Welcome to the 18th edition of Harrison’s Principles of Internal Medicine. In the 62 years since the first edition of this textbook was published, virtually every area of medicine has evolved substantially and many new areas have emerged.
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In 1949, when the first edition appeared, peptic ulcer disease was thought to be caused by stress, nearly every tumor that was not resected resulted in death, rheumatic heart disease was widely prevalent, and hepatitis B and HIV infection were unknown. In the intervening years, both the infectious cause of and the cure for peptic ulcer disease were identified; advances in diagnosis and treatment made it possible to cure two-thirds of cancers; rheumatic heart disease virtually disappeared; atherosclerotic coronary artery disease waxed and then—at least in part through management of modifiable risk factors—began to wane; hepatitis B and its consequences, cirrhosis and hepatocellular carcinoma, became preventable by a vaccine; and HIV, first viewed as a uniformly fatal worldwide scourge, became a treatable chronic disease. During this same period, the amount of information required for the effective practice of medicine grew unabated, and learning options for students, residents, and practicing physicians also burgeoned to include multiple sources of information in print and electronic formats. While retaining the founding goals of Harrison’s, this edition has been modified extensively in light of the varied needs of the book’s readers and the diverse methods and formats by which information is now acquired.
The print version of the 18th edition is more reader-friendly in several respects: the book is printed in type that is easier to read than prior editions, the graphics and tables have been enhanced for ease of interpretation, and more than 300 new figures are included. This improved format requires publication of the print edition in two volumes conveniently divided by subject matter. A DVD accompanies the book and contains additional e-chapters, videos, and atlases; its image bank includes figures and photographs from the book that can be incorporated into slide presentations. All chapters have been extensively updated by experts in the field. In addition, this edition includes 25 new chapters and more than 100 new authors. The pathophysiologic approach to evaluating patients on the basis of their presentation continues to receive emphasis in an enriched section on the cardinal manifestations of disease. A new section focuses on aging, its demographics and biology, and distinctive clinical issues affecting older patients. The e-chapters have increased in number from 39 to 57 and include a new video atlas of neuro-ophthalmology, an audioenhanced chapter on the approach to a patient with a heart murmur, a case-based teaching exercise in fluid and electrolyte imbalances and acid-base disturbances, and explorations of infectious complications of burns and bites. New videos demonstrate the neurologic examination and several commonly performed medical procedures. A new chapter focuses on neuropsychiatric problems among war veterans. E-chapters on altitude sickness and hyperbaric and diving medicine form a new section on medical effects of changes in environmental pressure.
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