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The fourth edition of this essential textbook has been fully revised and updated to ensure it continues to meet the needs of all those learning the principles of surgical examination. Together with Sir Norman Browse, the three new authors bring their specialized knowledge and experience to complement the book's much-praised clear, didactic approach and broad insight into the principles of surgery in general. The authors have updated all chapters in line with current developments, paying special attention to 'Muscles, tendons, bones & joints', and to 'The breast', where the terms describing benign breast disease and the classification of cancer staging have been fully revised. The book's numerous illustrations have also been fully revised, with many new photographs showing the more subtle surgical signs and demonstrating new approaches to surgical examination. In addition, there is greater emphasis on the doctor-patient relationship and patient confidentiality.

Norman L. Browse, MD, FRCS, FRCP, Professor of Surgery, Emeritus University of London; Hon. Consulting Surgeon, St. Thomas' Hospital, London; Past-President, Royal College of Surgeons of England, UK
John Black, MD, FRCS, Consultant Surgeon, Worcestershire Royal Hospital; Member of Council, Royal College of Surgeons of England Examiner, Intercollegiate Board in General Surgery, UK
Kevin G. Burnand, MS FRCS, MBBS, Chairman of the Department of Surgery and Anesthesia of Kings College at the St. Thomas' Campus, London, UK
William E.G. Thomas, BSc, MBBS, MS, FRCS, Consultant Surgeon and Clinical Director, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield; Member of Council, Royal College of Surgeons of England, UK

Preface to the First Edition

vii

Preface to the Third Edition

viii

Preface to the Fourth Edition

ix

Acknowledgements

x

History taking and clinical examination

1

(35)

How to take the history

2

(5)

History of pain

7

(4)

The clinical examination

11

(18)

History and examination of a lump

29

(3)

History and examination of an ulcer

32

(4)

The symptoms, signs and emergency management of major injuries

36

(11)

The primary survey and management at the site of the event: first-aid

36

(2)

The primary survey in the accident and emergency department

38

(3)

The secondary survey

41

(6)

The skin and subcutaneous tissues

47

(57)

The diagnosis of skin conditions

47

(3)

Congenital skin disorders

50

(7)

Genetic skin disorders

50

(1)

Non-genetic skin disorders

51

(2)

Haemangiomata/lymphangiomata

53

(4)

Acquired dermatological conditions

57

(47)

Conditions of the skin caused by trauma

57

(9)

Infections of the skin

66

(5)

Benign tumours and benign skin lumps

71

(4)

Pigmented naevi

75

(3)

Benign subcutaneous swellings

78

(8)

Tumours of the skin appendages

86

(1)

Pre-malignant skin lesions

87

(2)

Malignant diseases of the skin

89

(10)

Other common skin conditions often seen in surgical patients

99

(1)

Subcutaneous infections

100

(4)

Muscles, tendons, bones and joints

104

(39)

A general plan for examining the muscles, bones and joints of a limb

104

(2)

Soft tissues

106

(8)

Muscles and muscle disease

106

(4)

Fibrous tissue

110

(2)

Tendons and tendon sheaths

112

(2)

Bones and bone irregularities

114

(13)

Examination of bones

114

(3)

Fractures

117

(1)

Bone diseases and deformities

118

(4)

Benign tumours of bone

122

(1)

Malignant tumours of bone

123

(4)

Joints

127

(16)

Examination of a joint

127

(7)

Examination of the spine

134

(2)

Diseases of joints

136

(7)

Conditions peculiar to the hands

143

(22)

A plan for the examination of the hand

143

(5)

Recording data about the hand

148

(1)

Abnormalities and lesions of the hand

149

(11)

The nails

160

(2)

Infections in the hand

162

(3)

Conditions peculiar to the feet

165

(10)

Congenital and acquired deformities of the foot and ankle

165

(5)

The toe nails

170

(5)

The arteries, veins and lymphatics

175

(39)

The arteries

175

(21)

Clinical assessment of the arterial circulation of the lower limb

175

(4)

Symptoms produced by arterial insufficiency

179

(11)

Haemorrhage

190

(1)

Transient and permanent weakness, paralysis and blindness

190

(2)

Cold, blue digits, hands and feet

192

(4)

Hypertension

196

(1)

