Browse's Introduction to the Symptoms and Signs of Surgical Disease (4th edn)

Abstract

The preface to the first edition of this book, published 28 years ago, expressed surprise that some students present themselves for qualifying examinations unable to take a history or conduct a physical examination in a way that is likely to detect all the abnormal symptoms and signs. It also pointed out that it is essential for them to realise that the major part of medical education is an apprenticeship where watching and listening to someone more experienced is followed by practice under supervision. Essentially, a strict ritual when taking a history and performing an examination must remain a vital component of clinical education to accelerate diagnosis and avoid errors and omissions. Indeed, the book is designed to accompany the student through this as a ward-round ‘teach-book’ rather than a library-shelf textbook. In this fourth edition, the distinguished principal author has invited three eminent colleagues to join him, each active not only in clinical practice but also experienced in examination and assessments, and they are to be congratulated on the result. They have extensively revised and, where appropriate, combined each of the progressively updated original chapters and introduced a new one on the all important symptoms, signs and emergency management of major injuries. In addition, the chapters on the breast, muscles and bones have been completely rewritten. Nevertheless, the original systematic approach and style has been maintained. The first chapter on history taking and clinical examination sets the tone for the whole book, emphasising a careful, methodical approach, always giving the patient complete attention and never taking short cuts. After the new second chapter on trauma, the subsequent 16 cover sequentially and logically the major anatomical areas. The book is beautifully illustrated with high-quality photographs, including 150 new ones, and colour line diagrams, each succinctly annotated. The illustrations generally appear on the same page as the text to which they refer, thereby avoiding the need to search one or two pages on either side as is so often the case. I particularly liked the representation of the history of pain in graphical format and also in the clinical examination section a series of diagrams that provide a helpful foundation in understanding basic clinical signs. Another helpful feature is the inclusion throughout the book of revision panels, summarising the important aspects of, for example, examination, causes and classifications. The index is comprehensive and there is clear cross-referencing when appropriate between chapters. Although initially aimed at undergraduate medical students, there is no doubt that it should be read and re-read by basic surgical trainees preparing for the MRCS examination. Higher surgical trainees will also find it provides a helpful aide-memoire for areas outside their immediate specialist field, as will, I suspect, more senior colleagues faced with the odd clinical feature that they may not have seen for some time. At £26.99, it represents extremely good value and I would strongly recommend it to all medical students and surgical trainees, both young and old.