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2015v1.0

Macleod’s

Clinical Examination

Content Strategist: Laurence Hunter

Content Development Specialist: Helen Leng

Project Manager: Anne Collett

Designer: Miles Hitchen

Illustration Manager: Karen Giacomucci

John Macleod (1915–2006)

John Macleod was appointed consultant physician at the Western General Hospital,

Edinburgh, in 1950. He had major interests in rheumatology and medical education.

Medical students who attended his clinical teaching sessions remember him as

an inspirational teacher with the ability to present complex problems with great

clarity. He was invariably courteous to his patients and students alike. He had an

uncanny knack of involving all students equally in clinical discussions and used

praise rather than criticism. He paid great attention to the value of history taking

and, from this, expected students to identify what particular aspects of the physical

examination should help to narrow the diagnostic options.

His consultant colleagues at the Western welcomed the opportunity of contributing

when he suggested writing a textbook on clinical examination. The book was first

published in 1964 and John Macleod edited seven editions. With characteristic

modesty he was very embarrassed when the eighth edition was renamed Macleod’s

Clinical Examination. This, however, was a small way of recognising his enormous

contribution to medical education.

He possessed the essential quality of a successful editor – the skill of changing

disparate contributions from individual contributors into a uniform style and format

without causing offence; everybody accepted his authority. He avoided being

dogmatic or condescending. He was generous in teaching others his editorial

skills and these attributes were recognised when he was invited to edit Davidson’s

Principles and Practice of Medicine.

Macleod’s Examination Clinical

Edited by

J Alastair Innes

BSc PhD FRCP(Ed)

Consultant Physician, Respiratory Unit, Western General

Hospital, Edinburgh; Honorary Reader in Respiratory Medicine,

University of Edinburgh, UK

Anna R Dover

PhD FRCP(Ed)

Consultant in Diabetes, Endocrinology and General Medicine,

Edinburgh Centre for Endocrinology and Diabetes, Royal

Infirmary of Edinburgh; Honorary Clinical Senior Lecturer,

University of Edinburgh, UK

Karen Fairhurst

PhD FRCGP

General Practitioner, Mackenzie Medical Centre, Edinburgh;

Clinical Senior Lecturer, Centre for Population Health Sciences,

University of Edinburgh, UK

Illustrations by Robert Britton and Ethan Danielson

14th Edition

Edinburgh London New York Oxford Philadelphia St Louis Sydney 2018

© 2018 Elsevier Ltd. 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. Details on how to seek permission, further information about the publisher’s permissions policies and

our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,

can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the publisher (other than

as may be noted herein).

The

publisher’s

policy is to use

paper manufactured

from sustainable forests

First edition 1964

Second edition 1967

Third edition 1973

Fourth edition 1976

Fifth edition 1979

Sixth edition 1983

Seventh edition 1986

Eighth edition 1990

Ninth edition 1995

Tenth edition 2000

Eleventh edition 2005

Twelfth edition 2009

Thirteenth edition 2013

Fourteenth edition 2018

ISBN 978-0-7020-6993-2

International ISBN 978-0-7020-6992-5

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any

information, methods, compounds or experiments described herein. Because of rapid advances in the medical

sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent

of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to

persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any

methods, products, instructions, or ideas contained in the material herein.

Printed in Europe

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contents