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. 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 audio-enhanced 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.
For readers who wish to continue using Harrison’s in a single-volume format, we are pleased to offer two new eBook versions of the 18th edition: a traditional eBook, with text and illustrations from the new edition included for reading on a portable e-reader or on a desktop, and an enhanced eBook developed especially for new tablet devices (e.g., iPad, Galaxy, Playbook, Nook) that offer high-definition resolution of multimedia content and interactive features. The Harrison’s 18th edition enhanced eBook will contain extensive embedded video footage, including all of the new clinical procedural videos; the wonderful neurologic examination videos from Samuels and Lowenstein; examples of cardiovascular imaging and assessment; and high-resolution versions of more than 2000 color images from the book and the Harrison’s atlases on the companion DVD. Along with other social media features, the enhanced eBook offers users the opportunity to take and share notes from lectures and their own reading. Additional resources include Harrison’s Online, a continuously updated electronic resource that highlights and summarizes newly published articles on significant medical findings and advances. Harrison’s Self-Assessment and Board Review, a useful study guide for board review based on information in the 18th edition, will soon be produced. Harrison’s Manual of Medicine, a pocket version of Harrison’s Principles of Internal Medicine, is available in both print and electronic formats.
We have many people to thank for their efforts in producing this book. First, the authors have done a superb job of producing authoritative chapters that synthesize vast amounts of scientific and clinical data to create state-of-the-art descriptions of medical disorders encompassed by internal medicine. In today’s information-rich, rapidly evolving environment, they have ensured that this information is current. Helpful suggestions and critical input have been provided by a number of colleagues; particularly notable was the advice of Chung Owyang on the Gastroenterology Section. We are most grateful to our colleagues in each of our editorial offices who have kept track of the work in its various phases and facilitated communication with the authors, with the McGraw-Hill staff, and among the editors: Patricia Conrad, Emily Cowan, Patricia L. Duffey, Gregory K. Folkers, Julie B. McCoy, Elizabeth Robbins, Kristine Shontz, and Stephanie Tribuna.
The staff at McGraw-Hill has been a constant source of support and expertise. James Shanahan, Editor-in-Chief, Internal Medicine, for McGraw-Hill’s Professional Publishing Division, has been a superb and insightful partner to the editors, guiding the development of the book and its related products in new formats. Kim Davis seamlessly stepped into the position of Associate Managing Editor, ensuring that the complex production of this multi-authored textbook proceeded in an efficient fashion. Paula Torres, Dominik Pucek, and Michael Crumsho oversaw the production of the new procedural and neurology videos. Phil Galea again served as Production Director on this, his final edition, and did so with a peak performance. Mary A. Murray, Director, International Rights, is retiring from McGraw Hill in 2012, after 50 years with the company. Mary joined the Blakiston Division of McGraw Hill in 1961, when Tinsley Harrison was still the editor of the book. Her first assignment was to distribute reprints of Harrison’s chapters to the editors and contributors. For the next 23 years, Mary continued to be involved in the editorial process of Harrison’s. In the early 1990s, she was given responsibility for licensing McGraw-Hill’s medical titles; making use of her many cordial connections in global medical publishing, she licensed translations of Harrison’s into 19 languages. We are extremely grateful to Mary for her many accomplishments in support of the book through 13 editions.
We are privileged to have compiled this 18th edition and are enthusiastic about all that it offers our readers. We learned much in the process of editing Harrison’s and hope that you will find this edition a uniquely valuable educational resource.