February 10, 1922] 



SCIENCE 



143' 



ever have been any less, under the influence 

 of the incentives which spur on human beings 

 in general to give of the best that is in them. 

 These incentives are the opportunity for 

 achievement — achievement of worldly goods, 

 achievement of position or achievement of 

 fame. Under any circumstances there must 

 be provided for men entering scientific careers 

 an opportunity to gain by their own efforts 

 the prerogatives and comforts which now can 

 be acquired in other walks of life by any one 

 of similar attainments who meets with a fair 

 degree of success. Position in the scientific 

 world can be attained only through scientific 

 accomplishment and, innate ability aside, its 

 attainment depends in large degree upon the 

 provision of certain conditions, amongst which 

 may be mentioned freedom of action, oppor- 

 tunities for research and often a certain, though 

 not excessive, contact with students. It may 

 not be superfluous to state that medical scien- 

 tists have been known to decline at great finan- 

 cial sacrifice proffers from institutions of ex- 

 cellent repute but which were not in a posi- 

 tion to supply the last only of the conditions 

 just outlined. It can not be denied, however, 

 that the financial incentive seems to be gain- 

 ing in importance. And the reason seems to 

 be that in times like the present, when funda- 

 mental discoveries are rather infrequently made 

 and scientific achievement therefore is relatively 

 slow, the hope of gaining distinction as an in- 

 vestigator alone is not sufficiently strong to 

 induce assistants to put up with "the depriva- 

 tions attendant on a scientific career." It is 

 as true now as when Cannon stated it in 1911, 

 that "the satisfactions of a life devoted to in- 

 vestigation like the satisfactions of other 

 careers, arise from a profitable use of one's 

 powers." 



The recent movement to increase the sup- 

 port of clinical departments which in some 

 places includes putting them on a full uni- 

 versity basis, has had the effect of adding stUl 

 further to the difficulty of the preclinical de- 

 partments in securing assistants. In the 

 physiological, the chemical and the biological 

 divisions of the clinics men who desire them 

 are given opportunities to devote themselves 



to any branch of medical science and at salaries 

 usually in excess of those paid preclinical in- 

 vestigators in the same stage of advancement. 

 These posts do not, as do the preclinical posts, 

 preclude contact with clinical medicine; it 

 therefore happens that incumbents in the form- 

 er may at one and the same time, fit them- 

 selves for university careers or to step out into 

 practice. It is obvious under these circumstanc- 

 es that such departments rather than the pre- 

 clinical departments will have first choice of 

 any such men as may wish to devote themselves 

 to experimental medicine. The so-called full 

 time movement unquestionably is a step in the 

 right direction. But unless the disparity in 

 compensation be removed, and unless, in gen- 

 eral, appointments to the science posts in the 

 clinical departments be conditioned, as they 

 logically should, upon an apprenticeship in 

 the preclinical department of the subject which 

 later is to have the candidate's attention in 

 the clinic, the fundamental departments will 

 be ruined and will drag down clinical science 

 with them. 



This brings us to the last of the difficulties 

 we desire to discuss which stand in the way 

 of a healthy development of medical science 

 in the United States. It is obvious that in so 

 far as departments are inadequately provided 

 for and that in so far as able men cannot be 

 induced to take up preclinical science as a 

 career, these conditions in turn will stand in 

 the way of securing strong men. "If a depart- 

 ment has a professor, an assistant professor 

 and several instructors who are well trained, 

 active investigators, they by contact with the 

 students are able to interest them in investi- 

 gation and thus increase their chances of be- 

 coming permanently attached to investigation 

 as a pursuit. Just because we have an in- 

 adequate or ill qualified personnel we continue 

 to have such a personnel." 



It seems clear then that the United States 

 is not accomplishing all that it should toward 

 the advancement of medical science; that in 

 part this is due to the absence of that com- 

 plete fusion of hospital with the research lab- 

 oratory, that permits the free transfer of prob- 

 lems from laboratory to hospital and from 



