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SCIENCE 



[Vol. LVI, No. 1441 



h'ated in connection with blood and with the 

 subject of the etiology of malignant growths. 

 In connection with anemias, for example, we 

 have had a complete survey of all the types of 

 blood-cells that appear in the circulation under 

 abnormal conditions, so that the hope of suc- 

 cess now lies in a very careful study of the 

 fundamental origin and relation of the types 

 of blood-cells in the hope of finding out how 

 to stimulate them differentially. If you will 

 permit me to speak for a moment of my own 

 work, it is now possible to cut out the blasto- 

 derm of a chick and watch it develop under 

 the microscope, in a hanging drop preparation. 

 In such a preparation, one can see the devel- 

 opment of the blood-cells in the embryonic 

 membranes of the living specimen. On the 

 second day of incubation only red cells arise 

 and they can be seen to come from the endo- 

 thelial walls of the blood-vessels. The white 

 cells on the other hand begin to appear on the 

 third day. They come in part from new cells 

 that differentiate directly from mesenchyme 

 without becoming a part of the lining of a 

 vessel. Moreover, the type of the white cor- 

 puscles that come from endothelium, namely, 

 the monocytes, have the same kind of phago- 

 cytic activity, with the storage of phagocytized 

 material, that characterizes the parent endo- 

 thelium. These observations seem to me to open 

 up anew the question of relationship of the 

 white cells of the blood, from the standpoint 

 of their classification on the basis of function. 

 In connection with the great subject of new 

 growths it is clear that we now await the dis- 

 covery of their fundamental cause and that 

 toward this discovery we need certain very fun- 

 damental biological studies in connection with 

 the reactions of cells to normal and abnormal 

 conditions; such as, for example, are involved 

 in the investigations of Loeb, Murphy and 

 others. 



Problems which can be solved by purely 

 clinical methods, or problems which need for 

 their completion the application of clinical 

 methods are not lacking. Indeed, their roots 

 cover the whole period of modem medicine. 

 In the full-time scheme, it is the argument 

 that these problems can be solved at enor- 

 mously greater ad^^antage by a gi-oup of men 



concentrating their interests on the study of 

 patients in hospitals rather than in private 

 practice. The idea involves changing the em- 

 phasis of the interests of the leaders of the 

 medical profession from the application of 

 knowledge to the cure of disease, to the study 

 of the problems of disease. It is, I believe, 

 clear that, in the development of medicine, 

 there is a very wide range of pi'oblems that 

 are immediately feasible, some of them to be 

 attacked in the laboratories of the pre-elLnical 

 sciences, some in the wards of hospitals, and 

 some by combinations of workers in laborato- 

 ries and in the clinics; but that all of them 

 wOl gain by being in the hands of those to 

 whom theu' solution is a major interest seems 

 absolutely certain. 



In the development of a group of scientific 

 workers in direct connection with clinics who 

 are actually engaged in applying the tech- 

 nique of ithe underlying sciences to clinical 

 problems, there have grown up two groups of 

 workers doing the same kind of work, one in 

 connection with the clinics and the other in 

 the pre-clinical departments. In this connec- 

 tion there have come discrepancies in salaries, 

 the workers on the clinical side receiving the 

 higher salary and ultimately the greater re- 

 ward. The student becomes interested in re- 

 search while still a student and finds that if 

 he joins a clinical staff and does the same type 

 of work that he might have done in a pre- 

 clinical laboratory he will gain more respect 

 from the university. Already there is begin- 

 ning to be some surprise that such a system 

 works against the fundamental sciences. It is 

 said frankly that a man who keeps in touch 

 with the clinical branches has a greater earn- 

 ing capacity in the community than the man 

 who severs his connection with practice , and 

 devotes himself to the fundamental sciences. 

 This in my judgment is a direct challenge to 

 the leaders of universities to renew their faith 

 in the kind of work for which universities exist. 

 They must remedy this condition before the 

 laboratories are depleted of their workers; 

 they must show clearly that in estimating the 

 use of a university they do not accept the 

 popular estimate of the value of the practice 

 of medicine over and above its study; and 



