Eugene Joseph Kucharz
Man is the Way of Medicine
Man is the way and aim of medicine, no matter if a physician, as a representative of a sub-specialty concentrates on a particular organ, system or cell, or just the opposite, as a doctor dealing with epidemiological threats or public health is interested in human populations. An individual human being is always the way and target of medicine combining in itself science and art of healing. A man is an extraordinarily integrated system, and his/her state of health conditioned by numerous factors, not only biological ones, should always be perceived as an entity. The holistic attitude to a patient results in obtaining the utmost efficiency of medical activity. Such an approach to the issues of health and sickness constitutes, since the very beginning, a mission of internal medicine and it is one of the unchangeable principles that differentiate internal medicine from the whole of medical disciplines. Internal medicine is a speciality that combines both basic medical science and detailed specialities which grew out of it in the previous century.1
The hundredth anniversary of setting up the Polish Society of Internal Medicine is an opportunity to reflect on the past, on the present and the prospects for internal medicine. The remembrance of past achievements cannot obscure the view of difficulties and even crises which are part of our discipline.2 They are not an immanent part of the internal medicine, but result from different conceptions of the place and role of an internist in the structures of the health care system.3 The experience of many countries show that no health care system can exist without a physician-generalist who deals with the whole of a patient's problems, and who can co-operate with doctors of particular narrow specialities.4 Such a physician is indispensable both from the patient’s point of view and the point of view of the economics of a particular health care system. That is why an internist may be called otherwise but he/she cannot be replaced with neither a team of specialists of various sub-specialties nor with a family doctor or with anybody else.5
The origin and development of internal medicine
Internal medicine emerged from the whole of medicine in the second part of
the 19th century. It was a result of the development of both medical sciences
and clinical practice and was conditioned by many factors. Among them was the
rejection of the humoral theory as an exclusive mechanism of origin of diseases,
distinguishing illnesses concerning particular parts of the human body and also
the development of basic sciences, especially pathological anatomy, which made
it possible to associate particular clinical symptoms with morphological changes.
Some time later followed new advances in physiology, clinical chemistry and
bacteriology, delivering new information about mechanisms of the etiology and
development of new illnesses. At the same time surgery was isolated, quickly
developing thanks to, among others, the improvement of the methods of anaesthesia,
as well as paediatrics, as a discipline clearly separated from the medicine
of adults. The predominant feature of medicine in the 19th century was describing
various morbid states, which helped to create opportunities for the development
of dermatology and neurology, specialities which are strongly connected with
the internal medicine.6 However, the factor which decided about separating internal
medicine was the possibility to assess the state of internal organs thanks to
the development of the methods of physical examinations (percussion, auscultation)
and using in clinical examinations methods which had been worked out by the
basic medical sciences (chemical and microscopic examinations of body fluids,
evaluation of the functioning of internal organs, e.g. tubing of the stomach,
sphygmomanometry, spirometry), and in the later period - electro-physiological
and imaging examinations. It created an opportunity to make a “direct inspection”
of internal organs and to recognise abnormalities and to evaluate the efficiency
of treatment of internal organs, which previously had been accessible only to
surgeons or during an autopsy.
The science of internal medicine was since it beginning a medical speciality closely connected with basic sciences and dealing predominantly with diseases of internal organs of adult people, not using surgical techniques. This relation to basic sciences made it possible to apply the discoveries in such sciences in clinical practice very soon, and the needs of the clinical practice inspired new research programmes and experiments.7 In its further stage of development internal medicine fought the therapeutic nihilism and treatment based exclusively on empirical knowledge,8 which was the effect of discoveries in bacteriology and immunology (vaccinations, therapeutic sera)9 and advances in modern pharmacology. The development of internal medicine became an essential factor of the progress towards rationalisation of hypotheses concerning etiology and spreading of diseases.
