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Medical Subject Headings (MeSH):
Director of Medical Sciences, 1930-1945
Box Number: 30
Folder Number: 8
Memorandum to Mr. Fosdick re the MS
Scope of MS
Practically speaking the time and interersts of the Director of the MS are spent about half in the RF and about half divided
between the GEB and the CMB. Thus at the outset it might be said that there is a considerable demand on the time of the MS
officers (since Dr. Lambert is working also on GEB program) on other than RF work.
Broadly speaking the activities of the division are selection and administration of fellowships, selection of recipients for
grants in aid, study and preparation of general program and of the larger projects. This work is done partly at the office
in New York and partly through travel and visits to institutions and individuals. As a general impression I would be inclined
to think that the amount of time for preparation of plans and for study of the field is too small, being in considerable measure
stolen away by claims of old programs and a necessity for being reasonably polite and considerate of the interests of correspondents
and visitors at the office.
A major and minor program are now connected with Medical Sciences,
the major in psychiatry, the minor in the field of the teaching of public
health to medical students. Relatively little has been done in this second
field and it requires preliminary study and planning to a considerable degree
before it is wise to launch much in the way of an active program. In psychiatry
the order of procedure has been attendance first to the recruitment
of personnel through a fellowship program. This is reasonably well under way
in the U.S. and will be extended as occasion permits and as experience directs
us to other countries.
During the current year several appropriations have been made to strengthen the most promising university teaching centers.
This has been done on a 3-5 year basis but strengthening must become more permanent in order to be definitely
Grants in aid program in psychiatry is small in the absence of thoroughly competent investigators but would naturally become
more important an item as better trained personnel appears.
In my mind we have some extraordinary possibilities still to be developed notably in connection with more effective teaching
of psychiatry in the State insane asylums to the medical personnel of the asylum sytems, in the development of superior psychiatric
nursing, and in the liason between competent psychiatrists and men training for the professions of teacher, minister and lawyer.
It is probable also that the almost invaluable aide of the psychiatrist, now known as the psychiatric social worker, is a
field in which training can be made more effective.
I should feel it a sound and sensible criticism that inadequate attention thus far had been given to psychology, and it would
also be my hope that within the next two years some definite steps can be taken towards improving the status of psychiatry
as related to the general subject of criminology and legal medicine.
In general the proper order of events I should conceive to be the finding and training of personnel, sifting out of good workers
through experience obtained by grants in aid and with the combined knowledge that this gives, eventually the formulation of
plans involving larger sums of money and the proper organization and financing of permanent institutions.
Ideally the best procedure for Foundation officers is to have ample time to read, to discuss, to visit, and thus study the
possibilities in a given field of interest, this to be followed by further familiarity obtained through minor projects directly
or indirectly supported, and at a later time either upon our own initiative or on a justified request, prepare a project that
will have some appreciable and permanent influence in developing the subject. My criteria are: (1) the undisputed quality
a man or a man with competent assistants, (2) a workable idea, (3)
favorable circumstances and a likelihood of permanence, and (4) that the whole
project be something which the RF can do peculiarly well and which is not just as easily done by a legislature or a group
of private citizens or a single donor. In some circumstances I should place the idea first in importance but in this outline
I put the man of first importance since I think it is important to realize that though RF officers may have ideas, it is really
more important for them to find men who have ideas
since without an active and responsible agent even our own ideas will betray us. Furthermore it is wise in my opinion to follow
Rose's procedure of giving the credit to the other man.
I should like to point out that the termination of old program takes a great deal of time - it not only takes time before
4 or 5 or 10 year programs run out but it takes a great deal of time to talk with the recipients and arrange for a conference
and to have considered the treatment of the usual hopes that there will be a renewal or extension. In January, 1931, the Director
of the MS was responsible for 116 going projects. It is futile to assume that such commitments as the RF has entered into
can be ruthlessly eliminated without seriously qualifying the good name of the
Foundation. This is one reason why tempo must be slow. Another and very cogent reason is that we are in a position different
from the first officers of the Foundation in that their earlier years were not marked by the visits and letters of a public
well informed as to the nature of their probable interests. They consequently had time to study and inclination to discuss
workable programs and this time to study included time to travel and develop a scheme of procedure which was reasonably orderly
and consistent, This time is hard for their successors to find and consequently new cplans came on but slowly.
A third reason for having a slow and deliberate tempo is that permanent effects cannot be expected in several subjects, notably
psychiatry, since personnel not only has to be found - it has to be lost, i. e. some men must leave certain posts before change
can be expected in way of development.
There is no likelihood of any definite effect being obtained in a hurry in many of the scientific fields today. Familiarity,
confidence, tenacity of purpose, all require time, and sometimes the subject of investigation itself, e. g. eugenics, requires
the passage of time for its raw material to be gathered.
My experience indicates that programs in the RF tend to get small scrappy, numerous and diffuse to get into what Mrs. Wharton
aptly calls the "thick of thin things." I could believe it wise for us to work longer and fewer Subjects better selected
and costing more, and eventually meaning more. There is a steady temptation to go in for small financing for short periods
of time of projects which in the end are ephemeral and trivial. Not much of a case has to be made for a $2000 item and what
is more twenty such items take so much time that there is not the time to find the shoddy and unsubstantial in them. I should
feel it extremely wise for the Trustees to make an effort as early as possible to remove an effect which is pushing all of
the officers towards an numerous scrappy inconsequential undertakings, namely the limiting of obligations to one year which
so far as we
understand has not yet been removed frankly and fully.
I would also like to point out again a tendency against which it seems wise to make a steady effort, namely the provincial
outlook in contrast to a wide familiarity to officers of conditions throughout the world. Of the six officers, including
the president, the following I believe is true: Four have never been in South America, four have never been in the Orient,
six have never been in Australia, South Africa, India, and four have never lived outside the United States for more than a
year. This I believe has sequalae which must be garded against and a definite effort should be made to see that at every meeting
there is a criticism made if the program offered for trustee consideration has not a certain geographic balance.
I would give it as my personal impression that the tendency towards too rigid an interpretation of research and concentrated
programs has already been realized. I believe that in the long run research can be aided better through some attention to
teaching facilities than through ad hoc Simon pure research grants. One might as well insist that the tree has nothing to
do with the fruit as to say that assistance to the stability and healthiness of education has nothing to do with the quality
Furthermore the wisest and most effective support is given when there is no hurry, no over-reaching, no pressure for sudden
results, but a steady and intimate familiarity that enables plans to be matured at the right time.
It might be useful for the trustees to indicate that they expected definite warning from the officers when in the officers'
opinion the threshold of diminishing returns is reached in any given program since I believe such a threshold can be reached,
and I would point out that in both the field of psychiatry and public health it is not research alone which will leave a permanent
stamp but general husbanding, stimulation, protection, and support which will make the permanent difference which I understand
to be our best objective.
In the way of practical suggestions I should say that the fellowships should have more time spent on selection and less on
administration; that they should be in larger measure related to program, that grant in aid should either be decentralized
to the NRC or similar body or show a somewhat larger connection with program, that larger projects be put on the calendar
of possibillities as early as is financially wise and that where adequate case can be made, staff appointments be slightly
increased in number.