Page 20 - Bulletin Fall 2024

Practitioners’ Corner
Tyson versus Cecil
Richard F. Lockey, MD rlockey@usf.edu
This is a story of contrasting medical books to teach medical stu- dents over the last 125 years. James Tyson, MD, 1841-1919, is the author of Tyson’s The Practice of Medicine, 2nd edition, published in 1901, of which I am fortunate to have a copy. Tyson’s 1901 textbook is compared to the 1966 5th edition of Harri- son’s Principles of Internal Medicine, which I used while an internal medi-
cine and allergy and immunology resident at the University of Michigan, 1966 -1970, and to the 2016 25th edition of Goldman-Cecil Medicine available for medical students to- day. The latter is now in its 27th edition; I was only able to locate the 25th edition at the USF medical library.
Dr. Tyson was a legend in medicine during his day, gradu- ating from the University of Pennsylvania School of Medi- cine. He served as a physician in the Union Army during the Civil War and eventually became Dean of the school from which he graduated. The 2nd edition looks like one pub- lished in 1901. It is 2 1⁄2” wide, skillfully covered with the name Practice of Medicine, Tyson, written in gold print on the spine. Inside the front cover, written in pencil, is a note, “$1.00,” the probable cost of the book at the time. Think about the time and effort to write a comprehensive medi- cal textbook in 1901, a monumental task for one person, no matter what the age.
As I perused this book over the past several months, vari- ous impressions came to mind. First, it is 1,182 pages with approximately 600 words per page and an estimated 709,200 words and 124 illustrations. Most importantly, the first and most interesting part of the book is devoted to “Infectious Diseases,” 297 pages, addressing the most common medical problems of the day. Fifty pages alone are devoted to tu- berculosis. The book is further divided into “Diseases of the Digestive System,” 186 pages; “Diseases of the Respiratory System,” 126 pages; and “Diseases of the Heart and Blood- Vessels,” 86 pages. Other section titles include “Diseases of the Blood and Blood Making Organs” and “Constitutional Diseases,” some of which include rheumatism, diabetes mel- litus and insipidus, obesity, purpura, and hemophilia. There
is a large section on “Diseases of the Nervous System,” 298 pages. It concludes with “The Diseases of the Muscular Sys- tem, the Intoxications,” and sections on high temperatures and parasitology. The figures and tables are of great interest because many of them illustrate the temperatures associated with various infectious diseases, some of which include ty- phoid, smallpox, and tetanus, to name a few, a common way of suspecting certain diseases at that time.
My generation of doctors grew up reading Harrison’s Textbook of Medicine or Cecil Textbook of Medicine. I still have my 5th edition of Harrison, which has six editors, 138 authors, and covers 1,816 pages with approximately 960 words per page or about 1,743,366 words, almost 21⁄2 times more than is contained in Tyson. I read every page, more than once, during my residency. Each of the internal medi- cine residents met with three colleagues in the evening once weekly to review three or four chapters. Each fourth week, one was responsible for highlighting the salient points of the chapters reviewed. It was a time-consuming task, not only to prepare for the written but also for the oral internal medi- cine boards.
I asked one of the medical students whom I mentored over this past year what medical books are used today in internal medicine. He wrote to me, “During our internal medicine rotation, there were assigned readings from Cecil’s Essentials of Medicine edited by Edward J. Wing and Fred J. Schiffman. *The textbooks were available in PDF form though some students prefer to use physical versions of textbooks. I would say the majority of students use electronic versions of books now over physical. From my personal experience, students usually do not use these primary textbooks and prefer to use review books such as Step-Up to Medicine or First Aid when reviewing material and preparing for exams. Question banks of case-based clinical scenarios meant to simulate those seen on United States Medical Licensing Ex- aminations, ‘UWorld’ being the most commonly used, are another go-to resource.”**
Today, one textbook of medicine has been replaced by a variety of different educational sources. The reason is the amount of knowledge to practice medicine is divided in so many ways among many specialties. This is illustrated by comparing Tyson’s book with my 5th edition of Harrison
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HCMA BULLETIN, Vol 70, No. 2 – Fall 2024