Internal medicine came into being as a medical speciality at the end of the 19th century. However, the idea of this science had been mentioned much earlier. It may prove that there had existed among open-minded physicians of all times an intuitive sense of distinction between medicine in general and this part of medical science called nowadays internal medicine. The Greek mythology mentions two sons of a god of the healing art, Asklepios.10 They were Podaleirios and Machaeon, both mentioned in Homer's 'Iliad'.11 Podaleirios treated his patients with herbs, whereas Machaeon was a surgeon. This fact stresses the division of medicine, depending on the applied diagnostic and therapeutic methods, into non-invasive and surgical disciplines. Podaleirios is considered as a mythological god of internal medicine.12 Herodotos (born around 485 BC, died in 425 BC), in 'History' wrote about a group of Egyptian doctors dealing with "invisible illnesses", which can be, with a certain amount of probability, interpreted as a mention on physicians corresponding to modern internists.13 The Hippocratic collection ("Corpus hippocraticum") contains a work "On internal diseases".14 In modern times the term "internal diseases" was used for the first time in 1528 by Paracelsus (real name: Theophrastus Bombastus von Hohenheim, born in 1493, died in 1541).15 Hermann Boerhaave (born in 1668, died in 1738), in the year 1706 published a handbook, in which one chapter is entitled 'On internal disease and fever in general'. It is considered to be the first monograph on internal medicine, using the name of the speciality in its title.16 In further years the first classifications of diseases were introduced which mentioned diseases of internal organs or systems, which was the merit of Thomas Sydenham (born in 1624, died in 1689) and Francois Boissier de Sauvages de Lacroix (born in 1706, died in 1767) . In the 18th and 19th century teaching about illnesses which are now dealt with by internal medicine was called "Praxis generalis", 'Cursus Medicus', 'Pathologia et therapia' or 'Medicina clinica'.17
The Polish Society of Internal Medicine came into existence as a result of many years of endeavours of Polish internists who, for the first time, started efforts to set up the Society in 1891.18 The Society was established in the times when there was no independent Polish State. Difficulties in setting up Polish scientific institutions caused by the invaders were the reason why not sooner than in 1906 the Organising Committee of the Internal Medicine Session was created19 and lead by professor Ladislas Anthony Gluziński (born in 1856, died in 1935).20 The Internal Medicine Session, taking place as part of the 10th Congress of Polish Physicians and Naturalists (Lvov, July 22–25, 1907), became the first Congress of the Society of Internists of Polish Lands.21 In 1923 in free Poland, after a break caused by the World War I and the Polish-Bolshevik War, the organisation resumed its work and its name was changed to the Polish Society of Internal Medicine.22
Identity of internal medicine
The 20th century witnessed unknown to previous generations progress in deciphering
human nature and supplied, as never before, suitable tools to fight diseases.
Both factors, being of fundamental importance to the emergence of internal medicine,
became also the factors facilitating the process of isolating sub-specialities
from the whole of internal medicine.
At the beginning of the 20th century internal medicine was a speciality not only new and developing at great speed but also having a different character. It resulted from the tendency towards pathogenetic perception of illnesses and integration of basic sciences with clinical ones, which created favourable conditions for adapting discoveries made in basic sciences for clinical practice. Achievements of the internal medicine are responsible for calling it 'the queen of medical sciences'. The development of laboratory diagnostic methods,23 introduction of X-ray examinations and progress in the specific therapy of some diseases are responsible for the fact that there was an avalanche of new knowledge concerning internal medicine. It caused, in turn, the orientation of research centres at first and then hospital departments to limited areas of internal medicine. The process continued and led to the emergence of sub-specialities. At the end of the 20th century in majority of university centres former internal medicine teaching hospitals were replaced with new teaching hospitals of narrow specialisations, In regional hospitals, however, non-surgical departments treating adult patients are still internal medicine departments. It made a false impression that internal medicine is in its twilight or that it is distancing from the academic centres.
Sub-specialities became separate medical specialities in the middle of the 20th century. They may be classified as: a) oriented to particular systems or organs of a human body (e.g. cardiology, gastrology), b) focused on the mechanism of disease (e.g. clinical immunology, oncology) or c) oriented to specific groups of patients (e.g. geriatrics, intensive therapy).24 The development and emergence of sub-specialities is a natural consequence of the development of internal medicine. This phenomenon, appropriate in its nature and unavoidable, had a bad feedback from the public and a bad influence on the organisation of hospital and outpatient health care system. Scientific discoveries or their practical applications are made, generally, within the scope of particular sub-specialities. It is a reason why doctors with narrow specialities are considered by the public as 'better' doctors than internists-generalists. However, sub-specialities cannot be opposed to the science of internal diseases because they constitute complementary and co-operating medical disciplines. What is unfortunate, however, is that in popular understanding, the role and position of an internal medicine physician in the health care system is misunderstood or forgotten, and that doctors of narrow sub-specialities are treated as more important or that an internist is considered equivalent with a family doctor. Appropriate co-operation between internists with sub-speciality doctors ensures the achievement of the most important target of medicine- the strive for recovering and maintaining the health of a whole human being.25
Since the very first years after internal medicine was considered a separate speciality, there were difficulties with its precise definition. Internal medicine was made an entity by separating other, often better defined branches of medicine. Initially its quality of integrating medical sciences was stressed. It was the basis of the definition created by William Osler (born in 1849, died in 1919) at the beginning of the 20th century.26 Throughout this century numerous attempts to define internal medicine were made and although a few different versions of the definition were presented, none of them does not describe a complex character of this science. Internal medicine, like every clinical discipline deals with diagnosing, treatment and prevention of diseases. In order to make this statement more precise, it is necessary to specify kinds of illnesses and methods used in treatment as well as patients undergoing internal medicine treatment. The most difficult task seems to be specifying kinds of diseases. Most definitions restrict themselves to stating: 'diseases of internal organs', but afterwards define them by enumerating them: diseases of the circulatory system, digestive system, excretory system, kinetic system, haematopoietic system and the endocrine system. It is obvious, of course, that the definition 'internal' should be treated symbolically. The traditional list of internal diseases does not include disorders of the immune system, metabolism and nutrition and water-electrolytic disturbances. It is necessary to mention that the term 'collagen diseases', introduced in the middle of the 20th century, now outdated, drew attention of physicians to diseases of tissues which do not have a determined location, and which are also part of the internal medicine problems.27
It has to be indicated that in the past communicable diseases constituted part of internal medicine, although nowadays there is a tendency to separate this part of clinical medicine from internal medicine. Similarly, neurology was initially part of internal medicine but it stayed within this science only in the countries which accepted a wider term of 'medicine' which is an equivalent idea of internal medicine. Separating internal medicine from neurology has got a contractual character and depends on the tradition of the organisation of health care systems in particular countries.
