History‐taking and examination remain the essential tools of clinical examination. However, the environment in which medicine is practised continues to change, with advances in technology and an increasing evidence base to guide decision‐making. The eighth edition follows the format of previous editions of this book with two sections: Clinical Examination and Clinical Medicine. Each section has been updated to reflect the more objective methods of assessment that are now used and the increased evidence upon which clinical practice is based.

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Acknowledgements

We would like to thank Dr Francesca Crawley, Dr Ellie Gurnell, Dr Jane Sterling and Dr Mark Lillicrap for their contributions, help and advice during the preparation of the manuscript.

This book is intended primarily for the junior hospital doctor in the period between qualification and the examination for Membership of the Royal Colleges of Physicians. We think that it will also be helpful to final‐year medical students and to clinicians reading for higher specialist qualifications in surgery and anaesthetics.

The hospital doctor must not only acquire a large amount of factual information but also use it effectively in the clinical situation. The experienced physician has acquired some clinical perspective through practice: we hope that this book imparts some of this to the relatively inexperienced. The format and contents are designed for the examination candidate but the same approach to problems should help the hospital doctor in his everyday work.

The book as a whole is not suitable as a first reader for the undergraduate because it assumes much basic knowledge and considerable detailed information has had to be omitted. It is not intended to be a complete textbook of medicine and the information it contains must be supplemented by further reading. The contents are intended only as lecture notes and the margins of the pages are intentionally large so that the reader may easily add additional material of his own.

The book is divided into two parts: the clinical approach and essential background information. In the first part we have considered the situation which a candidate meets in the clinical part of an examination or a physician in the clinic. This part of the book thus resembles a manual on techniques of physical examination, though it is more specifically intended to help the candidate carry out an examiner’s request to perform a specific examination. It has been our experience in listening to candidates’ performances in examinations and hearing the examiner’s subsequent assessment that it is the failure of a candidate to examine cases systematically and his failure to behave as if he were used to doing this every day of his clinical life that leads to adverse comments.

In the second part of the book a summary of basic clinical facts is given in the conventional way. We have included most common diseases but not all, and we have tried to emphasise points which are under stressed in many textbooks. Accounts are given of many conditions which are relatively rare. It is necessary for the clinician to know about these and to be on the lookout for them both in the clinic and in examinations. Supplementary reading is essential to understand their basic pathology, but the information we give is probably all that need be remembered by the non‐specialist reader and will provide adequate working knowledge in a clinical situation. It should not be forgotten that some rare diseases are of great importance in practice because they are treatable or preventable, e.g. infective endocarditis, hepatolenticular degeneration, attacks of acute porphyria. Some conditions are important to examination candidates because patients are ambulant and appear commonly in examinations, e.g. neurosyphilis, syringomyelia, atrial and ventricular septal defects.

We have not attempted to cover the whole of medicine, but by cross‐referencing between the two sections of the book and giving information in summary form we have completely omitted few subjects. Some highly specialised fields such as the treatment of leukaemia were thought unsuitable for inclusion.

A short account of psychiatry is given in the section on neurology since many patients with mental illness attendgeneralclinicsandit ishopedthat readersmaybe warned of gaps in their knowledge of this important field. The section on dermatology is incomplete but should serve for quick revision of common skin disorders.

Wherever possible we have tried to indicate the relative frequency with which various conditions are likely to be seen in hospital practice in this country and have selected those clinical features which in our view are most commonly seen and where possible have listed them in order of importance. The frequency with which a disease is encountered by any individual physician will depend upon its prevalence in the district from which his cases are drawn and also on his known special interests. Nevertheless, rare conditions are rarely seen; at least in the clinic. Examinations, however, are a ‘special case’.

We have used many generally accepted abbreviations, e.g. ECG, ESR, and have included them in the index instead of supplying a glossary.

Despite our best efforts, some errors of fact may have been included. As with every book and authority, question and check everything – and please write to us if you wish.

We should like to thank all those who helped us with producing this book and, in particular, Sir Edward Wayne and Sir Graham Bull who have kindly allowed us to benefit from their extensive experience both in medicine and in examining for the Colleges of Physicians.