This book has been written so that those concerned with service or with research or with education may perceive the stream of events pursuing different courses, accelerating in pace or seeming to stand still as it is acted upon by various internal and external factors. The realization for all readers should be that we have a medical establishment which has had a Topsy-like growth to tremendous size and complexity, which is characterized by ideas and plans that were born before their time, by clashes between vested and perceived interests resulting in expediencies and compromises that have constituted obstacles to progress lasting years on end, and by failure to recognize that what may be considered progress in one area can cause almost insoluble problems in another.