Harrison's Principles of Internal Medicine has a long and distinguished tradition in the field of hematology. Maxwell Wintrobe, whose work actually established hematology as a distinct subspecialty of medicine, was a founding editor of the book and participated in the first seven editions, taking over for Tinsley Harrison as editor-in-chief on the sixth and seventh editions. Wintrobe, born in 1901, began his study of blood in earnest in 1927 as an assistant in medicine at Tulane University in New Orleans. He continued his studies at Johns Hopkins from 1930 to 1943 and moved to the University of Utah in 1943, where he remained until his death in 1986. He invented a variety of the measures that are routinely used to characterize red blood cell abnormalities, including the hematocrit, the red cell indices, and erythrocyte sedimentation rate, and defined the normal and abnormal values for these parameters, among many other important contributions in a 50-year career.
Oncology began as a subspecialty much later. It came to life as a specific subdivision within hematology. A subset of hematologists with a special interest in hematologic malignancies began working with chemotherapeutic agents to treat leukemia and lymphoma in the mid-1950s and early 1960s. As new agents were developed and the principles of clinical trial research were developed, the body of knowledge of oncology began to become larger and mainly independent from hematology. Informed by the laboratory study of cancer biology and an expansion in focus beyond hematologic neoplasms to tumors of all organ systems, oncology developed as a separable discipline from hematology. This separation was also fueled by the expansion of the body of knowledge about clotting and its disorders, which became a larger part of hematology.
In most academic medical centers, hematology and oncology remain connected. However, conceptual distinctions between hematology and oncology have been made. Differences are reinforced by separate fellowship training programs (although many joint training programs remain), separate board certification examinations, separate professional organizations, and separate textbooks describing separate bodies of knowledge. In some academic medical centers, oncology is not merely a separate subspecialty division in a Department of Medicine but is an entirely distinct department in the medical school with the same standing as the Department of Medicine. Economic forces are also at work to separate hematology and oncology.
Perhaps I am only reflecting the biases of an old dog, but I am unenthusiastic about the increasing fractionation of medicine subspecialties. There are now invasive and noninvasive cardiologists, gastroenterologists who do and others who do not use endoscopes, and organ- or individual disease-focused subspecialists (diabetologists, thyroidologists) instead of organ system–focused subspecialists (endocrinologists). This fractionation has also begun within hematology and oncology. Some oncologists specialize in a single type of cancer and divisions of hematology have designated experts in clotting. At a time when the body of knowledge that must be mastered is increasing dramatically, the duration of training has not been increased to accommodate the additional learning that is necessary to become highly skilled. Extraordinary attention has been focused on the hours that trainees work. Apparently, the administrators are more concerned about undocumented adverse effects of every third night call on trainees than they are about the well-documented adverse effects on patients of frequent handoffs of patient responsibility to multiple caregivers.
Despite the sub-sub-subspecialization that is pervasive in modern medicine, students, trainees, general internists, family medicine physicians, physicians' assistants, nurse practitioners, and specialists in nonmedicine specialties still require access to information in hematology and oncology that can assist them in meeting the needs of their patients. Given the paucity of single sources of integrated information on hematology and oncology, the editors of Harrison's Principles of Internal Medicine decided to pull together the chapters in the "mother book" related to hematology and oncology and bind them together in a subspecialty themed book called Harrison's Hematology and Oncology. The first edition of this book appeared in 2010 and was based on the 17th edition of Harrison's Principles of Internal Medicine. A second edition based on 18th edition of Harrison's Principles of Internal Medicine appeared in 2013. This third edition is derived from the 19th edition of Harrison's Principles of Internal Medicine. The book contains 57 chapters organized into 12 sections: (I) The Cellular Basis of Hematopoiesis, (II) Cardinal Manifestations of Hematologic Diseases, (III) Anemias, (IV) Myeloproliferative Disorders, (V) Hematologic Malignancies, (VI) Disorders of Hemostasis, (VII) Biology of Cancer, (VIII) Principles of Cancer Prevention and Treatment, (IX) Neoplastic Disorders, (X) Endocrine Neoplasia, (XI) Remote Effects of Cancer, and (XII) Oncologic Emergencies and Late Effects and Complications of Cancer and Its Treatment.
The chapters have been written by physicians who have made seminal contributions to the body of knowledge in their areas of expertise. The information is authoritative and as current as we can make it, given the time requirements of producing books. Each contains the relevant information on the genetics, cell biology, pathophysiology, and treatment of specific disease entities. In addition, separate chapters on hematopoiesis, cancer cell biology, and cancer prevention reflect the rapidly growing body of knowledge in these areas that are the underpinning of our current concepts of diseases in hematology and oncology. In addition to the factual information presented in the chapters, a section of test questions and answers is provided to reinforce important principles. A narrative explanation of what is wrong with the wrong answers should be of further value in the preparation of the reader for board examinations.
The bringing together of hematology and oncology in a single text is unusual and we hope it is useful. Like many areas of medicine, the body of knowledge relevant to the practice of hematology and oncology is expanding rapidly. New discoveries with clinical impact are being made at an astounding rate; nearly constant effort is required to try to keep pace. It is our hope that this book is helpful to you in the struggle to master the daunting volume of new findings relevant to the care of your patients.
We are extremely grateful to Kim Davis and James Shanahan at McGraw-Hill for their invaluable assistance in the preparation of this book.