Unparalleled in demonstrating the art of clinical diagnosis, this classic text has been used by several generations of medical students and house staff since its original publication seventy years ago. Thoroughly revised by one of America's most distinguished gastrointestinal surgeons, it combines the enduring principles of prompt, accurate diagnosis of the acute abdomen with many fresh observations culled from Silen's own experience. Retained from Cope's original work are his emphasis on clinical diagnosis by direct examination, his highly readable style of writing, and the book's overall structure. New to this edition is a concise chapter on the acute abdomen in AIDS. In recent years there has been a misdirected emphasis on the use of invasive and non-invasive tests rather than clinical evaluation of individuals with acute abdominal pain. These tests are no substitute for an adequate history and physical examination as well as in-depth knowledge of the natural history of disease. More effectively than any other volume, this book redresses that balance, helping students and clinicians gain facility in clinical diagnosis and management of acute abdominal pain.
Reviewer:Willem J.S de Villiers, MD, PhD(University of Kentucky College of Medicine)
Description:What does one say about the 21st edition of an authoritative clinical text first published in 1921? This revised edition by the eminent surgeon William Silen clearly demonstrates the beauty of succinct medical writing and the durability of clinical pearls. The previous edition was published in 2000 and the march of technology has continued relentlessly, threatening to overwhelm even the most ardent medical student's or resident's desire to obtain a complete history and perform a rigorous physical examination on patients presenting with symptoms and signs consistent with an acute abdomen.
Purpose:The purpose is to teach those features in the history and physical examination that lead to an accurate diagnosis of the underlying cause of abdominal pain and the acute abdomen. Specialized diagnostic tests are placed in context and over-reliance on these expensive modalities discouraged. The author makes these points admirably; however, in an increasingly technological world, the continued emphasis on history and physical diagnosis may appear somewhat quaint and old-fashioned.
Audience:The treatise is primarily aimed at medical students, surgical residents, and GI fellows. These groups will benefit the most, but many experienced gastroenterologists will also enjoy perusing this short, clearly written book which contains countless helpful clinical pearls. The author is an eminent, well-respected emeritus professor of surgery from Harvard Medical School.
Features:A logical approach is used to decipher the vast differential diagnosis of the acute abdomen in a logical, thought-provoking fashion. The chapter dealing with synthesis of different symptoms and signs to arrive at a diagnosis is especially enjoyable. The book is generally weak on advanced technology and reproduction of some of the earlier black-and-white glossy plates is of substandard quality.
Assessment:The book provides a wealth of clinical information and experience and is a pleasure to read for its concise, crisp style and historical context. However, recent imaging advances are not included, which detracts from the overall relevance. I would hope that a subsequent edition would rectify this to much greater extent.