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O'Leary and Capote are to be congratulated on improving on what was already a project of grand design. WhenThe Physiologic Basis of Surgerywas first published in 1993, it was among a number of volumes issued to address the problem of fulfilling the Special Requirements for the training of residents in all aspects of basic surgical physiology. O'Leary's opus emerged as one of the finer volumes addressing this issue. The requirements have not changed since then and specifically demand that residents in surgery programs be instructed in the fundamentals of wound healing, hemostasis, oncology, shock, circulatory, respiratory, gastrointestinal and genitourinary physiology, microbiology, nutrition, fluid and electrolyte balance, the metabolic response to injury, musculoskeletal biomechanics, immunology and transplantation, and applied anatomy and pathology (American Medical Association.Graduate Medical Education Directory.Chicago, Ill: American Medical Association; 1996). Perhaps it is a sign of the times that the second edition has been

Management of the injured suddenly became a respectable professional surgical specialty following the Arlie Conference in 1979, when the societal impact of civilian trauma became recognized. Prior to that time, interest in the injured was relegated primarily to orthopedists and a few academicians interested in the metabolic response to injury. Of course, there were many who became involved in the care of the injured during war, but this was episodic. Reflecting the sudden popularity of and concern with civilian traumatology, there has been a veritable flood of textbooks dealing with trauma in the past five years. The three texts listed above all hit the market in one month! McSwain and Kerstein's book is a pragmatic guide to early assessment and management of the severely injured as practiced in New Orleans. It is more than a manual but by design is of manageable proportions to make it suitable for ready reference

This is a fascinating volume—now, in its third edition, authored by surgeons primarily from Glasgow, but also from other parts of Scotland and England, with one contribution from Australia. It is a welcome addition to surgical libraries that have not seen a surgical physiology volume since Zimmerman's in 1957. There is a particularly good chapter on wound healing with accompanying graphs and micrographs and an excellent one on radiation "injury," about which all surgeons worry. Fluid and electrolyte balance and the metabolic response to injury are clearly and concisely presented with a section on parenteral nutrition. Included in these chapters are sections on the fundamentals of hydrogen ion regulation and on the disturbances of acid-base balance and dehydration. The respiratory system and its functional measurements are well covered, although it is interesting that the acute respiratory distress syndrome is not described as such in this chapter. A section on assisted

• The importance of fluid replacement therapy in large-area, full- and partial-thickness burns has become widely recognized in the past 35 years. Experimenters have proposed various intravenous solutions and various ratios of fluid to body weight and percentage of body area burned. The importance of colloid and plasma during the early resuscitation phase has been questioned. The role played by age, by physical condition, and by individual response to injury in determining the patient's therapeutic needs has also been widely recognized. All physicians should bear in mind the need for careful observation of the patient in association with an understanding of the pathophysiology involved in treating burn shock. (Arch Surg114:247-252, 1979)

This study was part of a broad survey of the systemic response to injury, carried out at a forward surgical hospital on the Eastern Front in Korea during 1952. This was a time when the front lines were stable and the flow of casualties was usually limited. Evacuation time averaged three and one-half hours. Because the casualty load was seldom very heavy, patients could be held at the forward hospital until they were ready for evacuation. Intensive studies could be made during this period of relative quiescence. MATERIALS AND METHODS Twenty battle casualties were chosen for study during a period of 7 to 14 days immediately after injury. The study was designed to study adrenal function during this period of early convalescence. This was often a period of repeated traumas—initial injury, evacuation, anesthesia, operation, secondary dressings, and secondary debridement. All of the patients studied were critically injured. Several died

BLUNT abdominal trauma incurs a mortality as high as 45.6% 1 in some areas largely due to undiagnosed abdominal visceral injury in association with head and chest injuries. To reduce this high mortality, a more dependable means of detecting intraperitoneal visceral injury, diagnostic peritoneal lavage, was developed in 1964. 2 This simple technique will disclose even small amounts of blood within the peritoneal cavity regardless of the source and has been utilized now in nearly 190 patients. However, in an instance of a child with a ruptured distal ileum, no blood was found in peritoneal lavage, but many polymorphonuclear leukocytes were noted in the returning opalescent perfusate. This observation prompted the current laboratory study of the pathophysiology of the traumatized peritoneum. We were particularly interested in determining the dynamics of white blood cell (WBC) appearance in the peritoneal cavity to see if such data might be employed clinically. Experimental Studies