Publication history, Reflections & comments
Mr Haxton is a senior surgeon in Manchester, who has taken special interest in the methods by which operating time can be shortened safely. He scorns those, trained in departments whose standards he describes as inferior, who go through their career with a relatively inefficient and unsound technique, which he compares to an 18-hole handicap at golf. The opening chapters of his book describe his personal methods of management before and after operation; included is a method for intra-aortic transfusion of blood that he has had occasion to use. The chapter on instruments should appeal to most readers, with its emphasis on simplicity. He also mentions two instruments he has devised and found helpful. One is a "Coldlite" retractor, and the other is an attractive hernia retractor which could be made up in most workshops.
As in other parts of the book, the author's views on skin preparation are presented in detail and appear sound, but are unsupported by references to published literature or personal statistics of wound infection. Burst abdomen, however, is carefully documented. In the chapter on surgical handicraft, he describes his previously published technique of sewing abdominal wounds with a modified Reverdin's needleholder, inserting a removable suture of "Courlene" into the aponeurosis and securing it on the skin by aluminium buttons.
Most of the book comprises chapters for specific operations in the abdomen and chest, sympathectomy, thyroidectomy, and mastectomy.
Everywhere the author gives clear reasons for what he advocates (though many will disagree), and illustrates points with well-drawn line diagrams. Cholecystectomy is carried out from the left side of the patient, and he presents the advantages of this approach.
This is not a book for the occasional surgeon; the junior still learning the elements of his craft might also be tempted in rash attempts to emulate these techniques. Such surgery is based on vast experience, and learned by precept and example in the operating theatre. Likewise, older surgeons may find little of relevance to their future work habits, and react irritably (with a "humf!" rather than an "ummm") to their juniors who quote this book.
For many surgeons, however, this book will be a welcome addition to their personal library, and one would hope to see it on. departmental shelves as well. Until videotape recordings of methods such as Mr Haxton's are. available, this book will serve as a welcome communication of personal styles of work. Like "Garlock's Surgery of the Alimentary Tract" and Stephen Power's small book on surgical technique, this very readable volume should be a happy stimulus to those preoccupied with improving the quality of their handiwork.
Surgical Techniques. By Herbert Haxton, B.Sc., M.D., Ch.M., F.R.C.S.; 1970. Bristol: John Wright & Sons Ltd. 82"x 58", pp. 208, with illustrations. Price: £2 10s. (English).