A Manual on Clinical Surgery
A Manual on Clinical Surgery
with Diagnostic Algorithms
INCLUDES CLINICAL EXAMINATIONS, SPECIAL INVESTIGATIONS, DIFFERENTIAL DIAGNOSIS
SEVENTEENTH EDITION
Somen Das MBBS (Cal.) FRCS (Eng. and Edin.)
Senior Consultant Surgeon

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A Manual on Clinical Surgery
First Edition : March, 1986
Second Edition : March, 1987
Third Edition : May, 1988
Fourth Edition : February, 1996
Fifth Edition : March, 2000
Sixth Edition : June, 2004
Seventh Edition : August, 2008
Eighth Edition : April, 2010
Ninth Edition : August, 2011
Reprint : December, 2011, June, 2011
Tenth Edition : January, 2013
Reprint : June, 2013, March, 2014, Novmber, 2014
Eleventh Edition : August, 2015
Reprint : May, 2016
Twelfth Edition : November, 2016
Reprint : June, 2017
Thirteenth Edition : February, 2018
Reprint : August, 2018
Fourteenth Edition : February, 2019
Reprint : August, 2019, December, 2019
Fifteenth Edition : May 2021
Reprint : October, 2021
Sixteenth Edition : August, 2022
Reprint : December, 2022
Seventeenth Edition 2024
9789356963788
Printed in India
To the Memory of My Father
Late Dr K Das FRCS (Eng. and Edin.)
and
To the Memory of My Mother
The enduring popularity of this book has inspired me to release this new edition. In the planning process, we made a firm commitment to ensure a comprehensive and up-to-date text. The field of surgery has evolved significantly in recent times, and every effort has been exerted to keep abreast of advancements in Clinical Surgery. While we describe the special investigation techniques in this edition, the underlying principle remains that effective surgical practice relies primarily on the skill and knowledge of the surgeon, with special investigations playing a secondary role.
We as surgeons emphasize the importance of clinical observations and the need to elicit accurate physical signs for a precise diagnosis. Despite the inclusion of newer, non-invasive methods, we caution against over-reliance on these techniques, as they may lead to delays and unnecessary costs. Therefore, we advocate a judicious use of investigations, with a focus on clinical diagnosis whenever feasible. Each chapter has undergone thorough revision and updating with incorporation of algorithms to approach to diagnosis in important chapters.
Launching of subsequent editions of a warmly received text is in some respects more of a challenge and I am fully aware of it. To what extent this goal has been met, only readers and time will tell. But at least I can assure that an ardent attempt was made.
This book was originally brought out to guide the new entrants to the surgical ward to answer the vexed question ‘How to examine this case and come to a diagnosis?’. This original theme of the book has been maintained and adequate emphasis has been laid not only on ‘what to do’ but also on ‘how to do’ the various examinations to arrive at the provisional clinical diagnosis. More methods of examinations have been included in this edition with more illustrations to make the subject more understandable.
This manual has enjoyed great popularity in the Indian subcontinent and beyond. I express gratitude to the teachers who recommended this book to their students and believed it to be helpful in learning ‘Clinical Surgery.’ Thanks are also due to colleagues and patients who willingly participated in the photographic process. I owe a deep debt of gratitude to the multitude of students from this country and abroad who have shared their difficulties in understanding this subject. Their input has greatly aided in presenting this treatise in a more comprehensible manner, and I hope this edition proves even more helpful to them in learning ‘Clinical Surgery.’
S Das
13, Old Mayors’ Court,
Kolkata — 700 005
January 2024
PREFACE TO THE FIRST EDITION
This manual is an attempt to provide an answer to the vexed question ‘How shall I examine this case and come to a diagnosis?’. This is a question which confronts each and every clinician. Without doubt methods of history-taking and examination are different in various types of surgical diseases, e.g. a swelling in the neck, pain in a particular region of the abdomen, an ulcer in the leg, etc. Yet in the first chapter I have tried to formulate a general scheme of case-taking, so that the students can chalk out a common system of history-taking and physical examinations in all surgical cases. I think, this will be of great help to the students to build up a routine, which should be followed all throughout their careers. In subsequent chapters emphasis has been laid on the particular points of history-taking and special methods of physical examinations which are relevant to those diseases.
Each chapter begins with history-taking—the interrogations to be made to the patient, followed by the methods of physical examinations and special investigations which will be necessary for that particular case. While describing the methods of examinations I have not only mentioned ‘what to do’ but also have indicated ‘how to do’ aided by suitable illustrations. Emphasis has been laid on special investigations. The introduction of ever increasing sophisticated investigations over and above the basic techniques of history-taking and physical examination has helped the clinician to diagnose the cases more accurately. Ultimate aim of such a book is to teach how to arrive at a correct diagnosis and scope of special investigations in this regard cannot be underestimated. A number of illustrations have been used in this section to help the students in understanding particular investigations.
A reasoned explanation based on Anatomy, Physiology and Pathology has been included whenever necessary to explain most of the symptoms and signs. Diagnostic and prognostic significances have been discussed along with history-taking, various physical examinations and special investigations.
A list of differential diagnosis has been incorporated at the end of each chapter. This I think is very imporant and very helpful to the students. This I hope will make this book a complete one in its own field. Yet I have always tried to make this book handy. For this I have taken the advantage of photosetting which has accommodated much more matter in a single page. This book is in fact double the volume of its predecessor yet it looks so slim and handy. Coloured illustrations have been introduced to demonstrate in more details and more distinctly the figures of a few surgical conditions. I received request for this from various corners in the last few years.
I am grateful to my colleagues and many patients who voluntarily submitted themselves to the trouble of being photographed. I owe a deep debt of gratitude to the great mass of students from this country and abroad who have written to me and made me feel their difficulties in understanding this subject. If this book helps them in learning the ways of approach to Clinical Surgery, it will achieve its purpose.
S Das
13, Old Mayors’ Court,
Kolkata — 700 005
March, 1986.