Your Excellency, Mr. Chancellor, Ladies and Gentlemen:

I shall avoid a common practice of speakers, namely to begfn

so far away from the subject that their hearers, more newly captive

than captivated, sit in strained bewilderment, which the speaker misin-

terprets as interest, though actually they are wafting for some season-

able clue as to what he has chosen as the subject of his talk, I am go-

ing to talk of institutes in the field of medicine: not of thls Insti-

tute but rather more broadly and generically of medical institutes,

their nature, purposes, and component parts,

Having thus advised you of my direction and destination these

remarks will now admittedly begfn at some distance from the subject, the

better to locate it in the matrix of the facts that make the kind of

human associations we call uDu.tues, important now and for  the morrow


of Medicine.

By a notable if not, indeed, a very remarkable quality of hu-

man intelligence we are at times able to guess that some statement, is

probably important even when we cannot honestly say we fully understand

it. My younger years were studded with experiences of this sort, often

elusive, sometimes incomprehensible, but nearly always memorable. Con-

sequently I came to relish SwedenborgOs definition of revelation as

clouding over or obscuring of Divine Truthofv

to be dismissed with the easy apostrophe of 'sfmportant if true.'?

Such experiences were not

They

2

were more arresting than that, for they deserved the comment "important

if understandable

     Now among such revelations - in the Swedenborgian sense -

that I remember vividly was a remark made at Oxford to my chief Dr.

Richard M. Pearce.  I cannot trust my memory but 1 think it was

Sherrington who made it. It ran fn this wise: "After some hundreds of

years of experience we think we have learned here in Oxford how to

teach what is known. But now with the undenfable upsurge of scientific

research, we cannot continue to rely on the mere fact that we have learned

how to teach what is known. We must learn how to teach the best attitude

to what is not yet known.

we cannot escape this new challenge - nor do we want to."

This also may take centuries to acquire but

I knew at the time that that statement was important but I also

knew that it would take me time to understand it, It has, Even after

some thirty years I cannot be sure I understand all its implfcations.

For example, it is profitable to regard an institute in one of the clini-

7J-L

cal branches of medicine as the right way to teach the best attitude to

what is not yet known?

Is learning the rfght attitude to the unknown the

vital core of this new form of association we call an instftute? I thfik

it probably is.

But even more probable, I think it is wise to reflect

on what institutes are, suspending final decision until we see the matter


as a whole.

I wonder, for example, whether the research method will not

transform the structure, the methods and the purpose of all of university

education in, say, the next five decades. And what of secondary education?

Indeed will education as a whole not be profoundly changed?

Is an insti-

tute the forerunner and the prototype of higher education in the fu-bure?

3

For still another reason some increased reflection upon what

we call institutes may be needed today and fn the future.

institutions must reckon with two forces.

represents a sort of parallelogram of forces. One is the inherent in-

tent to supply stability of purpose and effort,  the other is to be

promptly and delicately responsive to changes in the environment and

even changes in objectives. The French economist Francis Delaisi had

an interesting interpretation of institutions:

was to supply the stability needed for long-term operations.

long-term operation of raising a family we have the institution of mar-

riage.

real property, land tenure etc., so that he who ploughs may reap. For

manufacture and commerce we have banks. For education we have schools

and universities.

with which institutions supply stability for human effort that he  came

to regard stability no longer as a mere characteristic of institutions

but rather as the essential purpose of instftutions - namely to provide
the stability that men and women of tenacious purpose require for bring-

ing long-term operations to a successful end,

All human

Their resulting conduct

their purpose, he held,

For the

For the raising of crops we have the various institutions of

Indeed Delaisi was so impressec? by the constancy

And yet we cannot safely exalt our need for stability and con-

tinuity to be the end-all and be-all. of an institution.   We must needs

adjust the institution to change - or see it perish of its own brittle-


ness.                                          It was Bertrand

Russell I belleve who suggested a new and impish form of conjugating vari-

ous verbs: "1 am firm, you are insistent, he is pigheaded" or "1 think,

you cerebrate, he theorizesrr or am open-minded, you are uncertain, he

.

Who can deny that stability can be pushed too far?

4

is positively schizofdOtf  Obviously even excellent resolves and poli-

cies can be pushed too far - there comes a time when it is reasonable

to dispense with reasons. Even certainty, stability and determination

have their proper limits.  As Oscar Wilde observed When you break the

little laws the big laws begin to operateQrv

And so with human institutions:

stability must reckon with

adjustability if we are to be concerned with survival.

stitutions, and a fortiori institutes, maintain a precarious balance

between opposing forces; tenacity in the face of adaptability, sta-

bility risking extinction in a world forever changing.

Nearly all in-

If the very survival of human associations depends upon the

skill with which they steer between the Scylla of senseless rigidity

and the Charybdis of unpredictably erratic changefulness, then what is

the wise cowse in these singularly changeful tfmes in which we live?

For clearly we live at a time when the circumstances of daily life are

changing more rapidly than they have ever changed fn man's experience.

