Dienstag, 17. Februar 2009

Demonstrations of Physical Signs in Clinical Surgery

Chris Barrett, specialist registrar in neurosurgery, Newcastle General Hospital, Newcastle upon Tyne

Hamilton Bailey’s classic text is well known to most surgeons, many editions having been published around the world over the years. It is essentially a textbook of clinical surgical examination that emphasises a logical approach to history taking, examination, and investigation. It is also memorable for a number of striking illustrations and the author’s incisive (and often witty) thoughts.
Bailey was a surgeon from another era. He had a strong family background in medicine, but his early career was colourful, to say the least. At the outbreak of the first world war, while still only a medical student, he joined the Red Cross and was despatched with the British Expeditionary Force to the western front. He was then captured, and while working as a prisoner of war on the railways he was accused of being involved in the sabotage of a German troop train. Bailey was reprieved; one of his French co-accused was not so lucky.
Later in the war he served as a naval surgeon aboard HMS Iron Duke during the battle of Jutland. This was undoubtedly an important experience for Bailey and informed both his strongly practical approach and his interest in military surgery, which lasted his whole career.
After the war Bailey was appointed to posts in Birmingham and then London. In addition to a busy clinical practice he embarked on a prolific writing career, with an emphasis on surgical education. Many of his publications have undergone many incarnations and are still in use today, such as Bailey & Love’s Short Practice of Surgery and Emergency Surgery. However, it is perhaps Physical Signs that has generated the most affection.
As always, Bailey takes an extremely well structured and logical approach. He begins by considering basic clinical signs and then moves from head to toe (lower limb) in separate chapters, discussing the localised pathology and specialised examination pertinent to each area. Many illustrations, photographic and diagrammatic, help to enliven his accurate, measured prose. He also includes, as footnotes, short biographical references on the eponymous syndromes and notes on the Greek and Latin etymology of medical terms. Often neglected in more recent publications, interesting details such as anatomists who later became bishops or the fact that the word atheroma has its origins in the ancient Greek for porridge are unforgettable.
Overall, what is striking is the breadth of Bailey’s learning and erudition. He was a general surgeon in the traditional sense, able to turn his hand to the diagnosis of surgical pathology in any part of the body and including orthopaedics, paediatrics, and neurosurgery. Though not without humour or a sense of the absurd, his writing is underlined by a strong respect for patients and for the art and science of medicine. Undoubtedly the emphasis on clinical aspects of surgery is Bailey’s fundamental message. "The history, and physical methods of examination, must always remain the main channels by which a diagnosis is made."

Cite this as: BMJ 2009;338:a2992
Demonstrations of Physical Signs in Clinical Surgery
By Hamilton Bailey
First published 1927

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