The second very significant element of the definition of internal medicine are the methods of work. At the time when internal medicine was emerging and in the first periods of its existence the fundamental part of the definition was indicating that internal medicine uses 'non-surgical', that is 'conservative' diagnostic and therapeutic methods. In many branches of internal medicine, especially in cardiology, gastroenterology and pulmonology in the second part of the 20th century numerous methods were introduced, which have qualities of traditionally understood surgical methods and it is a contractual thing, resulting from the tradition of medicine in particular countries, which techniques are used by internists and which ones are applied in other specialities.28 But surely there are such diagnostic and therapeutic methods used by internists that cannot be considered as solely 'conservative'.
The last mentioned characteristic is of internal medicine is the age of its patients. Traditional internal medicine is a clinical speciality taking care of adult patients. In some definitions this aspect had been, as we can see it, exaggerated. It especially refers to the definitions which describe internal medicine as the whole of clinical medicine of adult people. It is of course a significant simplification. Until quite recently, the issue of the patients’ age diagnosed and treated by an internist was not questioned and a division between an internist and a paediatrician was unambiguous. New concepts of the organisation of health care systems may bring some doubts. Doctors educated in internal medicine sub-specialities, having received full training in internal diseases and a specialist training can serve as consultants. The are competent to consult children too (e.g. rheumatologists consult children with the diseases of the motor system). The problem that has been discussed shows not only the lack of clear boundaries of the notion of 'internal medicine', but also the dependence of it on the accepted system of the organisation of health care.29
The European Federation of Internal Medicine provided the principal features of the internal medicine specialist.30 Among them are the ability to solve complex clinical problems concerning various organs and systems, ability to take into account mechanisms of mutual relationships between particular body systems, to concentrate on a patient as a person, and to include in the diagnostic and therapeutic, as well as in preventive proceedings, all aspects concerning a patient (among others social, behavioural, environmental or even cultural conditions). In other words, the definition stresses the holistic character of internal medicine as opposed to sub-specialities. Despite the evolution of the notion of 'internal medicine', what remains unchangeable and constitutes the identity of this speciality, is the ability to see complex problems of a whole patient.
Challenges of the internal medicine
Medicine is a challenge for a human intellect. However, leaving medicine solely
in the scope of reason deprives it of an essential part which is not only vocational
in its nature, but also human. The work of a physician cannot be limited to
actions dictated by the state-of the-art of medical sciences, but it should
contain elements of the love of people. The primacy of the integral good of
a patient, outdistancing all other principles underlying the work of a doctor,
is one of the oldest rules of conduct of a physician. It may be found in writings
by Hippocrates31 and in the Physician Charter32 and the codes of medical professional
ethics. One of the basic rules of a physician's proceeding is the respect for
human life as the most important token of respect for the dignity of human being.
These rules, although in the history of medicine they were interpreted from
the paternalistic position or from the position taking into the account the
autonomy of a patient, must constitute the basis of all activities aiming at
preventing diseases, bringing relief in a patient's suffering caused by the
illness, treatment and care of ill people and lengthening a patient’s life and
creating conditions for a quiet natural death.33
History proved many times that nations’ development depends on their level of civilisation, shaped to a great extent by a social group, nowadays defined as intelligentsia. That is why representatives of intelligentsia were so fiercely fought by the totalitarian systems, including fascism and communism. In the past physicians often took part in the fight for freedom, retaining national identity and better living standards of people. In the Polish history there are numerous examples of internists involved in the struggle for independence. I am convinced that such responsibility of internists as representatives of intelligentsia for the society is unalienable, although it often seems that we can give it in the hands of politicians or other leaders. It means the responsibility of physicians for shaping social consciousness, which results from a special position of the medical profession and the character of his/her meetings with people.
The modern health care system becomes more and more a system requiring co-operation of many people and is connected with technology and information technology.34 It is a result of the development of medical sciences as well as of the economic and social aspect of the health care system. The development of the structures of health care cannot obscure the view not only of a doctor's mission but also the fundamental method of carrying it out, a personal contact with a sick person. A conversation of a doctor with a patient is an essential form of attaining the aims of medicine, a form of diagnostics and therapy. It has both an emotional significance for a patient and physician as well as a social dimension. Striving for the most efficient use of knowledge and skills of a physician cannot be an excuse for authorities responsible for the organisation of health care to replace a meeting of a physician with a patient with an activity of other workers of the health care system or technological forms.
