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337 Annals Am. Acad. Pol. & Soc. Sci. viii (1961)

handle is hein.cow/anamacp0337 and id is 1 raw text is: FOREWORD In the summer of 1822, Miss Virginia Randolph, a granddaughter of Thomas Jefferson, reassured her fianc6 on the state of her health in a letter reproduced by Professor Shryock in The Development of Modern Medicine:1 We have had a rather sick family lately . . . and I am on Dr. Watkins' list. He has bled me twice, and prescribed a course of calomel, which I am getting safely through ... and I expect soon to be perfectly restored. You must not expect that my health is worse than it frequently is in summer, but Dr. Watkins wishes to make a permanent cure at once of all my complaints. . . . I have no doubt but that his advice is most judicious... . Modern medical practitioners are less buoyant than the impetuous Dr. Watkins and do not pretend to cure all bodily complaints and certainly not at once. Contemporary students of the corpus civitatis are even less sanguine about the prospects for establishing immediate, enduring, and completely adequate social provisions for meeting the health needs of Americans. Slightly more than a decade has elapsed since THE ANNALS last devoted an entire issue to problems of social medicine, and a comparison of the present undertaking with the earlier volume reveals both gratifying progress and the multiplication of perplexities.2 On the positive side, the current symposium records the further development of an ingenious nationwide network of health services which are characterized by every variant of function, auspices, and mode of control and are sustained by complex patterns of governmental, voluntary, and private financing. This comprehensive and pluralistic system has been responsible in part for a further extension in the expectation of life, for substantial gains in the conquest of infectious diseases, for predicted imminent breakthroughs in research on mental health, cancer, and the cardiovascular system, and for expanded programs in preventive and rehabilitative medicine. But, paradoxically, the triumphs of medical knowledge and organization have generated their own continuing dilemmas for the American system of meeting health needs. Scientific discoveries and technological advance increase the quality of health services and simultaneously render them more expensive. At the same time, the need for highly skilled personnel grows apace, and these must be recruited and retained in the increasingly competitive post-Sputnik intellectual market. Ambitious programs of health education are instituted and the public responds by exerting even greater pressure on existing preventive, diagnostic, and treatment facilities. There occurs a remarkable diffusion in Blue Cross and other hospitaliza- tion plans, and the subscriber newly initiated into the relative luxury of semi- private accommodations learns to demand even better care and wider coverage. Dramatic reductions in the mortality rate are achieved at the younger age levels, 1Richard Harrison Shryock, The Development of Modern Medicine (New York: Alfred A. Knopf, 1947), p. 268. 2 Franz Goldmann and Hugh R. Leavell (eds.), Medical Care for Americans, THE ANNALS, Vol. 273 (January 1951). viii

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