Vascular surgery Robert B. Rutherford, Philadelphia, 1995, WB Saunders, 2240 pages, $260. A correspondent apologized for writing a long letter with the excuse that he had no time to write a short one. The 14 editors of this enormous and successful book, struggling to martial an army of 181 experts into 2000 pages of text by a common deadline, will know just what he meant. The casual reader will be tempted to admire this book on grounds of labor and size alone, and the diligent will identify significant improvements since the previous edition of 1989 when there were only 159 contributors. Many chapters give authoritative help with clarity and economy. A few, including some by editors who should know better, are gridlocked with an abundance of unprocessed data posing as useful information. A textbook should try to represent all aspects of vascular surgery from its academic peaks to its idiosyncratic troughs, but we must judge it by the standards of analytical rigor and efficient access. Many chapters include historical vignettes that range from the intriguing (Jobst in the swimming pool), through the regurgitated (Hunter's observations on the antler), to the traditional but incomplete (sympathectomy). Worthy ancestors are sometimes neglected, as in the description of Homan's operation, whereas ghosts of the past, like renal ptosis, are given more respect than they deserve. Some contributors include techniques that really should be history, such as the Unna boot and the use of isotopes to determine amputation level. Occasionally we have a glimpse of history in the making as when attractive but discredited ideas are recycled without evidence. The quality of a chapter is often well illustrated by its tables. Many are exemplary ("Intermittent laudication"), but a few are marred by significant omissions, and the European literature is frequently neglected. Because tabulated errors are more influential than bias concealed in prose, the editors need comprehensive knowledge and vigilance to avoid them. The rules for life-table analysis are given in the text, but editors have nonetheless allowed them to be broken (endarterectomy) and have also allowed statements that are blatantly clumsy ("long in length"), unhelpful because unqualified ("acute renal dysfunction varies from 0% to 92%"), or simply wrong (amputation [is] inevitable in critical ischemia). Hazards should be fully acknowledged. This is particularly important when a difficult operation with uncertain indications has been popularized by easier endoscopic access. Compensatory hyperhidrosis after sympathectomy can be serious. Radiologic changes in the bones with severe sympathetic dystrophy deserve a showing. Not unnaturally, enthusiasts are well represented in this text, but some of their recommendations, for example redissecting the distal anastomosis of a failed bypass graft rather than looking elsewhere, are hard for ordinary folk to understand. Many chapters incorporate useful summaries. Rutherford's own on extracranial fibromuscular dysplasia is an excellent example, but not all authors conform to this style, and greater uniformity would make access easier. References are numerous and should be more selective. They should certainly be disciplined into alphabetical or text order and not both at once. In one chapter, 50% of the references are by the author himself and, in another, an author cites an unpublished previous communication written by himself. The index is as comprehensive as a computer-generated list can be but also gives rise to some interesting concepts ("occupation – see also disability") and omits personal references that might be useful, such as the Taylor patch, although that is referred to in the text. Illustrations are copious. Some should be cropped, and clinical illustrations deserve color. It is surprising to find the few color plates printed remote from the relevant text. Some illustrations are redundant, and one might be calculated to deceive because it is a mirror image of another printed four pages previously. Twelve diagrams of stump bandaging are 12 too many. With such a vast undertaking, lapses in editorial control over the volunteer army are inevitable, but the quality of the best chapters is outstanding, such as those on hemodynamics and visceral ischemia. Now is the time for the supreme commander to martial his generals, retire a few, and discipline the others so that they achieve the high standards set by the best. This fourth edition is bigger and better than the third. The real challenge, as every correspondent knows, is to make the fifth edition smaller and better.