Seventh International Edition
Revised and updated from the sixth edition by
Pratap
Kumar
MD FICOG
Prof. and Head, Department of Obstetrics and Gynaecology Kasturba Medical College,
Manipal,
Karnataka
(India)
Narendra
Malhotra
MD FICOG
Consultant and Director MNMH (P) Ltd.,
Agra
Apollo Pankaj Hospital (P) Ltd.,
Agra
(India)
President, Federation of Obstetric and Gynaecological Societies of India-2008
Jitendar P Vij
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Jeffcoate's Principles of Gynaecology
© 2008, Arnold
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition : 1957
Fifth Edition : 1987
Sixth Edition : 2001
Seventh Edition : 2008
9788184482881
Typeset at JPBMP typesetting unit
Printed at Ajanta
5Preface to the Seventh International Edition
We both, Dr Prof Pratap Kumar and Dr Narendra Malhotra feel very honoured for being asked to revise the best textbook on gynaecology by Sir Norman Jeffcoate.
In the rapidly advancing age of technology and rapidly changing trends in management, diagnosis, drugs and procedures, it is of paramount importance to update books and manuals periodically. This book was earlier updated and edited by Dr Neerja Bhatla in the year 2001, an International Edition (Sixth edition), but soon the publishers felt the need for revising it within a span of five years.
Prof Norman had expressed in 1974 that he had endeavoured to preserve his personal approach.
We have added many new chapters and rewritten a few chapters all together trying to maintain Sir Jeffcoate's style. We have retained the description of Professor Jeffcoate's original case discussions, photographs and pictures.
We hope that the undergraduate and the postgraduate students will appreciate our efforts to update this “Bible” of Gynaecology.
Pratap Kumar
Narendra Malhotra
7Preface to the Fifth Edition
It was inevitable that following Professor Sir Norman Jeffcoate's retirement there would be pressure to continue to publish the Principles of Gynaecology.
In the last revision in 1974 Sir Norman emphasised that he had endeavoured to preserve his personal approach, bearing in mind the objectives and principles outlined in the preface to the First Edition. In addition, some of Sir Norman's comments in the preface to his Fourth Edition are included to emphasize the guidelines the present author has taken in an attempt to maintain the format of the Principles of Gynaecology.
Much of the material presented is retained from the last edition, since it also reflects the gynaecological training of the author under Professor Jeffcoate in Liverpool. The views expressed are therefore personal ones from a pupil of Sir Norman Jeffcoate against the background of all the information available. Once given, the views expressed mean that references are excluded for the special reasons given in the preface to the First Edition.
In the process of being taught obstetrics and gynaecology by Sir Norman, one was encouraged to consider all the facts about a case, to come to a conclusion and to be able to justify it. Even though a critical approach to each case was expected, we were never allowed to forget that we were dealing with a woman, mother or child with a personal problem. Indeed, Professor Jeffcoate's personal approach was such that in a clinic with many students and postgraduates present, it was obvious that as far as the patient was concerned Sir Norman was the only person there. I have never been able to achieve the same effect, but I hope that my efforts in revising this book will be acceptable to an outstanding teacher, guide and friend. If so, then I am sure it will benefit all those who read it.
Victor Tindall
9Extracts from the Preface to the First Edition
The book is meant to add to rather than replace clinical and tutorial instruction, so those matters which can best be taught beside the patient, or which are easy for any student to learn and understand from other sources, receive little attention. In planning the text I recalled those subjects which I myself found (and still do find) difficult to master, or on which I had to search far and long for information, and gave them disproportionate emphasis. This and other considerations resulted in a disregard for the relative importance - as judged by their clinical frequency - of different conditions. Indeed, the reader will find that quite rare conditions are mentioned, illustrated or described at length; and that all manner of asides - even some with an obstetrical flavour — creep in. This is partly because they are of special interest to me but mainly because they appeared to offer scope for presenting an attitude of mind; for discouraging loose thinking and empiricism; for inculcating a scientifically and ethically honest outlook; for emphasising the Art as well as the Science of gynaecology.
I have not played safe by stating only generally accepted views, nor have I played fair by giving the differing views of various authorities. Instead, after weighing the evidence, I have attempted to reach a conclusion which satisfies me as being as rational as present knowledge allows. Without intended disrespect, mention by name of authors and workers has been avoided as a rule; references clutter up the text, destroy continuity and are hardly ever used properly. On the other hand, I have not hesitated to give my own views and have, at times, been more dogmatic than clinical experience ever really justifies. I have even gone so far as to enunciate ideas which in many respects are conjectural if not fanciful. I do not expect these all to be accepted; if they are I shall be disappointed because their object is to provoke trains of thought and discussion.
In offering this book to fellow students I remember with affection and gratitude W Blair-Bell, one of the great gynaecologists of this century. He not only taught me gynaecology and a particular approach to it, he taught me to think and to write. He, more than anyone else, provided me with the stimulus and the opportunity to obtain the experience which has led to this work.
Norman Jeffcoate
1957
10Acknowledgements
A mammoth project like revising Sir Norman Jeffcoate's Principles of Gynaecology requires lots of help from colleagues.
We are grateful to all those who have helped us to do this mammoth job. Special appreciation and thanks are to:
- Thank you doctors and staff of Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka.
- Thank you junior doctors of MNMH (P) Ltd. and Apollo Pankaj Hospital (P) Ltd, Agra.
- Our special thanks to the following, who have given valuable suggestions in various chapters: Prof Barun Sarkar, Prof Arun Nagrath, Dr Richa Singh, Dr Anju Sharma, Dr Alka Saraswat, Dr Jaideep Malhotra, Dr Anupam Gupta and Dr Neharikaa of Agra, Dr Sunder Rajan (Pondicherry), Dr Kavita Singh (Jabalpur), Dr Col R Puri (Jalandhar), Dr Sakshi Tomar (PGI Lucknow), Dr Maninder Ahuja (Faridabad).
- Special thanks to Dr Pranay Shah of Mumbai for contributing Chapter on Laparoscopy and Dr Richa Saxena for editing the manuscript.
We both are thankful to our families for bearing with us and sharing family time for work like this. Thank you Vidya, Dr Prabha Malhotra, Dr Jaideep Malhotra, Deepali, Deepika, Dr RM Malhotra, Kehsav and Neharikaa.