Browse's Introduction to the Symptoms & Signs of Surgical Disease

Citation

Gossage, J. A., Bultitude, M. F., & Corbett, S. A. (Eds.). (2021). Browse's Introduction to the Symptoms & Signs of Surgical Disease (6th ed.). CRC Press.

Chapter Summary

The sixth edition is a large volume of 658 pages with 668 colour illustrations, organised in eighteen chapters: one general chapter on history taking and examination, then seventeen chapters arranged by body region or system. The book was founded by Sir Norman Browse; this edition is edited by three consultant surgeons at Guy's and St Thomas' in London (upper gastrointestinal, urological and orthopaedic), with two associate editors and contributors new to this edition. The publisher describes a highly structured, consistent layout supported by tables and revision panels, and a companion website with self-assessment material, video animations and an image library.

Chapter 1: History Taking and Examination

The general method on which the rest of the book depends. John Lowry, reviewing an earlier edition in the Annals of the Royal College of Surgeons of England, wrote that this chapter sets the tone for the book, with its careful, methodical approach, full attention to the patient and refusal of short cuts; Carol Scott-Conner, in Doody's Reviews, noted that it includes assessing the patient's overall appearance and clinical situation.

Chapters 2–4: The Heart, Lungs and Pleura; The Brain, CNS and Peripheral Nerves; The Skin and Subcutaneous Tissue

Three chapters on the thorax, the nervous system and the skin.

Chapter 5: The Symptoms, Signs and Emergency Management of Major Injuries

The only chapter whose title names management as well as symptoms and signs, covering the assessment of the injured patient.

Chapters 6–9: Musculoskeletal Conditions; Bones and Joints of the Upper Limbs (Including Hands); Bones and Joints of the Lower Limbs (Including Feet); The Spine and Pelvis

Four chapters on orthopaedics: a general musculoskeletal chapter, then the upper limb with the hand, the lower limb with the foot, and the spine and pelvis.

Chapter 10: The Arteries, Veins and Lymphatics

Vascular surgery: the arterial, venous and lymphatic systems.

Chapters 11–13: The Mouth, Tongue and Lips; The Neck and Salivary Glands; The Breast

Head and neck conditions, from the oral cavity to the neck and salivary glands, followed by the breast.

Chapters 14–16: The Abdominal Wall, Herniae and the Umbilicus; The Abdomen; The Rectum and Anal Canal

General surgery of the abdomen: the abdominal wall and herniae, the abdomen itself, and anorectal conditions.

Chapters 17–18: The Kidneys, Urinary Tract and Prostate; The External Genitalia

Urology, closing the book with the external genitalia.

Key Concepts

Chapter 1: Method

• Surgical history: a structured account of the presenting complaint and its features that points towards a diagnosis.
• Systematic examination: examining each region in a consistent, methodical order, the approach the reviewers praise.
• General assessment: noting the patient's overall appearance and condition before focusing on the region concerned.

Chapters 2–18: Region by region

• Symptoms and signs: what the patient reports and what the examiner finds, the two sources of a clinical diagnosis.
• Emergency assessment of injury: the structured evaluation and initial management of the seriously injured patient.
• Regional organisation: each chapter collects the surgical conditions of one part of the body or one system.

Critical Analysis

Strengths

• Illustration. With 668 colour illustrations, the book is built around clinical photographs and line diagrams; Scott-Conner called the range of conditions illustrated extraordinary, and the publisher notes that the images were refreshed for this edition.
• Method first. Both quoted reviewers single out the opening chapter on history and examination, which Lowry saw as setting the tone for the whole book.
• Revision aids. Tables, revision panels and a consistent layout are designed for quick reference before examinations, and the companion website adds self-assessment questions, animations and an image library.
• Breadth across specialties. Eighteen chapters span cardiothoracic, neurological, skin, trauma, orthopaedic, vascular, head and neck, breast, abdominal, anorectal and urological surgery, and the editors and contributors cover several of these specialties.

Limitations

• Diagnosis rather than treatment. As its title says, the book concentrates on symptoms and signs. Apart from the emergency management of major injuries, it is not a guide to investigation, operative treatment or perioperative care.
• Long for an introduction. At 658 pages it is too long to read straight through on a short rotation; students will need to read it selectively.
• Reviews cover earlier editions. The published reviews quoted by the publisher refer to earlier editions; no independent review of the sixth edition was found.
• No separate paediatric chapter. The contents are arranged by region with no chapter devoted to children, so students on a paediatric surgery placement should check which conditions the regional chapters include.

Where It Fits in the Course

Browse is the clinical-skills book of the surgery and anaesthesia course: it teaches how to recognise surgical disease at the bedside. Crash Course Surgery is the other introductory book, a short revision text covering the principles of surgical care and common ward presentations with history and examination guides and exam-style questions. The two can be used together: Crash Course for an overview of what to know, Browse for how each condition looks and feels on examination.

Garden, Parks and Wigmore's Principles and Practice of Surgery is the undergraduate textbook that adds investigation and management, from perioperative care to gastrointestinal surgery and the specialties; read the relevant Browse chapter first to recognise a condition, then Garden for what to do about it. Quick Hits in Obstetric Anesthesia and Surgical and Perioperative Management of Patients with Anatomic Anomalies are specialist clinical guides for later training, not alternatives to Browse.

How to Use This Book

The publisher addresses medical students learning history taking and examination, especially on a surgical rotation and before surgical examinations, and those moving into postgraduate surgical training. Preclinical anatomy is the most useful preparation, since every chapter is organised by region.

A practical plan:

• Read Chapter 1 carefully before the first surgical attachment and practise its method on every patient.
• Read by placement. Read the chapters that match the current firm (orthopaedics, Chapters 6–9; vascular, Chapter 10; breast, Chapter 13; urology, Chapters 17–18) and the abdominal chapters, 14–16, for general surgery.
• Study the pictures. Look at the photographs and diagrams before reading the text, and try to describe each lesion as an examiner would.
• Use Chapter 5 before emergency placements.
• Revise with the panels and companion website. Use the revision panels and tables in the run-up to examinations, and the online self-assessment questions and image library to test recognition.