ACE inhibitors are one of the most exciting and interesting of recent medical developments. They fit the patho-physiologica1 processes of cardiovascular disease with fascinating precision and are a constant stimulus to the acquisition of greater understanding of the mechanisms involved and of the mode of action of the drugs themselves. There is still much to be learned, especially about the wider effects of the drugs, their precise mode and site of action and about differences between the different preparations. ACE inhibitors are of proven benefit to patients with chronic congestive heart failure and are the latest in the series of drugs used in the treatment of hypertension. Interest in the treatment of hypertension has paralleled the development of hypotensive drugs and the realisation that long-term prognosis could be significantly improved. The treatment of hypertension has progressed in stages following the development of a succession of increasingly effective drugs, each allowing a greater proportion of patients to be treated with fewer and fewer side-effects. First, the ganglion-blocking agents such as hexamethonium and guan ethidine transformed the outlook for patients with malignant hypertension but proved too unpleasant for routine use in other forms of hypertension."

The original Beecham Manual for General Practice was produced by Dr Selwyn Carson, of Christchurch, New Zealand, whose objective was a set of instructions for patient care for his practice team. Beecham Research Laboratories published and distributed it. Dr Ed Gawthorn of Melbourne, Australia, edited an Australian version again published and distributed by Beecham Research Laboratories. We were invited to adapt the New Zealand and Australian editions for British readers -but we decided that we should produce an entirely new Manual. This was done and it was published and distributed to general practitioners by Beecham Research Laboratories. This latest edition has been revised and updated. The Manual is a ready reference on planned care of certain age groups and situations; specific procedures and emergencies; and clinical care in general practice of important conditions. We have intentionally adopted a concise didactic style that should be helpful for trainers, trainees and members of the practice team. We thank Beecham Research Laboratories, and especially Ed Stanford and Bill Burns, for their support and help over many years. John Fry (Editor) June 1982 viii Section A PLANNED CARE Family Planning A1 Discuss with the individual patient the advantages and disadvantages of all the methods. Keep in mind individual needs, wishes and religious beliefs. In Great Britain * 2.5 million women are registered with their G.P.'s for contraception. -100 per G.P. * 95% of G.P.'s provide contraceptive services.

ACE inhibitors are one of the most exciting and interesting of recent medical developments. They fit the patho-physiologica1 processes of cardiovascular disease with fascinating precision and are a constant stimulus to the acquisition of greater understanding of the mechanisms involved and of the mode of action of the drugs themselves. There is still much to be learned, especially about the wider effects of the drugs, their precise mode and site of action and about differences between the different preparations. ACE inhibitors are of proven benefit to patients with chronic congestive heart failure and are the latest in the series of drugs used in the treatment of hypertension. Interest in the treatment of hypertension has paralleled the development of hypotensive drugs and the realisation that long-term prognosis could be significantly improved. The treatment of hypertension has progressed in stages following the development of a succession of increasingly effective drugs, each allowing a greater proportion of patients to be treated with fewer and fewer side-effects. First, the ganglion-blocking agents such as hexamethonium and guan ethidine transformed the outlook for patients with malignant hypertension but proved too unpleasant for routine use in other forms of hypertension."

Although we have no good definition of 'health', all people have their own ideas of whether they are healthy or not. Based on personal experience and knowledge each person comes to accept that within themselves there is a normal range of feelings and performance, departure from which could be considered abnormal or unhealthy. Despite the many amazing technological advances made over recent decades it cannot be said that access to advanced medical care is the main determining factor in the healthiness or otherwise of a society. Even in these modern times most diseases and health problems are non-curable in the strict sense, and the scope for effective prevention of disease is more limited than some enthusiasts suggest. Individuals must appreciate the limitations of modern medical care and, while seeking to use the care available to best possible effect, accept that the responsibility for trying to prevent major disease rests in their own hands. In this book we have tried to present a balanced and realistic picture of the many factors that must be taken into account if optimum disease prevention and health maintenance are to be achieved. The health of your family is your responsibility. An understanding of what can go wrong, how it can be prevented or how it can best be coped with can only be helpful to you.

Cardiology embraces a number of different conditions and disease processes. Cardiovascular disease is now responsible for most of the deaths of adults, especially premature deaths, in the developed world. The development of effective preventive measures, new drugs and surgical techniques makes it increasingly important to recognise those at risk, to diagnose accurately those suffering from disease and to prescribe, monitor and refer appropriately. This book is intended to focus attention on the opportunities which family' practice provides for this and to look at the need for a change in emphasis in approaching the problems. The book is in five parts. Part 1 is a reminder of some of the basic principles, which are essential if sensible cardiology is to be practised. Part 2 is about cardiac drugs, their use, effectiveness and risks. Part 3 looks at the diagnostic process; it comprises the history, examination, investigation and referral of patients, who might have cardiac disease and also the drugs which are most likely to be used. Part 4 is devoted to specific conditions. In Part 5, we look at the need for prevention and consider how it may be tackled in general practice. This is not a comprehensive textbook of cardiology. It is not intended for students. It is hoped that it may be useful to experienced doctors, struggling to provide a sound, sensible service in an environment of ever expanding technology.

sehenden Forschungsansatz in der Allgemeinen Psychologie geworden ist. Einer Rekonstruktion des Assoziierens in Kate- gorien kognitiver Prozesse kommt deshalb Relevanz zu fur die Konzeptualisierung des Gedachtnisses und insbesondere dessen struktureller Grundlagen. Zum Aufbau des Buches Im ersten Kapitel wird ein kurzer Abriss der Assozia- tionspsychologie gegeben mit dem Ziel, daraus eine Systematik des Assoziationsbegriffs zu entwickeln und zugleich das Verhal tnis von Beschreibungs- und Erklarungsbegri ff zu kla- ren. Dabei werden das Konditionierungsexperiment und der Wortassoziationsversuch als experimentelle Paradigmata der Assoziationspsychologie dargestellt. In der Konfrontation zwischen dem bedeutendsten Vorlaufer einer assoziationisti- schen Theorie des Erinnerns, namlich Aristoteles, und den assoziationistischen Aspekten heutiger Modelle des Gedacht- nisses wird die Frage nach theoretischen Alternativen ent- wickel t. Teil I (Kap. 2-5) bietet zunachst einen UEberblick uber '. die wesen t lichen deskript i ven Be fU''Jlde zur W ortassoz ia t ion und neue Ergebnisse zur zeitlichen urid semantischen Gliederung des Verlaufs beim fortgesetzten freien Assoziieren. Das drit- te Kapitel gilt der Analyse der inhaltlichen Prinzipien, durch die der Verlauf des Assoziierens charakterisiert werden kann. Die freie Interpretation einzelner Verlaufe dient dabei als Ausgangspunkt fur die Gewinnung von Hypothesen, deren Prazisierung und UEberprufung in Kapitel 4 anhand von Struk- turanalysen aggregierter Asso z i a ion t sda te n er f 0 I g t. D abe i tritt vor allem der episodische Charakter assoziativer Orga- nisation zutage. Dieser Befund wird in Kapitel 5 weiter untermauert.