''Oh, never, never let us doubt what nobody is sure about''

Inevitably, these manuals contain a huge quantity of didactic detail with few reasons as to ''why' you should do anything, and few references to the original papers. We have tried to select the best methods for your needs. Even so, remember that accepted methods change, that few have been rigorously evaluated by controlled trials, and that some, which were widely accepted only a few years ago have now been completely abandoned or reversed.

Here are some examples of how fallible medical practice can be: (1) A low-fibre diet used to be prescribed for diverticulitis, but is now thought to be one of the causes of it. (2) Complete immobilization was and often still is considered to be the ideal treatment for all long bone fractures. It is now increasingly realized that many of them benefit from early controlled movement (69.4). (3) In many centres it has been standard practice to separate mothers from their babies immediately after birth. Now, this is completely reversed and their close contact immediately after delivery is considered essential for bonding. (4) Shaving a patient the day before an operation, which used to be standard practice, has now been shown to increase the incidence of infection[...]

This list could be expanded. So be prepared to ''doubt what nobody is sure about', even while you follow the didactic instructions we give.

Fig. 1-6 WHICH OF THESE SURGEONS ARE YOU? Doctor A, found a nearly perfect surgical system, and stepped in and out of it without needing to change it. Doctor B, found a moderately functioning system and slowly let it deteriorate. Doctor C, found a poorly functioning system, and with great difficulty was able to improve it considerably. Doctor D, found and left chaos. Kindly contributed by Peter Bewes.