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An eighteenth century health care provider and medical entrepreneur.

A DECADE after H.R.6675 was enacted into law as the Social Security Act of 1965, the Congressional Committee on Ways and Means issued a report titled National Health Insurance Resource Book. On its first page appears the phrase "major characteristics of the American Health Industry."' On a subsequent page, having to do with the functions of "Health Care Personnel," there can be read "More specifically, these services include prevention, detection, treatment, rehabilitation, research, training, and capital investment in medical facilities."2 In short, the medical entrepreneur is, by federal fiat, a bona fide member of the heterogeneous family of "health care providers." It is axiomatic that the legal profession is uncomfortable in the absence of precedent. In this instance, the atavistic urge can be fully satisfied by considering the career of Joanna Stephens, health care provider and medical entrepreneur extraordinary of mid-18th century London. She was described by David Hartley (1705-1757), an early and loyal supporter, as " .... the Daughter of a Gentleman of a good Estate and Family in Berkshire. About twenty years ago she accidently met with a Receipt for the stone...."3 He then goes on to list the numerous ingredients of her cure for renal lithiasis and its effectiveness in his own case. In March of 1738 Hartley had published a report of nine "cures" and one autopsy of a patient with retained bladder stone.4 In the preface, he states: "My design in printing these Cases and Experiments is to engage the Public to purchase the Discovery of the Medicines from Mrs. Stephens. She offers this at £5,000 and is ready to submit the effects of the Medicines which she discovers, to any Examinations which Gentlemen of Worth and Skill shall propose...." Although he did not possess a medical degree, Hartley was a medical