In thinking about a contribution we could make to the modern practice of medicine that had not yet been achieved by others, we remembered what constituted the complete physician at the time of Sir William Osler: A working knowledge of multiple disciplines and of disease processes that affect many organ systems. This was perhaps even more important in that era of medicine when laboratory and imaging modalities were essentially nonexistent, forcing physicians to use their powers of history-taking, physical examination, keen observation, and even sense of smell to enable them to come to a correct diagnosis. Further, Osler's famous and oft-quoted comment, "To know syphilis is to know medicine," was especially meaningful at the time because of that particular disease's possible presentation in so many different organ systems. Osler clearly understood that a physician must know the manifestation of a systemic disease in every region of the body.

We have spent our respective careers caring for challenging patients and investigating diseases in the laboratory, as well as serving as teachers of young physicians and medical students. As a result, we can confirm that one must strive to enlarge the base of knowledge of one's own specialty to a broader knowledge of systemic diseases. Because of the enormous expansion of medical knowledge over the past several decades, it is natural to find comfort in a subspecialty area. However, it is still apparent that the very accomplished physician must know more than his or her own specialty area and be wellversed in multiple disciplines.

It is in this spirit we have assembled this textbook, Head and Neck Manifestations of Systemic Disease. We recognize that while we have made every effort to include common as well as somewhat esoteric entities that affect the head and neck, this list is not complete or exhaustive and is somewhat limited by what is practical and timely for the life of this textbook. We have selected disorders that a specialist or primary-care practitioner working in this area of the body should keep in mind when seeing an ailment or a complaint. We have divided this book into two sections. The first section, Systemic Disorders with Head and Neck Manifestations, includes chapters that deal with specific disease classifications: rheumatic diseases, infectious diseases, malignant diseases, and other systemic diseases. The second section, Differential Diagnosis and Treatment of Clinical Presentations in the Head and Neck, covers common signs and symptoms in the head and neck region and is intended to give a perspective of the differential diagnosis that would be compiled by an expert practicing in the field. In this way we have presented our topics both from a traditional didactic approach and a practical hands-on point of view.

We wish to thank the many individuals who have contributed their time, expertise, and energy to this effort. Additionally, we want to thank our students, who have taught us the value of our own knowledge and the need to keep current by prodding and questioning what we teach them. Finally, we wish to thank our mentors and professors, vi

Preface who imbued in us the intellectual curiosity and ethical responsibility to become well-rounded physicians. We both acknowledge that much of the joy we get from practicing our profession is enhanced by the interactions we have with our colleagues in sharing these difficult clinical problems and challenging patients.

Jeffrey P. Harris Michael H. Weisman

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