As Elton Mayo insfsted ours is an adaptive not a traditional civiliza-

tion.  What tradition could we consult to guide our conduct in point of

atomic bombs, Jet planes, and television, antfbfotfcs, ACTH, artificial

insemination and even artificial rainstorm?

the Hippocratic Oath for the problems of birth control?

mention even of Preventive Medicine in that Oath.

What guidance is there in

There is no

      For these reasons and theilp cumulative impact on our tradi-

tional forms of living and working together, I would insist that we would

be wise to hold our medical institutes up to careful review - not because

I suspect there is something wrong about them, but because it Is so

5

important to know exactly what is right about them,  and thus what we


can count on.

sible about what you want most of all, because sooner or later you are

so likely to obtain it.

Goethe held that it is important to know as much as pos-

Medical institutes generically have for me two leading char-

acteristics, one that of a deliberate independent identity and the

other that of something initiated or originated for a new and specific

purpose. The words "task force1I connote an ad hoc specified focus of

attention and energy.

become a cliche', that an institute is an institutionalized task force.

Now the advantages of having a declared and recognized sepa-

One might say, if the new phrase has not already

rate status for an institute fi a university depend in large measure on
the way in which it articulates with other members of the body corporate.
I like my arms to have separate parts articulating with each other by

means of strong, supple and painless Joints, though of course complete

rigidity from shoulder to finger tips might appeal to the administra-

tive principles of uniformity, simplicfty of control and predictability

of behavior.

painlessly, freely and yet tightly works far more effectively than a

single rigid unit.  Everything depends on the quality of the joints.

By the same token the character of an institute's articulations with

other members of the university decides whether you will be partners in

a beautifully supple and adroit instrument, or contributors to acute

rheumatic inflammation or a chronic anchylosing arthropathy - in simpler

terms and fewer syllables - a flail instead of an arm.

Clearly an arm with several separate units articulating

There are other reasons for an institute to have recognizable

identity.

Separate status provides a focal point not only for the loyal

6

energies of its members but also for  the interest of its actual and

potential supporters. Human loyalty seeks vfsible, tangible objects

of manageable proportions .... need I expatiate on the theme of loyalty

to the clan of Scots descendants in Montreal?  Sir James Barrie acting

as toastmaster at a dinner in London on St. Andrew's Night opened with

the remark "1 have always thought that it was right and proper for the

Scots resident in London to assemble  at least once a year and examine

that grave question:  is there any defect in the Scot's character?If

Though apparently a purely rhetorical question it could perhaps have

well been answered by another question (for Charles Lamb says that a

Scotsman fflives fn a twilight of dubiety"), namely Ifis there not a

limit to the extent to which clannish loyalty can wisely goff?

Besides serving the purpose of stability and continuity both

of effort and of the best circumstances for effort,  an institute can

help to stimulate as well as to reassure its members. By the very

self-imposed circumscription of its size and ambit an institute can

provide an extraordinary aid to human effort and satisfaction - namely

the chance to be intimate with excellence. Whether we invoke memory,

or bear witness to our present and immediate experience, who of us

will set a trivial value upon intimacy with excellence?  If that in-

timacy be sacrificed, whether because of increased size or excessive

busyness, then the members of any institute can look at each other in

just if iable dismay.

Granted that an fistitute articulates smoothly and well with

other parts of the university and that its members are loyal and de-

voted, and that its size and activity actually permit, as well as

7

theoretically encourage, excellence to be attained and be felt,  there

is one more purpose an institute must serve,

differentiation of function and a division of labor amongst its mem-

bers, but there should be an air of expectancy among them:

not merely that each will do his expected task well but that in some

way not yet clear each will bring to the work of the institute some-

thing distinctly and peculiarly his own, and at his own good time will

add something unique to what may be expected of one in his position.

division of labor that is not accompanied by the enhancement of personal

dignity and individuality offers no permanent solution to the difficul-

ties of collaborative work. My phrase Pthe atmosphere of expectancy'

refers to the value of realizing that men can be more than the positions

they occupy, and that in medicine, as fn art, there remains for each of

us the problem of style. This shows in a comment I remember about Dr. Rea

here in McGI11.

But it was the                 That kfnd of comment is healthy

and it is bracing.  The members of Institutes cannot be wasting time when

they brood upon the problem of style - for both teaching and research are

ways of life.

Not only must there be a

expectancy

A

"It wasn't merely that he was a good teacher:

he was.

he taught and lived,"

The greatest and deepest need of a medical institute is to be

needed.

organization came quite sfmply from the fact that it met a cogent and

widely recognized need.  Indeed the kudos and honor of some emergency

organizations, once their task is done, becomes so extraordinary that

mere membership becomes a much sought after honor - in short the organi-

zation becomes honorific and no longer meets any need more urgent than

that of ambitfous vanity.

The hedfate and the long-remembered success of many an gd hoc

8

Now there are needs that are recognized and there are needs

         To create an institute to meet a need that is

that are unrecognized.

widely felt and already formulated requires no mean abilities:   to

institute an organization to meet a need not yet perceived by most

men calls for quite exceptional talents.  But the cardinal question

must always remain - is there a real need?  Furthermore there is a

delicate question nearly always of great practical importance,  the

question of timing, for it is quite possible to organize an institute

so long before the need it will meet is generally recognized that sup-

port for the institute cannot be found in time to save it.

