Within any health profession, we begin to examine a person, animal, community or ecosystem when we have some inkling that something might be amiss. Usually, someone comes to the practitioner with a complaint: the animal has diarrhoea, the person is having trouble breathing, the water smells funny, there are dead ducks along the shoreline. This is called the ‘presenting complaint’. Certain symptoms and signs characterize this complaint. Symptoms are what a person or animal feels (headaches, depression); signs are what can be measured (temperature, heart rate, dead bodies). We tend to think that a dysfunctional ecosystem might have signs but no symptoms; however, ecosystem ill-health may be manifest by symptoms in the people and animals living there. For instance, poet Leonard Cohen captured the feeling of dis-ease between external events and internal feelings in one of his songs when he said it ‘looks like freedom but it feels like death’. In general, presenting complaints have to do with symptoms, and practitioner responses have to do with signs. This book will tend to focus on signs, but the process we finally arrive at in Chapter 6 is designed to improve symptoms as well.

What are the clinical signs?

While those who are primarily concerned with environmental management might struggle with the need to find a coherent framework within which to define, evaluate and promote ‘progress’, we might ask why health practitioners need to be bothered with this.