Foreword

The adjective "tenth" connotes a milestone, and, in the case of a "tenth edition" of a textbook, it is evidence of readership acceptability. This continued reader response would evoke parental pride from those who generated the original publication more than 45 years ago. I can still vividly recall the meeting in New York City at which John DeCarville, an editor at McGraw-Hill, brought together David M. Hume, Richard C. Lillehei, G. Thomas Shires, Edward H. Storer, Frank C. Spencer, and me to create a new surgical textbook. The new surgical publication was to serve as a companion to Harrison's recently introduced medical textbook. The favorable reception of the first edition was most encouraging. The consistency of style and the deliberate inclusion of 52 chapters to allow for review of one chapter a week throughout the year were particularly appealing. Subsequent to the initial publication and following the tragic and premature deaths of Dr. Lillehei, Dr. Hume, and Dr. Storer, Dr. Shires, Dr. Spencer, and I were privileged to shepherd six additional editions over the ensuing 35 years. Under the direction of Dr. F. Charles Brunicardi and his associate editors, a new vitality was infused over the three most recent editions.

The ten editions, as they are considered in sequence, serve as a chronicle of the dramatic evolution that has occurred in surgery over the past half century. Those, who have been charged with providing current information to the readership, have had to filter and incorporate extraordinary and unanticipated scientific breakthroughs and technical innovations. At the time of the genesis of the first edition, success had not been achieved in cardiac, hepatic, or intestinal transplantation. Adjuvant therapy for a broad variety of malignancies was in its infancy. Minimally invasive surgery would not become a reality for two decades. On the other side of the spectrum, operative procedures that occupied the focus of symposia have slipped into obscurity. Vagotomy for peptic ulcer has become a rarity, as a consequence of an appreciation of the role of Helicobacter pylori and the efficacy of proton pump inhibitors. Surgical procedures to decompress portal hypertension in the treatment of bleeding esophagogastric varices have essentially disappeared from the operating room schedule. They have been replaced by transjugular intrahepatic portosystemic shunt (TIPS) and the liberal application of hepatic transplantation.

As Bob Dylan pointed out, "The Times They Are A-changin." And they most assuredly will continue to change, and at an unanticipated rate. The scientific basis for the practice of surgery is increasing at an ever accelerating pace, and the technologic improvements and breakthroughs are equally extraordinary. The dissemination of the expansion of knowledge has resulted in a shrinking of the globe, necessitating an extension or adaptation of the more modern approaches to underdeveloped nations and underprivileged populations. Global medicine has become a modern concern. The importance of internationalism is manifest in the clinical trials and data acquisition provided by our surgical colleagues on the other sides of the oceans that surround us. It is therefore appropriate that a more international flavor has been developed for Principles of Surgery related both to citations and contributors. A distinct consideration of global medicine and, also, the qualities of leadership in surgery that must be nurtured are evidence of the editorial credo of "maintaining modernization" and "anticipating the future."

As the editors and contributors continue to provide the most up-to-date information with a clarity that facilitates learning, it is the hope that the seed, which was planted almost a half century ago, will continue to flourish and maintain the approval of its audience.