Intestinal ischaemia

196

(1)

The veins

196

(13)

Clinical assessment of the venous circulation of the lower limb

196

(13)

The lymphatics

209

(5)

General and facial appearance

214

(25)

Colour

214

(3)

General appearance

217

(7)

Diseases affecting facial appearance

224

(2)

The eyes

226

(4)

The nose

230

(1)

Shape of the skull

230

(2)

The ears

232

(2)

Meningocele

234

(1)

The chest wall

234

(5)

The salivary glands

239

(11)

The submandibular salivary gland

239

(3)

The parotid gland

242

(6)

Autoimmune disease

248

(2)

The mouth

250

(20)

Congenital abnormalities of the lips and palate

250

(1)

The lips, buccal mucosa and tongue

251

(10)

Other conditions of the tongue

261

(1)

The palate

261

(2)

The tonsils

263

(1)

The floor of the mouth

263

(3)

The gums

266

(1)

Swellings of the jaw

267

(1)

The jaw

268

(2)

The neck

270

(42)

The history and examination of swellings in the neck

270

(1)

Cervical lymphadenopathy and other neck swellings

271

(17)

The thyroid gland

288

(24)

Symptoms of thyroid disease

288

(2)

Examination of the thyroid gland

290

(5)

Different forms of goitre

295

(4)

Thyrotoxicosis and myxoedema

299

(4)

Carcinoma of the thyroid gland

303

(4)

Thyroiditis

307

(5)

The breast

312

(19)

History and examination of breast disease

312

(6)

Presentation of breast disease

318

(1)

Carcinoma of the female breast

318

(4)

Benign breast tumours

322

(1)

Benign breast disease

323

(3)

The nipple

326

(2)

Breast abscess

328

(1)

Pregnancy

329

(1)

The male breast

329

(1)

Carcinoma of the male breast

330

(1)

The external genitalia

331

(28)

Examination of the male genitalia

331

(3)

The penis

334

(8)

The scrotal skin

342

(1)

The testes

343

(14)

The female external genitalia

357

(2)

The abdominal wall, herniae and the umbilicus

359

(27)

Abdominal herniae

360

(1)

Inguinal hernia

361

(12)

Femoral hernia

373

(2)

Umbilical hernia

375

(3)

Epigastric hernia

378

(1)

Incisional hernia

378

(1)

Divarication of the recti

379

(2)

Rare abdominal herniae

381

(1)

The umbilicus

381

(5)

The abdomen

386

(49)

The examination of the abdomen

386

(5)

Abdominal pain

391

(2)

Upper abdominal pain -- acute and/or chronic -- caused by inflammatory and malignant conditions

393

(8)

Central abdominal pain -- acute and/or chronic

401

(2)

General abdominal pain -- acute and/or chronic

403

(2)

Lower abdominal pain -- acute and/or chronic -- caused by inflammatory and/or malignant conditions

405

(6)

Symptoms and signs resulting from the perforation of a viscus

411

(1)

Symptoms and signs caused by an obstructed viscus

412

(2)

Infarction of a viscus causing abdominal pain

414

(1)

Abdominal pain caused by intra-abdominal or retroperitoneal haemorrhage

415

(3)

Extra-abdominal and medical conditions causing acute abdominal pain

418

(1)

Alimentary conditions presenting with dysphagia or vomiting

419

(1)

Conditions presenting with diarrhoea

420

(1)

The abdominal mass: causes and signs

421

(6)

Causes of a mass in the right iliac fossa

427

(3)

Causes of a mass in the left iliac fossa

430

(1)

Causes of a lump in the groin

430

(1)

Abdominal distension

431

(4)

The kidneys, urinary tract and prostate

435

(12)

Symptoms of renal and urinary tract disease

435

(2)

Diseases of the urinary tract

437

(4)

Retention of urine

441

(2)

The prostate gland

443

(2)

The urethra

445

(2)

The rectum and anal canal

447

(24)

Symptoms of ano-rectal disease

447

(1)

Technique for ano-rectal examination

448

(3)

Sigmoidoscopy and proctoscopy

451

(3)

Conditions presenting with rectal bleeding

454

(5)

Conditions presenting with anal pain

459

(6)

Conditions presenting as an anal lump with or without pain

465

(6)

Index

471

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