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Title: Davidson’s Principles and Practice of Medicine, 21st Edition
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Davidson’s
Medicine
Principles and Practice of

21st Edition

Sir Stanley Davidson (1894–1981)
This famous textbook was the brainchild of one of the great Professors of
Medicine of the 20th century. Stanley Davidson was born in Sri Lanka and
began his medical undergraduate training at Trinity College, Cambridge;
this was interrupted by World War I and later resumed in Edinburgh. He
was seriously wounded in battle, and the carnage and shocking waste of
young life that he encountered at that time had a profound effect on his subsequent attitudes and values.
In 1930 Stanley Davidson was appointed Professor of Medicine at the
University of Aberdeen, one of the first full-time Chairs of Medicine anywhere and the first in Scotland. In 1938 he took up the Chair of Medicine at
Edinburgh and was to remain in this post until retirement in 1959. He was a
renowned educator and a particularly gifted teacher at the bedside, where
he taught that everything had to be questioned and explained. He himself
gave most of the systematic lectures in Medicine, which were made available
as typewritten notes that emphasised the essentials and far surpassed any
textbook available at the time.
Principles and Practice of Medicine was conceived in the late 1940s with its
origins in those lecture notes. The first edition, published in 1952, was a masterpiece of clarity and uniformity of style. It was of modest size and price,
but sufficiently comprehensive and up to date to provide students with the
main elements of sound medical practice. Although the format and presentation have seen many changes in 20 subsequent editions, Sir Stanley’s original
vision and objectives remain. More than half a century after its first publication, his book continues to inform and educate students, doctors and health
professionals all over the world.

For Elsevier
Commissioning Editor: Laurence Hunter
Editorial Project Manager: Wendy Lee
Project Manager: Nancy Arnott/Glenys Norquay
Designer: Stewart Larking
Illustration Manager: Bruce Hogarth
Medical Illustrator: Robert Britton
Charts: Hard Lines Agency

Portrait reproduced by courtesy of the
Royal College of Physicians of Edinburgh

Davidson’s
Medicine
Principles and Practice of

21st Edition

The Editors

Nicki R. Colledge BSc FRCP(Ed)
Consultant Geriatrician, Liberton Hospital, Edinburgh,
and Royal Infirmary of Edinburgh;
Honorary Senior Lecturer in Geriatric Medicine,
University of Edinburgh

Brian R. Walker BSc MD FRCP(Ed)
Professor of Endocrinology, University of Edinburgh;
Honorary Consultant Physician, Royal Infirmary of Edinburgh

Stuart H. Ralston MD FRCP FMedSci FRSE
ARC Professor of Rheumatology, University of Edinburgh;
Honorary Consultant Rheumatologist, Western General Hospital, Edinburgh
Illustrated by Robert Britton

Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2010

An imprint of Elsevier Limited
© 2010, Elsevier Limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s
Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333;
e-mail: healthpermissions@elsevier.com. You may also complete your request online via the Elsevier
website at http://www.elsevier.com/permissions.
First edition 1952
Second edition 1954
Third edition 1956
Fourth edition 1958
Fifth edition 1960
Sixth edition 1962
Seventh edition 1964
Eighth edition 1966
Ninth edition 1968
Tenth edition 1971
Eleventh edition 1974

Twelfth edition 1977
Thirteenth edition 1981
Fourteenth edition 1984
Fifteenth edition 1987
Sixteenth edition 1991
Seventeenth edition 1995
Eighteenth edition 1999
Nineteenth edition 2002
Twentieth edition 2006
Twenty-first edition 2010

Main Edition
ISBN-13: 978-0-7020-3085-7
International Edition
ISBN-13: 978-0-7020-3084-0
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors
assume any liability for any injury and/or damage to persons or property arising out of or related to
any use of the material contained in this book.
The Publisher

