WITH AN ever-present influx of war injuries plus the increasing amount of civilian trauma, it becomes imperative that the surgeon who is called upon to treat trauma must consider the patient first as an injured person, not just a compound fracture of the tibia, a rupture of the spleen, or a fracture of the skull. Quite apart from the obvious local injury, other even more severe trauma may be present, a suspicion of which should be aroused in the mind of any well-trained surgeon. Furthermore, the patient as a whole reacts acutely to major trauma, not only with blood loss but also with biologic mechanisms set up by the alarm reaction and by what Moore has so ably described as an initial adrenergic corticoid period with an immediate disturbed metabolism.
Perhaps the organ most commonly missed is the urinary bladder. The "general" surgeon today is becoming more and more an