Of this I am assured, that he will be the best practitioner who begins his life work as a student among patients, learning for himself under guidance how to observe, how to think, learning what disease is and how it is to be treated. Years ago, my preceptor, Dr. Bovell, placed in my hands Latham's "Clinical Medicine," and he marked a passage which contains the alpha and omega of clinical teaching, and with it I will conclude: "In entering this place," speaking of St. Bartholomew's Hospital, "even this vast hospital, where there is many a significant and many a wonderful thing, you shall take me along with you, and I will be your guide. But it is by your own eyes, and your ears and your own minds and (I may add) your own hearts that you must observe and learn and profit. I can only point to the objects and say little else than 'see here and see there.' "

—William Osler

The Natural Method of Teaching the Subject of Medicine, JAMA 36:1673–1679,1901

The goal of this book is to "be your guide" and say "see here and see there" as the reader becomes skilled in the techniques and analysis of clinical data. This third edition of Clinical Methods has undergone substantial revision based upon feedback from students and other users of the first two editions. These changes enhance the usefulness of the book and help us to achieve our goal of providing clinicians and students with the best current knowledge of the techniques of collecting and using clinical data.

The book is composed of seventeen sections. Each begins with a drawing by Leon Schlossberg of a great physician who made seminal contributions to the discipline covered. A biographical sketch by Charles Stewart Roberts delineates the contributions and gives insight into the character and personality of these eminent physicians.

The first section is the Introduction. Chapter 1, "The Origins of the History and Physical Examination", describes the historical evolution of clinical methods. The purpose is to give the reader insight into the rich heritage of clinical methods, to reinforce knowledge presented in the text, and to excite the desire to emulate. The remainder of the first section presents general techniques applicable to all aspects of the clinical examination: interviewing, the physical examination, approach to the laboratory, analyzing clinical data, and decision making.

The next fifteen sections are organized by body system. Each section contains clinical data items from the history, physical examination, and laboratory investigations that are generally included in a comprehensive patient evaluation. There are some exceptions: examination of the cerebrospinal fluid and determination of arterial blood gases are certainly not performed routinely. These selected nonroutine topics are performed with enough frequency to merit inclusion. Each section begins with an illustrated overview that encompasses the history and physical related to that body system. The instruments required and sequence of the examination are outlined. Data collection is presented in an integrated fashion so that a beginning student acquires a coherent picture of how to examine the particular organ system. Each chapter in this part of the book, with a few exceptions, contains four divisions:

• Definition: A succinct description of the information sought
• Technique: Explicit directions for collecting the data, often given in stepwise fashion
• Basic science: Relevant information is presented with emphasis on binding clinical and basic science together in a rational and intelligible fashion
• Clinical significance: The clinical implications of abnormal findings

The purpose is to provide the student and clinician with the techniques for examining each body system as well as an understanding of the underlying basic science and the clinical implications of abnormal data.

The final section deals with special patient groups: the young, the adolescent, the well adult, the elderly, the traveler, the infected patient, the difficult patient, and the patient from another culture.

The editors wish to thank Grover Hogan and the Department of Medical Illustration at the Woodruff Medical Center of Emory University School of Medicine, Mildred Perry and Linda Garr Markwell of the Health Sciences Center Library of Emory University, Nancy Megley of Butterworths, and our secretaries: Joann Holland, Marlis McDowell, Marian Thorpe, and Carol Miller. Their support, encouragement, and help made this book possible.

H. K. W.

W. D. H.

J. W. H.