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Harrison's Principles of Internal Medicine
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Thirteenth edition. K. J. Isselbacher, E. Braunwald, J. B. Martin, A. S. Fauci, J. D. Wilson, and D. L. Kasper; eds. 2048 pages. New York: McGraw-Hill; 1994. Single volume, $98.00; Two-volume set, $125.00.
According to publishing statistics, Harrison's Principles of Internal Medicine has traditionally been one of the two most popular internal medicine textbooks. Its successful style has been maintained in the 13th edition, which begins with an introduction to clinical medicine followed by 290 pages dealing with the cardinal manifestations of diseases. These pages, organized according to symptoms and dysfunctions, is a good beginning for the internal medicine trainee. But rare is the person who starts at the beginning of Harrison's and reads to the end; this book's primary function is as a reference. It has great depth and covers internal medicine from the molecular level, discussed in the genetics section, to the most pragmatic clinical issues, such as differentiating the approach to skin lesions on the basis of their color. Information is accessible and detailed tables augment the text. Dual-color illustrations and radiographs are clearly reproduced; the helpful illustrations in the section on stroke syndromes are good examples. A color atlas includes a newly photographed dermatologic section.
How does the 13th edition compare with the 12th? Additions to Part I reflect the broadening scope of internal medicine and include new chapters on medical ethics, women's health, adolescent health, and medical disorders of pregnancy. Many organ-system-based sections have been significantly revised. Noteworthy changes include those made to chapters on cystic fibrosis, acute renal failure, viral hepatitis, head and neck tumors, cancer of unknown primary cause, gout, and multiple sclerosis. A new chapter on the chronic fatigue syndrome is strategically located at the end of the neurology section, immediately preceding the discussion of psychiatric disorders.
The most significant revisions have been made to the section on infectious diseases and to the immunology section dealing with human immunodeficiency virus (HIV) disease. Antimicrobial therapies for mycobacterial, viral, and parasitic infections have been given separate chapters. Chapters on laboratory techniques and immunization use have been revised. Other major changes include those made to discussions of hospital infection control, infectious diseases of drug abusers not related to the acquired immunodeficiency syndrome (AIDS), and bacterial meningitis and brain abscess (in the neurology section). Chapter 279, on HIV disease, represents the single most striking update, particularly in the areas of viral transmission and risk, epidemiology, and clinical manifestations. This 51-page chapter replaces 8 pages in the 12th edition, which indicates the expansion of our knowledge and the ever-increasing dissemination and clinical expressions of this pandemic.
Publishing deadlines being what they are, it is not surprising that certain sections do not seem current. For example, little has been changed in the cardiology chapters dealing with fibrinolysis, angioplasty, and transesophageal echocardiography. Similarly, only a few sentences in the endocrinology sections refer to current information on the effect of close diabetic control on end-organ disease.
This review allowed me to study the complete Harrison's for the first time since the fifth edition helped me prepare for my boards. Used for board preparation or as a clinical reference, this text strikes me as remarkably good. And at the unchanged price of $98.00, the 2487-page, one-volume edition, weighing in at just under 4 kilograms, is a bargain.
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