Third edition. Volumes I, II, and III. Peter Rosen and Roger M. Barkin; eds. 2836 pages. St. Louis: Mosby-Year Book; 1992. $225.00.

A recent flurry of publications of major new texts and new editions in emergency medicine includes this work, edited by Rosen and Barkin. This three-volume edition of 2800 pages of text weighs in at 15.5 pounds. The third edition exceeds the previous 1988 edition by 30%. The text is organized in seven major sections: general concepts (resuscitation, analgesia, and medico-legal and ethical issues), trauma, musculoskeletal disorders (orthopedics and rheumatology), environmental disorders, systemic disorders (medical emergencies), toxicologic emergencies, and pediatric management.

This multiauthored text has been tightly edited with only minor areas of overlap and repetition and an almost seamless flow from section to section. Most of the authors are emergency physicians or noted authorities in the field who work closely with emergency medicine programs. The paper, printing and reproductions (including roentgenograms) are of extremely good quality.

I will not pretend that I was able to read each chapter in this new edition. What I attempted was to keep the work on hand and consult it first when a clinical question was raised that required substantiation or as a primary information source. I also read several chapters at random in all three volumes. The text did unusually well in providing the required information, including such diverse subjects as posthepatic neuralgias, urinary retention, management of metacarpal fractures, and management of mid-foot fractures. The references are broad based, numerous, and current, with a number of citations as recent as 1990.

In many of the sections, the submissions could stand on their own as monographs. The chapter on adult asthma, for example, is 27 pages long and lists 412 references. The superb chapter on analgesia is covered in 28 pages and contains 202 references. Although primarily a clinical text, several well-done sections discuss the pathophysiologic basis of the particular clinical entry. The sections on the basic mechanism of shock and the overview of the immune system are notable examples. Although I would have oriented some sections differently or would have changed the emphasis, I did not find any significant omissions or questionable statements. The major problem with the work is its cost—$225.00.

I would recommend this book as a key reference for the general internist's library, as well as a staple for departmental libraries. The text is definitely not a "handy" management guide, nor does it provide brief overviews of major clinical problems. It has the type of in-depth coverage of many topics that would provide a foundation for a clinical talk or would help initiate a literature search. This is the ranking comprehensive text in the field of emergency medicine against which future publications will be measured.