The medical profession imposes responsibility on people doing the job for the progress of medical sciences and implementing them in the clinical practice. Internal medicine has always been associated with the development of basic medical science, which it really created or inspired.35 Such responsibility refers to every internist, not only the one whose place of work predisposes him/her to do research. It imposes the obligation of continuous medical education, informing the medical society of the discoveries and observations and participating in training of other physicians. Such activities belong to the tasks objectives of the Polish Society of Internal Medicine, and the forms of continuous medical education designed by the society became an example for other medical specialities.36
The roots of internal medicine impose, especially on internists, an obligation to oppose any methods which are not acknowledged by the medical sciences and which are used to treat patients and whose application by internists is completely unacceptable. At the same time, internists can, while maintaining a necessary critical approach, to verify information coming from so called alternative medicine, at the same time obeying the rules of doing scientific research, ethical principles and current regulations of law.
Medicine is by its nature a common property of all people. Polish medicine developed in contact with the leading scientific centres of Western Europe but it developed at the crosswords between the civilisation of the West and the eastern world. Its fate, like the fate of the Polish nation was difficult and complex. Polish medicine was created, in amicable co-operation, by Polish physicians of different denominations and scientists from other countries. Their common contribution to the science and clinical practice cannot be underestimated. Here it is necessary to mention the activity of Polish doctors of Jewish origin who had a great contribution to the development of medicine and health care system.
Polish internists were always very open to co-operation with their colleagues from abroad. In spite of the fact that the Polish state was non-existent, in the 19th century they actively participated in International Medical Congresses, although the occupants did not let them organise a Polish national committee.37 What cannot be overlooked is the contribution of Ladislas Anthony Gluziński, the founder of the Polish Society of Internal Medicine, to the organisation of scientific meetings of doctors coming from the Slavonic countries in the first part of the 20th century.38 There were also relationships of Polish internists with their colleagues from Austria, France, Germany and Italy. After World War II, Polish internists took part in the First International Congress of Internal Medicine, organised in 1950 in Paris, but not until 1956 political circumstances made it possible for the Polish Society of Internal Medicine to join the International Society of Internal Medicine. The Polish Society if Internal Medicine maintained also contacts with the European Association of Internal Medicine - Association Européenne de Medecine Interne. In 1996, Polish internists attended the First Central-European Congress of Internal Medicine,39 and during the Third Central European Congress of Internal Medicine, held in Wisła (Poland) on 22 May, 1998, the Declaration of Cooperation of the Central-European Internists40 was signed, the initiator of which was the Polish Society of Internal Medicine. Since 1997 the Polish Society of Internal Medicine has been a member of the European Federation of Internal Medicine. It seems proper to mention also co-operation of our Society with internists from the neighbouring countries,41 especially the Polish-Slovak Conferences on Internal Medicine held annually since 2000.42
Medicine combines national and all-human qualities. Thus it constitutes part of a nation's culture but by its nature it has got an international character. I believe that properly understood co-operation, or even globalisation of medical sciences is by all means desirable and it does not hinder the preservation of tradition and national character of medicine in particular countries.
Reflections on the year of the anniversary
Medicine teaches modesty in relation to the sophistication of phenomena taking
place in human organisms. Feeling this modesty we express the admiration and
respect for great creators of internal medicine. Thanks to their discoveries,
relentless work and vision of the future, modern development of medicine is
possible. We make use of their discoveries in everyday work, not always being
conscious of the fact.
We are very grateful to particularly outstanding Polish internists. We recall the names also of those who rendered Polish science famous in the world and those whose names are known more to local communities but who, being practitioners shaped the Polish internal medicine in the eyes of the society. A big number of them worked in hard times. The 20th century has been recorded in history as the time of enormous changes, but also the time of the most ferocious wars in the history of mankind and the birth of inhuman totalitarian systems. We recall with pride Polish internists who retained the respect for a human person and their profession in spite of totalitarian systems surrounding them, in spite of partitions, wars and the extermination of parts of human populations. Looking backwards, we pay homage to all people who have contributed to setting up the Polish organisation of internal medicine doctors. The first person to mention is the founder and first chairman, Ladislas Anthony Gluziński. His endeavours led to founding and changing the organisation that came into being at the times of partitions of Poland into the full scientific corporation which has been promoting Polish internal medicine for a century.
We thank our teachers who have passed down not only medical knowledge to us abut also those skills which are so difficult to find in handbooks and which are indispensable in the work of a good physician. We are looking with hope at the young generation of internists and we are proud that we can create a historical chain of generations of Polish internists.
We can feel the pride of the heritage of past generations, being conscious that as humans we can err both by reason and heart. The Polish Society of Internal Medicine have spoken many times on behalf of Polish internists. In this special reflection on the past, in the year of the 100th anniversary, I am asking everybody to accept apologies for any possible harm done by Polish internists.
I believe that internal medicine, a medical speciality of great history will always be an intellectually and emotionally leading branch of science and medical practice and Polish internists will continue to have their share in the world medicine.
Medicine deals with a man whose health or illness always concern the man as
an indivisible whole. In the year in which we celebrate the 100th anniversary
of setting up the Polish Society of Internal Medicine I appeal to all those
making decisions about the organisation and financing of the health care system,
to those who are responsible for education of doctors, to all physicians and
the whole society to pay attention to the fact that internal medicine is an
indispensable element in the health care system which is to ensure appropriate
preservation of public health.
