Zachary Cope published the first edition of this treatise on the diagnosis of the acute abdomen in 1921. From the outset, he emphasised the importance of personal experience and clinical observation, confirmed frequently by everyday practice in arriving at early and timely diagnoses. Eighty-four years later in this latest edition, Silen has remained true to Cope's key ideology.
The style is somewhat reminiscent of a grand master such as Goligher giving out useful tips gleaned from a lifetime's experience on an imaginary ward round. Unlike Goligher, the text is at times awkward and unnecessarily long-winded. Nevertheless, there is no doubting the author's dedication to his subject, including a description of Cope's own signs and symptoms during an attack of cholecystitis culminating in a laparotomy for a perforated gall bladder!
The book is aimed at the tyro dealing with the unselected general surgical ‘take’ and would form a useful reference in establishing a clinical diagnosis. Its layout includes the regular lists of differential diagnoses followed by a detailed explanation of how they differ from one another. For example, there is particular detail on how to differentiate intestinal obstruction from other abdominal catastrophes by careful attention to the nature, colour and frequency of vomiting. There are pearls of wisdom even for the experienced clinician and clear descriptions of clinical signs, such as liver resonance in perforated peptic ulceration, and how to determine abdominal pain of thoracic origin. Contained within its 26 chapters, there are useful sections covering the acute abdomen in pregnancy, the immunocompromised, patients with impaired sensation following injury and operation, as well as a discussion of those conditions that mimic abdominal disease. There are 16 black and white plates, predominantly of plain abdominal films, illustrative of the common conditions described in the text.
This book champions the skills of clinical diagnosis founded on the cornerstones of careful history taking and examination. Both Cope and Silen eschew the modern doctor's reliance on laboratory tests and cross-sectional imaging, constantly stressing that many diagnoses can be arrived at purely through careful attention to detail. This mantra is repeated throughout and bears an important message to all of us lazily reaching for the CT scan request card.