September 2, 1921] 



SCIENCE 



isr 



wMcli imparts strength to all things and brings 

 them to maturity. 



But we need not concern ourselves unduly 

 about the extent and character of the 

 soil. Every year brings into medicine thou- 

 sands of young men — " good ground " capable 

 of bringing forth fruit, " some thirty, some 

 sixty and some an hundred fold." To be sure, 

 Vfe must participate in the cultivation of the 

 soil, but to the planting of the seed in the 

 ground at the proper season we must first di- 

 rect our efforts. 



The present season is unusually favorable. 

 Formerly much of the sowing and early culti- 

 vation among Americans was done abroad. 

 Since this is no longer possible, the responsi- 

 bility is clearly ours. ITever in the history 

 of American medicine has the responsibility 

 been heavier, the opportunity greater. Seed 

 time in medical life rarely lasts more than ten 

 years. It is represented by years in the med- 

 ical school and those immediately following 

 graduation. In the undergraduate years, in- 

 tensive cultivation, as a rule, preempts the 

 field and permits sowing and cultivation, but 

 rarely harvesting. Unless fruit is brought 

 forth within five years of graduation it is 

 rarely forthcoming. In this crucial period of 

 growth there are in this country at the pres- 

 ent time probably a thousand young men 

 properly seeded, but in need of cultivation. In 

 this period environment is all important and 

 includes subsidiary factors necessary to pro- 

 duction, such as time, space, facilities for 

 work, inspiration, guidance, criticism, advice, 

 and access to literature. Growth at this pe- 

 riod is, as a rule, not sufficiently advanced to 

 permit the investigator to control these fac- 

 tors personally. The responsibility rests, 

 therefore, upon the sowers. 



Some of these factors are supplied by the 

 creation of the so-called " atmosphere." Our 

 greatest need in medicine is institutions with 

 atmosphere. All of us who have worked in 

 certain medical centers have recognized the 

 existence of atmosphere and have felt its in- 

 fluence. It results from the reciprocal stimu- 

 lation of many capable workers in diversified 

 fields. It constitutes, as it were, a high tension 



center capable of furnishing inspiration to 

 many. 



The Cultivation of the Spirit — Work. — 

 Osier's masterword in medicine is also the 

 masterword in investigation. Every member 

 of this society should possess the spirit, and 

 is pledged to its diffusion. This means always 

 more work. American medicine looks to the 

 members of this organization for leadership in 

 clinical investigation. It is self-evident that 

 real leadership can not be exercised with work 

 that is finished. Only he who continues to 

 work continues to lead. 



Great efforts have been put forth in this 

 country during the last decade to do away 

 with the old system whereby the energies of 

 so many clinical investigators of merit are 

 diverted into other fields. A man capable of 

 high-grade investigation should not be con- 

 verted into a routine teacher, administrator, 

 or practitioner solely. For it can not be too 

 strongly emphasized that capable investigators 

 are more rare than good administrators, and a 

 first class teacher must be an investigator. 



The medical way is but a succession of de- 

 cisions. The successful investigator faces con- 

 tinuously the situation described by William 

 James. In one of his letters he says, 



I stand at the place where the road forks. One 

 branch leads to material comfort, the flesh pots, but 

 it seems a kind of selling of one's soul; the other 

 to mental dignity and independanee, combined, 

 however, with physical penury. On one side is 

 science, on the other business. 



The further the medical road is successfully 

 travelled, the more enticing are the by-paths 

 leading from investigation, and they need not 

 all be paved with gold. The sign posts carry 

 such inscriptions as " deanship," " professor," 

 " director," or " chief." These signs on the 

 medical way are dangerous, and ofttimes de- 

 ceive the very elect, especially if the elect be 

 hampered with physical penury or blessed with 

 a large family. Despite position failure to 

 continue to investigate leads to loss of those 

 attributes necessary for leadership. Neither 

 position nor worldly possessions should insure 

 leadership in medicine. Work is the master- 

 word, work in the class-room, laboratory. 



