Reviews and notices of books

Reactions to Injury and Burns and Their Clinical Importance S. Seaitt, Birmingham. 210 x 140 mm. Pp. 2 5 5 f c i . Illustrated. 1974. London: Williarir Heinemann Medical Books. f4.25. RECENT monographs concerning the response to injury have tended to deal with the more general metabolic features which follow injury, perhaps because this is the important feature of clinical management which has been most topical. There has therefore been a need for an approach to the subject which has taken a broader view of the systematic and general reaction of the body to injury. This is the purpose of this monograph by Dr S. Sevitt.

The first part deals with the statistics of accidental injury, the factors related to death from injury and the normal homeo- static responses, and this provides the base for the subsequent sections on the effect of injury on tissues such as the lungs, liver, kidney and central nervous system. Much of the descrip- tive element and the discussion revolves around severe trauma associated with shock or hypoperfusion. The chapter on endocrine responses in particular is comprehensive and is a useful review of the many changes which are found in the injured patient.

The last section details changes in coagulation, fat embolism and immunity, cellular and humoral, in the traumatized or burned patient. This is an especially useful part of the book which deals unusually with aspects of trauma not normally discussed in relation to the metabolic changes, and this adds considerably to the breadth of the topic being covered. It was, however, tantalizing to find points raised which could not be followed up in the rather brief bibliography supplied, but one must accept this in a relatively concise work such as this. This book will be of use to any doctor concerned with the manage- ment of the injured or severely i l l patient.

R. ti. CLARK

discussion. Whether a much wider audience exists justifying publication of the proceedings of such meetings is largely dependent on the importance of the topic and the speed with which the papers can be printed in an acceptable manner. Unhappily, 3 years after presentation is too long even for the most original and important contributions-and this meeting was held in January 1972! Since the editor personally thanks the participants for promptness in producing their papers the blame for delay must lie with the publishers. This is sad, for although the quality of reproduction of illustrations is poor this book represents exceedingly good value for money.

Twenty-five papers were given by contributors drawn from many countries and a wide variety of disciplines, ranging from respiratory physiology to phonetics. Their collective ambition was to evaluate the current position and possible lines of future research in the related fields of ventilatory and phonatory control. Despite the vastness of this undertaking they succeeded remarkably well, and the division of the various papers into four sections assists the reader in digesting the mass of Pacts and figures which appear to be an integral part of each paper.

An additional bonus is the inclusion of the free discussions which followed individual communications. All show evidence of meticulous editing, whilst the addition of appropriate references suggests that some of the delay in publication may be related to this section of the book.

All who are interested in the mechanisms which control breathing, speaking and singing will find this book a valuable source of information and ideas. Whether it will still stimulate new lines of research 3 years after its original conception is more doubtful, but in view of its modest price and original integration of multidisciplinary expertise it is certainly worth buying.

D. F. N. HARRISON

Surgery Annual: 1974 Vol. V1 The Systematic Manifestations of Inflammatory Bowel Disease

PP. 489+ xii. Illustrated. 1975. Hemel Hempstead: Prentice- 228 mm. PP. 356+xii. Illustrated. 1974. Hall International. f12.95.

series ~ l ~ ~ d M . Nyhus, Chicago, jllilIois. 236 165 mm. Edited W M a m M . Lukash and Raymond B . Jolznson, Bethesda,

Springfield, 111.: Charles C . Thomas. $15.50.

THIS annual review of surgery is now well established in its sixth year. The Editor has selected 3 1 contributors, mostly from the United States, but has included several South Africans, a Finn and Professor David Johnston, now at Bristol. The 20 chapters are widely ranging indeed; the spectrum stretches from chapters on basic topics such as metabolic aspects of shock, techniques of blood flow measurements and sickle cell disorders, through the applications of computers to patient care, paediatric anaesthesia and gastric mucosal anomalies to general surgical topics which include the management of pancreatic cancers. Under orthopaedics there are chapters on hand injuries, the surgery of rheumatoid arthritis and total knee replacement arthroplasty. Highly specialized subjects such as carbon dioxide laser surgery in laryngeal disease and intra- cranial infections give a fascinating account of the advances in these fields. Of particular interest are the excellent contributions by Leslie Wise on controversies in the management of so-called ‘early’ breast cancer, and a discussion by John Madden on the controversial topic of electrocoagulation in the treatment of cancer of the rectum, which includes useful advice on the exact technique of this method and the indications for its use.

This volume, like its predecessors, is beautifully produced and illustrated with up-to-date and copious references. Being so widely based, it will be particularly attractive to general surgeons (who are always keen to keep abreast of current work in adjacent fields) and to candidates for higher surgical degrees, rather than to our somewhat less fortunate colleagues, the ‘super-specialists’.

HAROLD ELLIS

THIS work will be of interest to the cognoscenre because of the surprises it contains and the occasional lacunae; it would be unwise to recommend it to those without experience. The first surprise comes early: ulcerative proctitis, it is stated, is a relatively uncommon form of inflammatory bowel disease. This is hardly the experience here; perhaps populations differ, for the book is based on a symposium of United States Army doctors. Perhaps it reflects the physician orientation which obtrudes elsewhere, for proctitis may be seen more often in surgical clinics whence patients are referred as cases of ‘bleeding piles’. This orientation is dominant in the attitude to therapy, an attitude hardly aggressive in character; of this the reader becomes particularly aware in the chapter on toxic megacolon, for its whole tenor is towards conservative treatment with little appreciation that the mortality of this condition can be con- tained only by recognition of bowel disintegration, with appro- priate surgical action, before dilatation has developed (more- over none of the four contributors to this chapter is a surgeon). Elsewhere ‘joint symptoms are seldom of sufficient severity to require surgery’ must be the attitude of a softline therapist rather than the activist who knows from experience that joint trouble is usually an additional factor indicating that the time for surgery has arrived.

Some of the lacunae are minor, such as the omission of Crohn’s stomatitis, and, in the chapter on cutaneous mani- festations, those stigmata of prolonged severe disease, the striae ‘non’-gravidarum seen in relation to the extensor surfaces of knees and elbows, and the skin attenuation on the digits of those with persistent hypoproteinaemia. Perhaps these conditions have not come the authors’ way (the author of the chapter on differential diagnosis states that he has never seen tuberculosis of the bowel, or has failed to recognize it).

A comprehensive chapter on radiographic features provides useful ‘visual’ differential diagnoses; here numerous conditions including parasitic infestations are presented, some of which

Ventilatory and Phonatory Control Systems Edited Barry Wyke, London. 230 X 155 mm. PP. 531 + xuiii. Illustrared. 1974. London: Oxford University Press. f6. SMALL symposia. whether they be national or international, are usually of considerable value to the participants most of whom have been selected for their special interest in the subject under

would hardly spring to mind for diagnostic exclusion, but lymphoma is omitted. More importantly, the simulation of diverticulitis by Crohn’s disease of the sigmoid and that of

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