The progress in science and technology is to blame for our feeling of having too many possibilities. A physician work shows that although extraordinary advances were made in the methods of diagnostics and treatment, still the possibilities restore patients to health and preventing death, which are at a doctor's disposal, are limited. We often see that we err in our actions and we see how infinitely perfect creation the human body is. All this makes us feel humble in front of the beauty and perfection of a human nature, this specific element of the Universe. In this humbleness, we turn to Lord Almighty with a request to bless all internists in their work for the benefit of people who entrust their health and lives to their care. From God's Mercy man was born and all good, including the good of life and health. Make God our work full of love towards a human being and let it restore this element of good which are long life and good health. Forgive us the Creator of Universe our nonfeasance, mistakes and imperfections.
Katowice, August 10, 2006
1 See also: Kucharz E.J.: Medycyna wewnętrzna specjalnością XXI wieku. Twój Magazyn Medyczny 2004, vol. 9, no 10/145, p. 8–11
2 Bauer W., Schumm-Draeger P.M., Koebberling J., Gjoerup T., Alegria J.J.G., Ferreira F., Higgens C., Kramer M., Licata G., Mittelman M., O’Hare J., Ünal S.: Political issues in internal medicine in Europe. A position paper. European Journal of Internal Medicine, 2005, vol. 16, p. 214–217
3 Horký K. Aktuální problémy koncepce vnitřního lékařství a jeho dílčích podoborů na konci 2. tisíciletí. Otvřený dopis České internistické společnosti. Vniřni Lékař, 1999, vol. 45, p. 251–252; Raptis S.A, Chalevelakis G.: Internal medicine in Greece. European Journal of Internal Medicine 1999, vol. 10, p. 225–228; Ďuriš I., Kinová S., Murin J.: The concept of general internal medicine of the Slovak Society of Internal Medicine. European Journal of Internal Medicine, 2000, vol. 11, p. 174–176; Tjen H.S.L.M.: General medicine in Europe beyond the millenium. European Journal of Internal Medicine, 2000 vol. 11, p. 112–115; Seremi D., Dupond J.L.: Internal medicine in France. European Journal of Internal Medicine, 2000, vol. 11, p. 55–58; Lindgren S., Kjelström T.: Future development of general internal medicine: a Swedish perspective. European Journal of Internal Medicine, 2001, vol. 12, p. 464–469; Ďuriš I.: Minulost’ a budučnost’ internej mediciny. Bratlavské Lekárske Listy, 2001, vol. 102, p. 263–265; Kellett J.: Internal medicine – back to the future of health care delivery. European Journal of Internal Medicine, 2002, vol. 13, p. 4–8; Szmatłoch E.: Internal medicine in Poland. European Journal of Internal Medicine, 2000, vol. 11, p. 355–356; Jotkowitz A.B., Porath A.: Internal medicine training in Europe. European Journal of Internal Medicine, 2005, vol. 16, p. 543–544; Moulopoulos S.D.: Internal medicine in 2003 or the specialty of "invisible diseases". European Journal of Internal Medicine, 2004, vol. 15, p. 77–78
4 Streuli R.A.: Generalists are needed more than ever [in:] Zbornik predavajn I Kongresa Združenja Internistov SZD, Ljubjlana 2001, p. 17–20; Streuli R.A.: The making of an internist: an European view. Vniřni Lékař, 1999, vol. 45, p. 253–255; Kucharz E.J.: Internal medicine: yesterday, today, and tomorrow. III. Specialists versus generalists or hospitalists. European Journal of Internal Medicine, 2003, vol. 14, p. 344–346; Sereni D.: La médecine interne, une spécialité incontournable. Presse Médicale, 2005, vol. 34, p. 979–980
5 See also: Kucharz E.J.: List otwarty Prezesa Towarzystwa Internistów Polskich. Kurier Zjazdowy [XXXV Zjazd Towarzystwa Internistów Polskich, Katowice 2004] 2004, no 3, p. 3
6 See also: Kucharz E.J.: Internal medicine: yesterday, today, and tomorrow. I. Origin and development: the historical perspective. European Journal of Internal Medicine, 2003, vol. 14, p. 205–208
7 See also: Hillen H. F. P.: Education and training in internal medicine in Europe. European Journal of Internal Medicine, 2002, vol. 13, p. 154–159
8 See also: Kucharz E.J.: The life and achievements of Joseph Dietl. Clio Medica. Acta Academiae Internationalis Historiae Medicinae, 1981, vol. 16, p. 25–35
9 See also: Opoka W., Kucharz E.J.: Vivo kaj agado de Odo Bujwid - pola kuracisto kaj esperantisto. [in:] Sciencaj prolegoj. III Internacia Medicina Esperanto Konferenco. Universala Medicia Esperanto Asocio. K. Popov (ed.), Ruse 1981, p. 160–165; Kucharz E.J.: Odo Bujwid - the pioneer in microbiology in Poland [in:] XXVIe Congres International d’Histoire de la Medecine. Actes du Congres, vol: II, Sofia 1981, p. 128–129; Kucharz E.J.: Życie i działalność Odona Bujwida - polskiego lekarza, społecznika i esperantysty. Wiadomości Lekarskie, 1986, vol. 39, p. 123–129; Kucharz E.J., Shampo M.A., Kyle R.A.: Odo Bujwid - pioneer in microbiology. Proceedings of the Mayo Clinic, 1990, vol. 65, p. 286
10 See also: Edelstein E.J., Edelstein L.: Asclepius. Collection and interpretation of the testimonies, vols 1 and 2. Baltimore: The Johns Hopkins University Press 1948, reprinted in one volume in 1998
11 Martini GA. Inaugural speech. [in:] Condorelli L, Teodori U, Beretta Anguissola A, Sangiorgi M (eds). Internal medicine. Proceedings of the XIV International Congress of Internal Medicine ISIM, Rome, October 15–19, 1978, Part 1, Excerpta Medica, Amsterdam-Oxford 1980, p. 3–5
12 Kucharz E.J., Kotulska A.: Did the ancient Greeks have a good of internal medicine? European Journal of Internal Medicine 2005, vol. 16, p. 287
