Fourth edition. Jay H. Stein; ed. 2861 pages. St. Louis, Missouri: Mosby-Year Book; 1994. $99.00.
Having used Cecil's Textbook of Medicine during my early medical training and Harrison's text in more recent years, I was particularly interested in evaluating the new edition of Stein's Internal Medicine. The preface of this edition states that the book's basic format is "appropriate for students, house officers, and practicing physicians." As a practicing physician, I used this textbook for 2 months as my primary information source, with mixed results.
I found that the organization of this textbook was a major asset. Each medical specialty is introduced by two sections, one on basic principles and one on diagnostic procedures and tests. Most of these sections were concise, clear, easy to read, and extremely helpful when I was faced with a problem in a less-familiar area of medicine. The numerous tables were particularly lucid, and the illustrations were pertinent and easy to understand. The content and style of these sections seemed to be aimed at the generalist but were appropriate for students, residents, and physicians not trained in internal medicine. An excellent section covered special topics, such as medical disorders during pregnancy, toxicology, drug interactions, and the periodic health examination.
The sections on specific disease entities were less helpful. For answers to the diagnostic and therapeutic questions I faced on the wards, I consulted numerous sections; frequently, the discussion was less detailed than I had hoped, and I had to use alternative sources. In fairness, most of the chapters on individual diseases were well organized, up-to-date, and a pleasure to read. However, they often lacked the encyclopedic data found in other major textbooks. For example, an otherwise excellent analysis of the approach to a patient with dementia was marred by the lack of a detailed discussion of nonneurologic diseases presenting as dementia (the reader was referred to a short table, then to "elsewhere in this book"). As in other medical textbooks, the references were generally sparse.
Because of its clarity and easy-to-read style, this textbook is an excellent choice for students, housestaff, subspecialists, and physicians practicing in areas other than internal medicine. Practicing internists, however, may find some chapters less comprehensive than they would want.
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