I read the 20th edition of this classic textbook 30 years ago while preparing for the final fellowship examination in Glasgow. Much has changed. As a testimony to its popularity and longevity, the latest edition is now a hefty tome comprising 1610 pages. One hundred and twenty-six authors have contributed to the 82 chapters of the book.
The preliminary chapters cover basic surgical principles, investigations and perioperative care. The chapters on basic principles include research, ethics and patient safety. Tissue engineering was also highlighted in one chapter. Injuries to the limbs, disaster and war surgery were discussed in the chapters on trauma. I found the chapters on disaster and war surgery enlightening. The organisational aspects of disaster management starting with the chain of command to definitive treatment was clarified. In war, the predominant cause of injuries was from explosions rather than gunshots. The mechanism of blast injuries including from improvised explosive devices were clearly explained.
Nine chapters were on elective orthopaedics. The rest of the chapters were on the other surgical specialties including abdominal, cardiothoracic, vascular, genitourinary, transplantation, breast and endocrine, head and neck, skin and subcutaneous tissue.
Learning objectives are stated at the beginning of each chapter. The text is easy to read and numerous colour illustrations makes the book visually appealing. Each chapter has several summary boxes highlighting the key learning points.
The appendix at the end of the book provided a poignant reminder on the global inequalities for access to safe and affordable surgery for the majority of the world population. In many African countries, the surgeon to population ratio is more than half a million people per surgeon. The book ends with a plea to health planners to ensure that surgical services remain a national priority.
Medical students may find this book overwhelming. Nevertheless, it is suitable as a reference textbook. Orthopaedic trainees preparing for their part one examination will find the chapters on basic surgical principles, trauma and elective orthopaedics useful.