The
Publisher's
policy is to use
paper manufactured
from sustainable forests

Printed in China

Contents



Part 1 PRINCIPLES OF MEDICINE
1 Good medical practice

v

1

A.D. Cumming • S.I.R. Noble



2 Therapeutics and good prescribing

17

J.K. Aronson



3 Molecular and genetic factors in disease

39

D.R. FitzPatrick • J.R. Seckl



4 Immunological factors in disease

69

S.E. Marshall



5 Environmental and nutritional factors in disease

95

P. Hanlon • M. Byers • B.R. Walker • H.M. Macdonald



6 Principles of infectious disease

131

R.P. Hobson • D.H. Dockrell



7 Ageing and disease

163

N.R. Colledge




Part 2 PRACTICE OF MEDICINE
8 Critical illness

177

I.S. Grant • G.R. Nimmo



9 Poisoning

203

S.H.L. Thomas • J. White



10 Medical psychiatry

229

M.C. Sharpe • S.M. Lawrie



11 Oncology

255

G.G. Dark • A.R. Abdul Razak



12 Pain management and palliative care

279

D. Oxenham



13 Infectious disease

289

D.H. Dockrell • S. Sundar • B.J. Angus • R.P. Hobson



14 HIV infection and AIDS
E.G.L. Wilkins

383
v

Contents



15 Sexually transmitted infections

409

G.R. Scott



16 Clinical biochemistry and metabolism

425

M.J. Field • L. Burnett • D.R. Sullivan • P. Stewart

vi



17 Kidney and urinary tract disease

459

J. Goddard • A.N. Turner • L.H. Stewart



18 Cardiovascular disease

521

D.E. Newby • N.R. Grubb • A. Bradbury



19 Respiratory disease

641

P.T. Reid • J.A. Innes



20 Endocrine disease

731

M.W.J. Strachan • B.R. Walker



21 Diabetes mellitus

795

B.M. Frier • M. Fisher



22 Alimentary tract and pancreatic disease

835

K.R. Palmer • I.D. Penman



23 Liver and biliary tract disease

919

J.D. Collier • G. Webster



24 Blood disease

985

J.I.O. Craig • D.B.L. McClelland • H.G. Watson



25 Musculoskeletal disease

1053

M. Doherty • S.H. Ralston



26 Neurological disease

1131

C.M.C. Allen • C.J. Lueck • M. Dennis



27 Skin disease

1237

O.M.V. Schofield • J.L. Rees



28 Laboratory reference ranges

1293

S.W. Walker
Picture credits

1299

Index

1301

Preface
Since Davidson’s Principles and Practice of Medicine was
first published in 1952, over two million copies have
been sold and the book has acquired a large following
of medical students, doctors and other health professionals all over the world. It has been translated into
many languages, most recently Russian and Polish,
and has won numerous prizes, the last edition receiving an award from the Society of Authors and the Royal
Society of Medicine. Davidson’s has endured because
with each new edition it has evolved to provide comprehensive updated information in a format suitable for its
­contemporary readership, and yet it has remained concise and easy to read. This 21st Edition has been extensively updated and revised, but has not increased in
length or size.
Since its beginnings, Davidson’s has sought to explain
the basis for medical practice. The integration of ‘preclinical’ science with clinical practice is now a feature
of many undergraduate medical curricula, and many
students use Davidson’s from the outset of their medical
course. In recognition of this, the first part of the book,
‘Principles of Medicine’, highlights the mechanisms
of health and disease, along with the professional and
ethical principles underlying medical practice. Many
examples of clinical problems are included to bring the
medical sciences to life for the new student and to rejuvenate the interest of the experienced clinician. The second part of the book, ‘Practice of Medicine’, covers the
major medical specialties. Every chapter has been rewritten for this edition to ensure that it reflects the ‘cutting
edge’ of medical knowledge and practice, pitched at a
level of detail to meet the needs of candidates preparing
for examination for Membership of the Royal College of
Physicians or its equivalent.
Many of the innovations introduced in recent editions have been warmly received. We have retained the
ever-popular ‘Clinical Examination’ overview pages
and the patient-orientated approach in the ‘Presenting
Problems’ sections, while enhancing the book’s practical
content with a new series of ‘Emergency’ and ‘Practice
Point’ boxes. Embedding horizontal themes within the
book—for example, with the ‘In Old Age’ boxes—has
been applauded, and we have extended this approach
by adding ‘In Pregnancy’ boxes in relevant chapters. The
inclusion of both SI and non-SI units in the last edition
proved popular and has been maintained.

