Armed with a knowledge of Russian and a medical degree, William Knaus accompanied an American exhibit on Outdoor Recreation on its lengthy Russian tour. As a result of firsthand travel to remote parts, as well as ongoing study, interviews, and negotiations for joint research ventures, Knaus is extraordinarily knowledgeable about medicine in the Soviet Union. Interspersed with background information, Party policies, and statistics, are eyewitness accounts of surgery, emergency services, life on the wards, prenatal care, and so on. The book opens with a real cliffhanger: the dramatic fight for life of a young American guide who underwent surgery for internal bleeding in Irkutsk (Siberia). In spite of repeated transfusions, his condition worsened. The story ends happily when the Russians, in an unprecedented gesture of compassion, allow a US Air Force plane to fly across Russia to evacuate the patient. Throughout the text Knaus conveys an openness and warmth that seem to have elicited a corresponding directness and empathy from those he interviewed. It may be well known that Russia produces an enormous number of doctors (many of whom are women vrachi--the lowest-ranking physicians), that medical care is free, and that all workers are entitled to 24 days of rest at workers' sanitoria. Behind the facts, however, Knaus points to the serious lack of new equipment, the limited choice and inadequate supplies of drugs, the often unsanitary working conditions and the just plain blunt needles and sticky rubber tubing that must be used and reused. Because conditions are harsh, stoicism is encouraged. Patients are scolded for moaning and groaning; some surgery employs only local anesthetics; childbirth is largely unmedicated; folk medicine continues to thrive. It is fascinating, also, to see how much of a culture can be gleaned from a medical perspective: one learns, for instance, that the average Soviet woman will have six abortions in her lifetime. On the good side are the caring doctors, the camaraderie between patients, some interesting and effective emergency services, some efficient specializations--e.g., hospitals where you go solely for appendectomies or gallstone surgery. Crisper editing, more frequent time-and-space references, and a clearer organization would have been helpful; but, as it stands, the book is an extremely vivid and valuable assemblage of observations and fact.