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Patients who attended the casualty department of the Middlesex Hospital during one week in 1973 were interviewed. A predominantly young and working population used the department. Relatively few patients lived close to the hospital but many worked nearby. One third of all attendances were by patients who had been asked to return by casualty doctors. About half the new patients came of their own accord; the next largest group had been sent directly from work by an employer or occupational health service. Half the patients came with injuries, many of them superficial, although there were also serious accident cases. One fifth of the patients had no general practitioner whom they could consult. Age and geographical mobility were related to whether or not patients were registered with a general practitioner. The main reasons for not consulting a general practitioner were that patients felt they needed hospital treatment or that it was more convenient to attend the casualty department. It is suggested that the view that casual attenders with relatively trivial complaints should be encouraged to go to a general practitioner is not always applicable since social as well as medical circumstances determine whether or not patients decide to visit casualty.