In this issue of the Archives, a series of reports from the Surgical Infection Society is published; these articles are related to the altered immune status or altered immune response with injury. This is an interesting phenomenon that is still incompletely understood. Why should it be that when an individual is injured and most needs to be able to resist infection, there is immunosuppression? The answer to this paradox may lie in tissue destruction and necrosis, with altered proteins; if extensive, tissue destruction and necrosis may initiate an autoimmune response. Thus, with severe injury, the individual (or wound) may need protection against itself, or its altered self. Biologic systems were not designed with modern therapy and support in mind. What is protective for a modest injury seems to become destructive with overwhelming injury.
John Border, MD, has provided an overview for the first five reports in this series. We are
BORDER JR. Hypothesis: Sepsis, Multiple Systems Organ Failure, and the Macrophage. Arch Surg. 1988;123(3):285–286. doi:https://doi.org/10.1001/archsurg.1988.01400270019001
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