13 Herodotos: History, book II, line 84: (physicians … of invisible diseases).
14 See also: Jouanna J.: Hippocrates, The John Hopkins University Press, Baltimore 1999; Kucharz E.J., Kotulska A.: Contribution of Hippocrates to foundation of rational rheumatology. Reumatologia 2004, vol.42, p. 580–586
15 Paracelsus: Theophrasti Paracelsi von Chemy und heilung der Franzosen [in chapter 9: Und wiewol es ist, so aus den innerlichen krankheiten auswending am leib etwas anstehet, der chirurgic besolen wird, aber der kleinen (pisownia oryginalna)]. Basilea 1538, cited in: Sudhoff K., Mattheissen W. (eds.): Theophrast von Hohenheim gen. Paracelsus: Samtliche Werke. O.W. Barth, München 1922, vol. 6, p. 444
16 Boerhaave H.: De morbis internis, et de febribus in genere [a chapter in the book: Aphrorismi de cognoscendis et curandis morbis]. Leyden 1706
17 Bloomfield A.L.: Origin if the term "internal medicine". Journal of the American Medical Association, 1959, vol. 169, p. 1628-2629; Innere Medizin in:] Eulner H.H.: (ed.) Die Entwicklung der medizinische Spezialfächer an den Universitäres des deutschen Sprachgebietes. Ferdinand Enke Verlag, Stuttgart 1970, p. 180
18 Korczyński E.: Wniosek tyczący się odbywania corocznych zjazdów internistow polskich. Dziennik VI Zjazdu Lekarzy i Przyrodników Polskich w Krakowie, Kraków 1891, vol. 5, p. 20; Kucharz E.J.: "Pradzieje" Towarzystwa Internistów Polskich. Polskie Archiwum Medycyny Wewnętrznej, 1994, vol. 92, p. 87–88
19 Szczeklik E.: Sześćdziesięciolecie Towarzystwa Internistów Polskich. Polskie Archiwum Medycyny Wewnętrznej, 1966, vol. 37, p. 609–614
20 Kucharz E.J.: Władysław Antoni Gluziński. Zarys biografii. Towarzystwo Internistów Polskich, Katowice 2006, p. 1- 75; Kucharz E.J.: Profesor Antoni Władysław Gluziński – życie i działalność założyciela Polskiego Archiwum Medycyny Wewnętrznej. Polskie Archiwum Medycyny Wewnętrznej, 1993, vol. 90, p. 375–379; Kucharz E.J.: Professor Anthony Gluziński: life and achievements of the founder of the Polish Society of Internal Medicine. Acta Medico-Historica Rigensia 2000, vol. 5/24, p. 93–101; Kucharz E.J.: Władysław Antoni Gluziński [in:] Gala Interny Polskiej. Program. Wydawnictwo Symposion, Poznań 2006, p. 10
21 Kucharz E.J.: Zarys dziejów Towarzystwa Internistów Polskich. Polskie Archiwum Medycyny Wewnętrznej, 2004, vol. 112, suppl. 1, p. 43–45
22 Kucharz E.J.: Towarzystwo Internistów Polskich [in:] Słownik polskich towarzystw naukowych, Sordylowa B. (ed.), Polska Akademia Nauk, Warszawa 2004, new ed., vol. I, p. 773–779
23 See also: Kucharz E.J.: 80th Anniversary of the discovery of erythrocyte sedimentation rate. Materia Medica Polona, 1975, vol: 7, p. 344–346; Kucharz E.J.: 80e anniversaire de la decouverte du test de la vitesse de sedimentation sanguine. Materia Medica Polona, 1975, vol. 7, p. 344–346; Kucharz E.J.: Edmund Biernacki and the erythrocyte sedimentation rate. Lancet 1987, vol. 1, p. 696; Kucharz E.J.: The forgotten contribution of Dr. Edmund Faustyn Biernacki to the discovery of the erythrocyte sedimentation rate. Journal of Laboratory and Clinical Medicine, 1988, vol. 112, p. 279–280; Kucharz E.J.: Dr Edmund Faustyn Biernacki i jego odkrycie. (W stulecie odkrycia odczynu opadania krwinek czerwonych). Polskie Archiwum Medycyny Wewnętrznej, 1994, vol. 94, p. 442–447; Kucharz E.J.: Dr Edmund F. Biernacki: life and contribution to the discovery of erythrocyte sedimentation rate. Acta Medico-Historica Rigensia, 1997, vol. 3/22, p. 47–54
24 Knockaert D.C.: Internal medicine in Belgium. European Journal of Internal Medicine, 2001, vol. 12, p. 386–392
