Book Review

The Physiologic Basis of Surgery

N Engl J Med 1993; 329:1900December 16, 1993

Article

The Physiologic Basis of Surgery
Edited by J. Patrick O'Leary. 648 pp., illustrated. Baltimore, Williams and Wilkins, 1993. $95. ISBN: 0-683-06634-X

Books on the physiology and pathophysiology underlying surgery constitute a distinct genre of surgical textbooks. They are devoted to the basic biomedical science that should be a part of the surgeon's education. They include, for example, Ian Aird's classic Companion in Surgical Studies (Baltimore: Williams and Wilkins, 1949), the more recent book from Australia entitled Clinical Science for Surgeons (W. Burnett. Sydney: Butterworth, 1981), Fischer's Surgical Basic Science (St. Louis: Mosby, 1993), and this ample and well-documented vade mecum providing up-to-date physiologic knowledge appropriate to the practice of surgery.

This type of surgical book is of special interest because it is almost entirely devoid of therapeutic suggestions, descriptions of treatment methods, diagnostic interpretation, suggestions for perioperative management, clinical precautions, and lists of danger signals. The purchaser of this book should not seek clinical answers here. Rather, this book should be a part of the basic education of the surgeon, in medical school, during the residency years, or later on in his or her career.

There are 22 chapters by 70 authors covering such matters as cell biology, growth and development, clinical oncology, and the liver, breast and other organs, with separate chapters on the digestive system, the endocrine system, biostatistics, and anesthesia. The final chapter, “Selected Technologies,” deals with such things as ultrasound and other new imaging techniques, including magnetic resonance.

Each chapter is accompanied by a bibliography and in some cases (e.g., the chapter on biostatistics) by a glossary. These praiseworthy bibliographies are usually not lengthy. For instance in the chapter entitled “Liver, Biliary Tract, and Pancreas,” the bibliography is limited to 61 references. Most of the references are recent, and the bibliography is up to date through 1991.

It is impossible to review briefly the content of all of these chapters, and no one reviewer would feel competent to do so. With respect to the chapters that I might feel competent to judge, “Nutrition and Metabolism,” “Cell Biology,” “The Breast,” and “The Digestive System” all cover their fields quite well. There is a good integration of basic biochemistry with whole-organ and whole-organism changes. The chapter on the breast reviews the anatomy, physiology, and endocrinology of the breast without becoming entangled in current controversies over treatment. The same would apply to many of the other chapters.

There are some excesses and gaps. In the chapter on oncology no bibliographic restraint has been exercised, and there are 220 references. There is almost no discussion of radiotherapy in spite of its frequent use with surgery. The chapter on immunology provides an excellent background of this field with ingenious cartoons to demonstrate the action of cells and antibodies. There is nothing on the mode of action of immunosuppressive drugs, however. Surprisingly, there is no chapter on the common threads of pathophysiology involved in organ transplantation, rejection, and immunosuppression. There is nothing on fluid and electrolyte homeostasis; surgeons faced with a burned patient with a plasma sodium level of 180 mmol per liter or a pancreatic fistula with a plasma sodium level of 100 mmol per liter will find nothing here to illuminate their situation.

Despite some flaws, this book accomplishes what it sets out to. It avoids encyclopedic coverage, on the one hand, and controversy or therapy, on the other. In the words of Aird, it certainly is a fine “companion in surgical studies.”

Francis D. Moore, M.D.
Harvard Medical School, Boston, MA 02115