that can be obtained in private practice.

Parts of the text and some of the illustrations that seemed antiquated or of minor importance have been omitted, and considerable new material has been incorporated.

The whole surgical treatment of Uterine Fibroid and Cancer has been rewritten and much simplified.

Vaginal Section has been placed on equal terms with Abdominal Section.

Descriptions of the chief methods employed in Intestinal Surgery have been added to the Appendix.

I have more extensively expressed my own opinion on the comparative value of different methods of treatment, but the applicability of these methods to particular cases depends upon circumstances of which only the attending physician or surgeon is judge.

716 LEXINGTON AVENUE.

PREFACE TO THE FIRST EDITION.

THE term "Diseases of Women" is understood to designate the affections of the genital organs in the female sex other than those connected with pregnancy, childbirth, and the puerperal state. That branch of medical science and art that is devoted to this subject is called Gynecology.

In writing this book I have first had in view the large class of physicians who have not had the advantage of hospital training, and who go to a post-graduate school in order to learn gynecology. They can only stay a short time, and they want a full but concise exposition, up to date, of the nature and treatment of the diseases peculiar to women.

Secondly, I have tried to satisfy the requirements of that much larger class who would like to go to such an establishment, but who find it impossible to leave their practice. They are busy men, who have to keep abreast of recent progress as best they can in all branches of a general practitioner's work. They want information about the present state of gynecology, but cannot find time to study large works.

If in large cities it is better for the general practitioner, as well as for his patient, to leave the treatment of most gynecological cases to those who have special experience and skill in this line, the same does not always hold good in country practice. The long distances in this immense country make it very difficult, and often impossible, to send patients to places where they can be treated by specialists. American physicians are enterprising, and some men practicing in a village have achieved world-wide renown, and become the leaders of their city confrères.

Finally, I think the book will be found useful by undergraduates studying in medical colleges. They will probably at that stage

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of their development skip many details about operations, which they will be glad to take up later, when the responsibility of a medical practitioner lies heavy on their shoulders. The division into a general and a special part will presumably be useful for the beginner, and he will hardly care to pay much attention to what has been placed in notes under the text.

This being a book for General Practitioners and Students, I have omitted all reference to the historical development by which gynecology has attained its present stage, as well as all reports of special cases.

The limits and the nature of the work have not allowed me to speak of all methods of treating every disease, but I have striven to give a clear and succinct description of the best modes of treatment; and the reader will in this book find many details which he would look for in vain in larger works.

My aim has been to write a practical work. The reader's time is not taken up by theoretical discussions, and the pathology has been treated very briefly. On the other hand, I have tried to help the reader to make a diagnosis, and to teach him how to treat the different diseases. In this respect I have gone into minute details affording manifold information about points which practitioners who live in large cities learn from one another or by visits to the shops of the instrument-makers.

I have treated so discursively of the anatomy of the female genitals because this subject, to a great extent, has been worked up by the gynecologists themselves, and is not as yet described satisfactorily in the text-books of anatomy, but only in large works of an encyclopedic character or in articles in journals to which many have not

access.

I expect to be criticised for having devoted special chapters to Hemorrhage and Leucorrhea. I know well that they are not diseases; but they are symptoms that play so great a part in the diseases of women, and so often require symptomatic treatment, that I take it to be in the interest of the general practitioner to treat them separately; and besides, by so doing infinite repetitions are avoided. This being a text-book for beginners and a manual for general practitioners, names of authors have been omitted as much as possible from the text, except when it was necessary in order to designate

different methods of operations. In making use of the work of American authors I have, however, given them credit for it in foot-notes, and I trust that it will be found that a large amount of information of this kind has been embodied in the text.

In indicating the treatment of the various affections, I mention always the simpler and innocuous means before the more complicated and dangerous, medical and electrical treatment being accorded precedence over surgical.

Throughout the work a chief object has been to give modes of treatment as they are practiced in America, by which I hope that it will be found more useful for American students and practitioners than the works written by or translated from foreign authors.

The Illustrations form a complete atlas of the embryology and anatomy of the female genitalia, and represent numerous operations and pathological conditions. Many come from my own operations, dissections, and microscopical examinations.

155 LEXINGTON AVENUE, New York, January, 1894.