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At the turn of the century gynecology had achieved independence from surgery in most medical schools; although gynecologists were surgeons, their interests were turning toward nonsurgical aspects of their specialty. In 1900, merely two years after the Curies' discovery, radium was first used as a treatment for carcinoma of the cervix. In that day cervical cancer claimed more women's lives than any other malignancy and was described by Wil liam P. Graves, the second professor of gynecology at Harvard as follows: 'Cancer of the cervix may rightly be termed of all tumors one of the most deadly and most ghastly. It kills by slow torture, causing in later stages months of agonizing pain and producing a discharge of such a foul and nauseating character as to repel proper medical assistance. Nurses declined to care for these cases, while many public hospitals closed their wards to them as patients. ' In late twentieth century parlance the dramatic results of radium therapy would indeed have been called a 'breakthrough'? and radium techniques, later combined with external irradiation, were devel oped by gynecologists, no longer just surgeons. Pathology was the basic science of gynecology and gynecologists with a special interest in pathology served as pathologist to the departments of gynecology. As late as 1970 six months of the three-year residency program in obstetrics and gynecology at Harvard were devoted to formal training in pathology.
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At the turn of the century gynecology had achieved independence from surgery in most medical schools; although gynecologists were surgeons, their interests were turning toward nonsurgical aspects of their specialty. In 1900, merely two years after the Curies' discovery, radium was first used as a treatment for carcinoma of the cervix. In that day cervical cancer claimed more women's lives than any other malignancy and was described by Wil liam P. Graves, the second professor of gynecology at Harvard as follows: 'Cancer of the cervix may rightly be termed of all tumors one of the most deadly and most ghastly. It kills by slow torture, causing in later stages months of agonizing pain and producing a discharge of such a foul and nauseating character as to repel proper medical assistance. Nurses declined to care for these cases, while many public hospitals closed their wards to them as patients. ' In late twentieth century parlance the dramatic results of radium therapy would indeed have been called a 'breakthrough'? and radium techniques, later combined with external irradiation, were devel oped by gynecologists, no longer just surgeons. Pathology was the basic science of gynecology and gynecologists with a special interest in pathology served as pathologist to the departments of gynecology. As late as 1970 six months of the three-year residency program in obstetrics and gynecology at Harvard were devoted to formal training in pathology.
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Gynecological oncology surgery has shown substantial progress in recent years. Most of the advances come from gynecologists with full time commitments to gynecological oncology. Jt is important for the general obstetrician-gynecologist to be informed about the possibilities offered by modern gyneco logical oncology. Thus he or she may acquire new techniques which can be used in general gynecological practice. On the other hand it is essential to know what his or her colleagues, specialised in gynecological oncology can offer in oncology centres. The chapters in this book are based on a post-graduate course organised by the Boerhaave Committee for post-graduate medical education of the medical faculty of the University of Leiden, in the Netherlands. In view of the considerable interest shown by many highly qualified specialists we are extremely grateful to our contributors who were prepared to lucidly present their knowledge and expertise within the covers of the present book. One of the conclusion of this book must be that the special surgical skills needed for adequate treatment of gynecological cancer cannot be developed within general residency programs. Thus European gynecologists should examine whether and to what extent additional training as usual in the U.S.A. is necessary. The editors want to thank the Royal College of Obstericians and Gynecologists for their kind permission to reproduce the contribution of J.A. Jordan (chapter 7 from "pre-clinical neoplasia of the cervix" (London, 1982). A.P.M. Heintz, M.D. C.Th.G~i66ith~,M.D.