Introduction

Opening a surgical text has a forbidding feel, page after page of closely set print interspersed with pictures which sometimes help to explain the text but more often confuse on account of their lack of clarity. Didactic teaching required dull tomes to buttress the ethos of complexity so often promulgated by the professional. Bailey and Love set out to alter this trend by presenting a text that was colourful, readable and contained the precise information required by the student of surgery. Since the first publication of this book in 1932, surgery has become simpler to study. Greater knowledge simplifies and more exact diagnosis leaves less to supposition and opinion. It is now easy to verify an opinion, and even the most arrogant are worn down by the certainty of the newer imaging techniques in providing an exact diagnosis. The spleen palpated only by the consultant can soon be verified by computerised tomography (CT) (Fig. 1.1).

Surgical diagnosis is based on a sound knowledge of anatomy, physiology and pathology, a specific history and examination with confirmation by imaging and operative surgery. It is unnecessary to learn what can be deduced, and thus studying surgery concerns defining the basic facts on which the consequences of a disease process can be built (Fig. 1.2).

It is often surprising that a book entitled Short Practice of Surgery does not contain more about operative surgery. The actual operation in surgery is but one part of the process of surgical care; diagnosis, preoperative care and postoperative management being of equal importance in differing circumstances. No matter how good the operation, if it is performed for the wrong diagnosis, the benefit to the patient will be limited or void. In other situations, such as the patient who presents as a surgical emergency in association with severe illness, a common occurrence in this era of the elderly patient, skilled preoperative resuscitation and management, often in conjunction with the relevant physician, can turn a high-risk procedure into a routine operation. Similarly, the very ill patient can be salvaged by expert postoperative management. Nevertheless, the trend to denigrate the skills of operative surgery has been exposed as false by audit, which time and time again shows that a surgeon who does a procedure frequently outperforms in every parameter the surgeon who does an operation intermittently. The skills of operative surgery are primarily taught in the operating theatre and by supervised practice aided by specific illustrative texts on operative surgery. The objective of this book is to ensure that the surgeon understands the basis of the craft.