BRITISH MEDICAL JOURNAL 14 AUGUST 1971 437 BOOK REVIEWS Quantitating the Agents Principles of Measurement for An esthetists. M. K. Sykes, F.F.A. R.C.S., and M. D. Vickers, F.F.A. R.C.S. (Pp. 316; £3-75.) Blackwell. 1970. Anaesthetists have for long been ardent missionaries of quantitation in both observing and controlling the physiological effects and the handling of the gases, vapours, and other substances used in anaesthesia. Today a wide range of monitoring instruments are an everyday part of practical anaesthesia. Many of the physiological ones have jumped the fence into other fields of medicine in which those principles of care which have evolved from anaesthesia are in use. A book of this sort written at the right level of comprehension has been needed for a long time by clinicians, to say nothing of their colleagues in the research laboratory. The authors set themselves the objective of describing the basic principles of measurement both general and specific in not too difficult language, and in not too great detail. In their preface they claim that the reader needs nothing beyond the rudiments of First M.B. physics and "O" level mathematics. Their own schools must have been centres of excellence in these respects, for the reader is likely to need rather a bit more of these subjects than he had when he started medicine. In the first part of the book they deal with the general principles of measurement, and discuss units, basic electricity, and electronics, and sufficient about recorders and computers for the anaesthetist to understand their practical applications. Part II deals with the particular measurements which anaesthetists may want to make in clinical practice. Here a wide range of topics is covered including such things as the measurement of pressure and flow, gas tensions and pH, and temperature. It is in the last part dealing with statistics that the authors' enthusiasm may have run away with their judgment. For a few pages the reader with his "O" level maths stays with them, but after that he may well lose himself among the "one and two tailed" tests of significance, and the calculation of regression lines. The authors have tried their best to explain in simple terms quite a substantial area of modem statistics-but can it be done in 50 pages? Altogether this is a first rate book for examination candidates and consultants alike. It is clearly written, well illustrated, and up-to-date, and is thoroughly recommended. It is certain to be an immediate success. The publisher deserves a good mark for asking so modest a price for such a well-produced volume. W. W. MUSHIN Clinical Information on Immunoglobulins Immunoglobulins. Ed. Ezio Merler. (Pp. 404; way and J. L. Fahey there is a large section, $9.50.) National Academy of Sciences. 1970. approximately one-third of the book, on immunoglobulin classes. Contributors to this The rate at which information is exchanged section include H. G. Kunkel, K. Ishizaka, between research laboratories and the clinical and J. F. Heremans. There is then a small fields is frequently a source of concern. In useful section on both how to avoid and the late 1960's it was apparent that much how to produce fragmentation of immunoof the work on the function and use of globulins. Immunoglobulin deficiency states immunoglobulins was being done mainly in and their treatment are dealt with by R. A. the basic research fields. The U.S. National Good, J. F. Soothill, and H. H. Fudenberg. Research Council felt there was a need to' Another large section follows on the uses of disseminate information and organized a immunoglobulin in prevention and therapy conference, held at Columbus, Ohio, at of hepatitis, rhesus iso-immunization, malaria, which these aspects would be reviewed. This and virus-induced disease. H. F. Deutsch book is the record of that conference and opens the final important section on the covers the field weLL preparation of immunoglobulin fractions and After introductory reviews by C. A. Jane- their standardization. As a matter of policy it was decided not to include immunochemistry of immunoglobulins or aspects of cellular immunity at this conference. Some published records of conferences merely consist of papers unrelated in content or style. This book differs in that it is readable and has a sense of continuity which in part is due to the fact that text has been kept free from masses of experimental data. The biological uses of immunoglobulins are well reviewed and the contributors succeed in their objective, which was to present a clear broad view of their own particular field. This book will be of value to anyone in, or allied to, clinical subjects, and useful to those interested in immunology. JOHN BRADLEY Doctor-patient Relations Visits to Doctors. K. J. Mann, M.D., Jack H. Medalie, M.P.H., Elinor Lieber, D.P.H., J. J. Groen, M.D., and Louis Gutman, Ph.D. (Pp. 335; Price not given.) Jerusalem Academic Press. 1970. How often do patients consult their doctors, and why? We know that some who are ill don't, and others who aren't do, but what factors other than overt disease determine doctor-patient contacts? This study, based on the records of the Kiryat Hayovel Health Centre in Israel, which serves an immigrant population, answers these and many other questions. The Israeli Health Service is based on the same concepts of personal and continuing family care as our own N.H.S., and the fascinating mass of information about patients it records will interest most British doctors. There is not, it appears, a group of permanently doctor-prone patients. Every year some people consult their doctors very frequently, but they do it for a few successive years only and then become average attenders. Frequent consultations are related to such factors as many young children, fear of pregnancy, and social maladjustment, and less support is needed as family circumstances change. Emotional problems exemplified this. European-born adult immigrants started with much higher consulting rates than Afro-Asians, but the rate fell steadily for the younger ones and rose for the older, a direct reflexion of their differing ability to adjust to a new environment. Disturbed family relationships led, as one would expect, to increased consultations for children, notably for child-rearing and behaviour prob- lems, but even for infectious fevers and other minor maladies. The range of medical care, preventive, supportive, and curative this health centre provides is a model of teamwork-a remarkable feat in a unit starting from scratch in a socially and nationally diverse immigrant area. Only in education were opportunities missed, but through no fault of the authors. The Hadassar Medical School, apparently quite unaware that traditional hospital-based curricula provide inadequate training for doctors working in community based health services, would not accept the health centre as a suitable place for teaching medical students. ANDREW SMITH