We are proud of Davidson’s international heritage.
As well as recruiting authors from around the globe,
particularly for topics such as Infectious Diseases and
Envenoming, we have welcomed new members on to
our International Advisory Board. These leading experts
provide detailed comments that, along with the feedback received from our global readership, are crucial to
our planning of every chapter in each new edition. In
2006, we had the privilege of visiting several medical
schools on the Indian subcontinent and were delighted
with the enthusiasm of the students and teachers that
we met, and the very useful criticisms and feedback they
provided. We have tried to address as many of these as
possible in this edition.
Education is achieved by assimilating information
from many sources and we are delighted that readers of this book can enhance their learning experience
using complementary resources. The StudentConsult
platform continues to provide online access to the
text and illustrations of the main edition. Davidson’s
has had a long-standing association with its sister
books, Macleod’s Clinical Examination (now in its 12th
Edition) and Principles and Practice of Surgery (now
in its 5th Edition). The Davidson’s ‘family’ has now
expanded with the publication of Essential Davidson’s,
a long-requested pocket-size version of the main text;
Davidson’s Foundations of Clinical Practice, an indispensable guide to starting work as a junior doctor; and
Davidson’s Clinical Cases, which contains over 90 cases
based on the ‘Presenting Problems’ in the main text.
We congratulate the editors and authors of these books
for continuing the tradition of concise, easily read and
beautifully illustrated text.
The regular introduction of new authors and editors to Davidson’s is important to maintain the freshness
of each new edition. On this occasion, Professor Stuart
Ralston has joined the editorial team and 14 new authors
have contributed material. We all take immense pride
in producing an outstanding book for the next generation of doctors, and in continuing the great tradition first
established by Sir Stanley Davidson and passed on by all
the previous editors and authors, for what remains one
of the world’s leading textbooks of medicine.
NRC, BRW, SHR
Edinburgh 2010

vii

viii

The Davidson family
of textbooks
Medical learning is a life-long process that is facilitated
by many different tools. Davidson’s Principles and Practice
of Medicine has stood the test of time because it provides
an overview that is both comprehensive and concise.
Its long-standing partner textbooks, Macleod’s Clinical
Examination and Principles and Practice of Surgery, share
a similar ethos. To add value for readers of Davidson’s,
its highly successful style has now been employed in a
‘family’ of new companion books. These complement the
main textbook, both by presenting its material in different formats to enhance learning, and by including supplementary material that could not be accommodated in
the main edition.
Davidson’s Essentials of Medicine is
a ‘handbook’ version of Davidson’s
Principles and Practice of Medicine, helping
those who need portable information to
study while on the move—whether commuting between training sites, or during remote attachments and electives. It
also serves as a condensed revision aid.
Every effort has been made to maximise
readability and avoid dry and unmemorable lists. The text
presents the essential elements in a structured format, key
Davidson’s illustrations are adapted and retained, and several new ‘added value’ sections have been included: Major
Investigations describes key diagnostic tests; Therapeutics
describes the clinical use of common drugs; and typical
OSCE scenarios are included to help the reader to prepare
for this examination format.
In the real world, patients do not present with a specific disease; instead they
come with problems that might involve
many systems, and the primary pathology may not be at all clear. In recognition of this, Davidson’s Clinical Cases has
been written by an impressive international group of physicians with wide
clinical experience. This book guides the
reader step by step to find the correct path in the maze
between a patient’s presenting complaint and the final
diagnosis. The selection of cases is closely based on the
‘Presenting Problems’ of Davidson’s Principles and Practice
of Medicine and includes illnesses that reflect an international outlook.
For those just qualified and starting out
on their initial years of hospital training, Davidson’s Foundations of Clinical
Practice provides key guidance on how
to manage the practicalities of working life. The emphasis is on acute rather
than chronic symptom presentation and
­management in a wide range of disci-

plines. It also ­provides an invaluable step-by-step guide
to undertaking a range of core clinical procedures, along
with an insight into the non-clinical aspects of managing
a medical career. Much of the text is written by junior
doctors, and so provides a real view of what it is like to
work as a trainee hospital doctor today.
Davidson’s is also closely linked to its two sister titles,
Macleod’s Clinical Examination and Principles and Practice
of Surgery.


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