The traditional teaching of clinical medicine by the
bedside, by lectures, tutorials and through textbooks is
mainly system- and disease-oriented. Diseases are presented
under their relevant system headings and all the
clinical manifestations, irrespective of their regional and
anatomical diversity, are presented under each disease.
This discipline of learning clinical medicine is contrary
to how it is practised in real life, where the history and
examination may have to be constructed on a single
symptom or an asymptomatic sign. The patient presents
with one or more symptoms and the examiner, during
history-taking and clinical examination, takes note of
various signs that are present and constructs a diagnosis
from these.
In this book I have endeavoured to mirror life and have
presented signs as they are likely to be seen on a visual
survey of a patient, starting at the face and moving down
step-by-step to the feet. A brief description of each disease
is given as the part of the body it affects is covered in
the sequence of the scalp-to-sole survey, and with each
mention of a condition a few more details are added. The
book explores the visual content of clinical medicine and
covers both pathognomonic and fundamental signs as well
as non-specific signs. These clinical features presented in
an anatomical context will, hopefully, offer an iterative
stimulus to the student's memory and thereby help the
retentive ability of the reader. Thus, this atlas presents the
synthesis of a clinical diagnosis from the features scattered
around the body and encourages the student to look for
these.
In this age of 'superspecialization', it is becoming
increasingly difficult for undergraduates as well as postgraduate
students anywhere in the world to see the full
spectrum of clinical signs. The increasing demands on the
clinical curriculum from the advancing old specialities and
emerging new ones have reduced the time available to students
to experience the full breadth of clinical medicine.
Today it is quite usual to find students graduating from
various medical schools in this and other countries with no
clinical instruction in, for example, dermatology, rheumatology
or neurology! This problem is compounded by the
fact that many diseases are often treated early, more effectively
and now, more often, in the community. There are
fewer opportunities for students to see the usual and less
common signs, and yet they are likely to be confronted
with these signs in examination and in their subsequent
clinical practice. In this book I have addressed this problem
by covering as much neurology, dermatology, rheumatology
and ophthalmology as may confront a hospital doctor
and a general practitioner. In addition to the colour pictures
of the clinical signs of each condition presented here,
anatomical sketches and line diagrams have been included,
wherever appropriate, both to improve the understanding
of clinical features and to cover some important, but nonvisual
signs.
This book presents a structured approach to clinical
diagnosis from a single sign, suggests other areas to look
at for relevant supplementary signs and, at appropriate
places, gives the critical 'chairside' tests to confirm a diagnosis.
This approach makes some repetition inevitable, but
this has been kept to a minimum and the clinical signs have
been cross-referenced for easy revision.
When I started work on the first edition of this book
my main objective was to present a pictorial guide for
the inspection part of the clinical assessment. Some of
my well-wisher colleagues had expressed understandable
doubt about the success of such a venture in an age
when technology makes it possible to see the condition of
almost any internal organ. Contemporary clinical practice
tends to suggest that the budding clinician of today
would much rather get an ultrasound of the abdomen
than spend time at looking at its external contours. I felt
that my modest effort would at least serve those students
whose self-esteem would not allow them to dispense with
what their eyes could do before calling technology to their
aid. It is pleasing to note that in the UK and USA 12,000
copies have been sold and the book was translated into
seven languages. Bedside medicine is not dead after all! I
am grateful to all those who have found this book of some
use and have encouraged me to produce the second
edition.
In introducing some embellishments I have taken advice
mainly from students who have generously given their
comments to me. In the first edition, I had omitted the
legends because I thought that students would have a
chance to make their own observations before reading the
text to look for the diagnosis. I am told that it would be
preferable to have the legends giving the telling feature of
each picture, and that it would also help students to apply
appropriate descriptive terms. In addition to providing the
legends, I have made some amendments and additions to
the text. I have withdrawn seven pictures that were either
repetitive or unsatisfactory, replaced eight others with
those with more expressive visual content, and introduced
39 pictures with additional signs. I hope the students will
find these changes useful.
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