PREFACE. An Introductory Course

INTERNAL DISEASES

An Introductory Course

Edited by V.Vasilenko and A.Grebenev

Translated from the Russian by Alexander Rosinkin

Mir Publishers Moscow

PREFACE

ISBN 5-03-001686-4

First published 1987

Second edition 1990

Revised from the 1989 Russian edition

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© English translation, A.Rosinkin, 1990

Internal medicine is the major branch of medical practice and research because internal diseases are the most common and run a grave and pro­tracted course involving many complications and impairing the patient's objective condition and his working capacity. Internal diseases have the highest mortality rates as well. Therefore prophylaxis of internal diseases is the main concern in the health care system of all countries, and the study of internal diseases is the leading subject of medical training.

The term " internal diseases" came into use in the 19th century to stand alongside with the then-popular term " therapy". The development of new, complicated methods of diagnosis and treatment, requiring specialized skills and training on the part of the physician, has led to the formation of separate branches of medicine such as cardiology, gastroenterology, en­docrinology, and haematology. This by no means indicates the division of the concept of " internal medicine" into " daughter subjects". Clinical medicine of the second half of this century is characterized by parallelism of differentiation and integration. Therefore, despite a further separation of special branches, general medical training and education, and the in­tegrating research into internal diseases and related subjects are now even more important.

It should also be noted that the new offshoots of medicine develop at the " interface" of several clinical subjects. Thus cardiology, which was formerly only a branch of internal medicine, gave rise to heart surgery and anaesthesiology.

At the present time the knowledge of internal diseases has improved greatly: many new diseases have been described, the aetiology and pathogenesis of the known diseases and their clinical course studied, and new methods of diagnosis and treatment have been developed and improv­ed. Therefore, despite the branching of internal medicine into special sub­jects, the amount of knowledge that is necessary today for a practitioner is much greater than say 20 or even 10 years ago. The requirements for ade­quate medical training have thus increased accordingly.

The course in internal diseases is given differently in various countries: the student may be educated at one clinic during his entire course of studies, or he may take classes in different departments consecutively. But in all cases there exists a certain optimum sequence in the studies. During their first years (usually the third year) the students study the main methods of examination, symptoms of internal diseases, and the main principles of

6 Foreword

their management. This book is a course in diagnostic principles and special pathology. In other words, this is an introduction to therapy, ox pro­paedeutics to internal diseases. This course is given to students after they have studied the fundamentals of medicine, such as anatomy, physiology, biochemistry, etc.

During their further studies the students broaden and improve their knowledge of all major internal diseases, their differential diagnoses, and their treatment. The students start managing patients independently. Future physicians are thus trained in stages.

This particular manual is intended for third-year medical students. It describes symptoms and syndromes, the main methods of examination used by internists and methodology of diagnosis. It helps students master the practical diagnosis of internal diseases and their management. The authors hope that this manual will help the student in his further detailed study of internal diseases and that it may also be useful to those who master other special medical subjects. The authors believe also that this book may be helpful to a practitioner.

The contributors to this manual are members of the staff of the Moscow First Medical Institute named after I. Sechenov.

The authors would gladly accept any criticisms or comments which would improve this manual.