Oxford Textbook of Medicine: 3-Volume Set

Book Preface

It is now 20 years since the first edition of the Oxford Textbook of Medicine appeared on the scene, a time when the concept of the all-encompassing textbook of medicine was being questioned. Its predecessor, Price’s Textbook of the Practice of Medicine, first published in 1922 and by then in its twelfth edition, had come under considerable criticism. One of its most voluble critics, the late J.R.A. Mitchell, had even gone to the trouble of weighing the book, after which he suggested that, because dinosaurs became extinct because of their sheer bulk, medical textbooks would suffer the same fate. In addition, he and many other reviewers suggested that large textbooks are out of date before they are published and hence are of extremely limited value. Notwithstanding Professor Mitchell’s outdated views on the extinction of dinosaurs, we thought that he had a point.

After considering these arguments carefully we came to the conclusion that there was still a place for at least one major British work of reference which attempted to cover the whole field of internal medicine. This decision was based largely on the view that, because of the enormous breadth of the subject and the increasing tendency to overspecialization, very few students and practitioners could have immediate access to smaller monographs on every branch of the field; even when they are available they are not always written by those who evaluate their patients in a general medical setting. And if this is true of clinicians in the richer countries, it must apply even more to those in the developing world, where access to libraries and review articles may be limited. Furthermore, although we were well aware that textbooks rapidly become out of date, few advances in medicine lead to major changes in patient care, and those that do often require many years of critical evaluation before they become an integral part of routine clinical practice. For this reason we decided to try to produce a wide-ranging medical textbook which would have a particular emphasis on the global aspects of disease, rather than focus simply on the day-to-day medical problems of the developed world.

Since the Oxford Textbook of Medicine first appeared there have been profound changes, both in the practice of medicine and in the problems of the provision of medical care. None of the richer countries has been able to solve the problem of the spiralling costs of health care, which have resulted in part from the introduction of new technology but, even more importantly, from the remarkable increase in the age of their patient populations. If anything, the gap between the quality of the provision of health care between the richer and poorer countries has widened, and although some of the poorer countries have made the epidemiological transition from high death rates due to infection and malnutrition towards a more westernized pattern of illness, particularly in sub-Saharan Africa infectious disease, notably respiratory infection, AIDS, tuberculosis, and malaria, remain the major causes of death; a review of over 11 million childhood deaths in 1998 disclosed, disgracefully, that over 4 million were due to diseases for which adequate vaccines or other forms of prevention already exist. The phenomena of ‘globalization’, and increasing corporate dominance, are also tending to exacerbate the divide between the rich and poor nations.

Another profound change which has occurred over the last 20 years is the emphasis on the study of disease at the molecular and cellular levels and the increasing role of what is still rather optimistically called ‘molecular medicine’. But while this remarkable field promises much for the health of mankind for the future, so far it has had little place in day-to-day clinical practice. Thus, while the fruits of the human genome project offer enormous potential for the better understanding, prevention, and management of the common killers of middle life and old age in richer societies, and the pathogen genome projects offer equal hope for controlling the infectious killers of the developing countries, it is still far from clear when the rich promises of these fields will come to fruition for preventative medicine and clinical care. And there is the danger that when they do, because many of them are likely to be expensive, the gap between the provision of health care in the poorer and richer countries will become even wider. Although many of the solutions to these problems depend on a complete change of attitude of governments and industry in the richer countries, there is no doubt that there will be a rapidly increasing role for their medical schools and doctors to develop collaborative programmes with those of the developing countries and, in general, to take a much more global view of disease, both in medical education and research.