25 See also: Kucharz E.J.: Najważniejszy jest lekarz, który widzi chorego całościowo. Lekarz 2006, no. 4, p. 10
26 Osler W.: Presidential address. Transactions of the Association of American Physicians, 1895, vol. 10, p. 13
27 Kucharz E.J.: Internal medicine: yesterday, today, and tomorrow. II. Definition and development in the 20th century. European Journal of Internal Medicine, 2003, vol. 14, p. 272–274
28 Anderson L. Internal medicine and the structures of modern medical sciences. Iowa State University Press, Iowa 1996
29 Stevens R.: Issues for American internal medicine though the last century. Annals of Internal Medicine, 1986; vol. 105, p. 592–602; Donnally R.S.: Internal medicine [w:] The Encyclopedia Americana. International edition, Grolier Inc., Danbury 1992, vol. 15, p. 288
30 European Federation of Internal Medicine. Just what is an internist? An identification of the specialist in the diseases of adults composed of six thumbnail definitions. Vniřni Lékař, 2001, vol. 47, p. 416–417
31See also: Ruggere C.A.: Quoting the Hippocratic oath. Science 1999, vol. 286, p. 901
32 A Medical Professionalism in the New Millenium: A Physician Chart. Annals of Internal Medicine, 2002, vol. 136, p. 243–246, Lancet, 2002, vol. 359, p. 520–522; European Journal of Internal Medicine, 2002, vol. 13, p. 215–219
33 See also: The goals of medicine: setting new prorities: a Hasting Center project report [in:] Howell J.H., Sale W.F. (ed.): Life choices: a Hasting Center introduction to bioethics, Washington, Georgetown University Press 2000, p. 58; Biesaga T.: Właściwe i niewłaściwe cele medycyny. Medycyna Praktyczna 2004, no. 5, p. 20–25; Muszala A.: Medycyna luksusowa – ocena etyczna nieterapeutycznych usług medycznych. Medycyna Praktyczna 2006, no. 5/183, p. 28–34; Rużyłło E.: Etyka i medycyna. Oficyna Wydawnicza Stopka, Łomża 1999
34 See also: Kucharz E.J., Kotulska A., Zmysłowski A.: Zastosowanie metodologii Dietrycha w analizie lekarskiego postępowania diagnostyczno-terapeutycznego. Wiadomości Lekarskie 2006, vol. 59, p. 125–126; Kellet J.: Internal medicine and health care quality. European Journal of Internal Medicine, 2004, vol. 15, p. 479–480; Tilney M.K.: Clinical quality improvement and medicine. European Journal of Internal Medicine, 2004, vol. 15, p. 481–486; Rużyłło E.: Myśli o Towarzystwie Internistów Polskich w 93 roku jego działalności. Polskie Archiwum Medycyny Wewnętrznej, 2001, vol. 106, p. 1115–1119
35 Barr D. P.: The responsibilities of the internist. Annals of Internal Medicine, 1947, vol. 27, p. 195–201
36 See also: Szczeklik A., Kucharz E.J.: Nowe zasady obowiązkowego doskonalenia zawodowego lekarzy. Rola Towarzystwa Internistów Polskich. Medycyna Praktyczna, 2005, no 1-2/167-168, p. 27–30; Kucharz E.J.: National Educational Conferences of the Polish Society of Internal Medicine Cracow, May 10–11, 2002 and Warsaw, April 3–4, 2003. European Journal of Internal Medicine, 2003, vol. 14, p. 399–400
37 See also: Rużyłło E.: Ogólny zarys roli internistów w dziejach medycyny polskiej XIX i XX wieku. Polskie Archiwum Medycyny Wewnętrznej 1989, vol. 82, p. 8–14
38 See also: Gluziński A.: Sprawozdanie delegacji polskiej ze Zjazdu Delegatów Słowiańskich w Dubrowniku (1925 r.): w Belgradzie (1926 r.). Lekarz Wojskowy, 1926, vol. 8, p. 380–382; Gluziński A.: Sprawozdanie delegacji polskiej ze Zjazdu Delegatów Słowiańskich w Dubrowniku (1925 r.): w Belgradzie (1926 r.). Nowiny Lekarskie, 1926, vol. 38, p. 813–814; Gluziński A.: Sprawozdanie delegacji polskiej ze Zjazdu Delegatów Słowiańskich w Dubrowniku (1925 r.): w Belgradzie (1926 r.). Polska Gazeta Lekarska, 1926, vol. 5, p. 855–856; Gluziński A.: Szkic historyczny powstania Związku Lekarzy Słowiańskich. Nowiny Społeczno-Lekarskie, 1931, vol. 5, p. 92–93 i p. 111–112; Szumlański W.: Zasługi prof. Antoniego Gluzińskiego na terenie Związku Lekarzy Słowiańskich. Medycyna, 1935, vol. 9, p. 756–757
39 Kucharz EJ.: Pierwszy Środkowoeuropejski Kongres Medycyny Wewnętrznej, Grado, 26–27 kwietnia 1996 r. Polskie Archiwum Medycyny Wewnętrznej, 1996, vol. 96, p. 90–92
40 Kucharz EJ (ed): Proceedings of the Third Central European Congress of Internal Medicine, Wisła 1998. Polskie Archiwum Medycyny Wewnętrznej, 1998, vol. 99, suppl. 1; por.: Kucharz E.J.: Trzeci Środkowoeuropejski Kongres Medycyny Wewnętrznej. Polskie Archiwum Medycyny Wewnętrznej 1998, vol. 100, p. 90–94
41 See also: Kucharz E.J.: Pierwsza Polsko-Litewska Konferencja Internistyczna, Katowice 7–8 marca 2003 r. Polskie Archiwum Medycyny Wewnętrznej, 2003, vol. 110, p. 803–804; Šapoka V.: Mieli Kolegos. Internistas, 2003, no 3/22, p. 1, 6; Kucharz E.J., Straszecka: Sprawozdanie z Polsko-Czeskich Dni Internistycznych, Nysa 11 IX 1993. Polskie Archiwum Medycyny Wewnętrznej, 1994, vol. 91, p. 462–463; Kucharz E.J., Straszecka: Sprawozdanie z Polsko-Czeskich Dni Internistycznych, Nysa 11 IX 1993. Towarzystwo Internistów Polskich. Oddział Opolski 1992–1995. Opole 1995, p. 17–19; Kucharz E.J.: II Czesko-Polski Dzień Internistyczny, Ołomuniec 9 września 1994 r. Polskie Archiwum Medycyny Wewnętrznej, 1995, vol. 93, p. 265–266; Kucharz E.J.: Trzeci Czesko-Polski Dzień Internistyczny, Brno 23–24 maja 1995 r. Polskie Archiwum Medycyny Wewnętrznej,1996, vol. 95, p. 168–169; Kucharz E.J.: Polsko-Czeska Konferencja Internistyczna. Pro Medico 1999, no 53, p. 11; Kucharz E.J.: Czwarta Polsko-Czeska Konferencja Internistyczna, Ustroń 21–22 kwietnia 1999 r. Polskie Archiwum Medycyny Wewnętrznej, 1999, vol. 101, p. 371–372
42 See also: Kucharz E.J.: From history of our conferences. Fifth Polish-Slovak Conference on Internal Medicine, Wysowa 26–28 III 2004. Annales Academiae Medicae Silesiensis, 2004, supl. 76, p. 7–9; Kucharz E.J.: Pierwsza Polsko-Słowacka Konferencja Internistyczna, Ustroń-Jaszowiec 26–27 maja 2000 r. Polskie Archiwum Medycyny Wewnętrznej 2000, vol. 103, p. 511–514; Kucharz E.J.: Druga Polsko-Słowacka Konferencja Internistyczna, Bardejov Zdrój 1–2 czerwca 2001 r. Polskie Archiwum Medycyny Wewnętrznej, 2001, vol. 105, p. 533–534; Kucharz E.J., Kiňová S., Ďuriš I.: Polish-Slovak Conferences on Internal Medicine 2000–2002. European Journal of Internal Medicine, 2002, vol. 13, p. 353–408; Kucharz E.J.: Czwarta Słowacko-Polska Konferencja Internistyczna, Modra Harmonia, 21–22 marca 2003 r. Polskie Archiwum Medycyny Wewnętrznej, 2003, vol. 110, p. 933–934; Kucharz E.J.: Piąta Polsko-Słowacka Konferencja Internistyczna. Reumatologia 2004, vol. 42, p. 498–499; Kucharz E.J.: Katowiccy lekarze na VI Słowacko-Polskiej Konferencji Internistycznej w Vyšné Ružbachy. Pro Medico 2005, no 6 (117), p. 10; Kucharz E. J.: VI Słowacko-Polska Konferencja Internistyczna. Biuletyn Informacyjny Śląskiej Akademii Medycznej, 2005, vol. 15, no 2, p. 26; Kucharz E.J.: VI Słowacko-Polska Konferencja Internistyczna. Vyšné Ružbachy 29–30 kwietnia 2005 r. Reumatologia 2005, vol. 43, no 4, p. 235; Kucharz E.J.: The 6th Slovak-Polish Conference on Internal Medicine, Vyšné Ružbachy, April 29–30, 2005. European Journal of Internal Medicine, 2005, vol. 16, p. 464–465