As one who has had thirty years' experience, both direct and

vicarious, with widely different forms of financial support to insti-

tutes and departments of medicine and surgery and various special fields,

I believe that endowment - whether from government or private sources -

is the soundest way to secure optimum results when it is certain the

work to be done is needed. The steady confidence that is conferred by

endowment calls out from scientists honesty and steadfastness of purpose:

the hesitant uncertainty of short-term grants all but insults the Intel-

ligence if not the sincerity of the recipient and certainly makes a

mockery of long-term planning.

Indeed it cannot be news to some of you that a reaction has set in against

short-term grants.

They dissuade the more honest and circumspect young men from entering

investigative careers.

for two years may be needed for some urgent problem

income from that sum, $4,500, as dependable:

ment.

Experience is our teacher In this matter.

They have favored hasty work on trivial questions.

Though there are occasions when $50,000 a year

I would prefer the

that is my considered judg-

9

You will notice that till now I have not referred to the

leader of an institute but only to the members.

at 24 or even younger took command of whalfng ships as captains, have


gone.

years gave comparably early responsibility to young men in academic

life.  But as the preparatory stages become longer and the candidates

more numerous we may expect to see more rarely the load of leadership

of institutes falling on men when they are really young.  Perhaps the

only thing I find myself wanting to say to most new leaders of insti-

tutes is this:

pected. As a corrective you may do well to find someone not on the

payroll, a man of perfect discretion and considerable detachment with

whom you can discuss your problems with complete freedom and confidence.

Indeed there is some evidence suggesting that some of the most success-

ful leaders of medical institutes took counsel quietly and steadily with

one or two advisers.  Certainly Shon Flexner relied on William H. Welch

in that way.

Now the days when men

Perhags the earlier frontier universities of the past hundred

you'll find the task a little lonelier than you ex=

The best leaders of scientific institutes whom I have known

had only this in common:

out the organization,

an institute seemed to rewad so wide a variety of temperaments, capaci-

ties and characters.  There didnPt seem to be any one formula to explain

the leader's role.  At long last I came to see that what a leader trans-

mits is the quality and the variety of his values, for he is quick to

recognize and encourage in others those qualities, purposes and interests

that seem most significant to hh,

they made their values known and felt through-

I used to be puzzled that success as the head of

10

One other aspect of leadership in a scientific institute re-

lates to the number of men on its staff. If we are to take seriously

the opinion of students of admfnistration we should be critical of the

leader who has more than eight men reporting to him.

vary in point of the number of colleagues with whom they can work ef-

fectively, to whose work they can bring discriminatfng and helpful en-

couragement and criticism, and of whose lives they can be effectively

informed.  Eight may not always be the maximum, but of one thing I am


sure:

as the technology of travel and communication has become quick, cheap

and easy to initiate, No sooner did we put in fnter-office telephones

than staff lunch or tearooms became necessary.

the lymphatic system, the circulatory system and the nervous system

each devoted to some form of transport, communication and coordination,

we may well suspect that the factor to pay most attention to in deciding

the size of an institute fs not the possible work to be done,  nor the

number of possible subdepartments, nor the size of its budget,  nor the

number of candidates for staff positions, nor the size of similar in-

stitutions elsewhere, but somethfng more stark and searching - the

quality of communications between its members, their clhity, brevity,

completeness, promptness, and sincerity. That is what makes an Insti-

tute

Doubtless leaders

the capacity to work with others has not Increased as rapidly

When the body possesses

Directly related to the most desbable size of an institute

and also of capital importance to the future, stands the subject of re-

cruitment,

like now merely to submit for your consideration a new word and the

Rather than attempt to review many of its aspects I would

11

need I feel for it, The word is decruitment, Recruitment comes from

the French re-croitre to grow again.  It has not quite the same meaning

as increase but rather the idea of replacement of expected losses. But

in some of the best institutes IDve known nobody wants to leave.

is needed is a decruitment policy, as clear and automatic and impartial

as can be, with this new specific word decruitment as impersonal as a

uniform and without any overtones of disapproval, failure or disappoint-

ment.

after a stipulated period of two or perhaps four years and those that

are wanted back can be called back after a lapse of not less than a

year. Like retirement policies whose application becomes more invidious

with every fnfractfon, recruftment without my policy of decruitment

seems insincere. Indeed it seems ominous,, It suggests to me one of the

common characteristics of cancer cells - they lack self-control. So I

commend to you a new word - decruitment - to draw attention to what is

needed in place of the shoddy euphemism "he was let go," as though he

was straining at the leash and choking for departure - which he was not,

and everyone knew it,

What

The policy of decruitment means that all recruits ought to leave

We can have something cleaner than that,

Having referred to institutes in terms of their purposes and

the role of membership, leadership, size and ways of self-renewal, I

come to the sub6ject of trustees or other forms of control and supervision.

Here, too, rather than try to cover the subject, I would underscore one

aspect of trusteeship that deserves more attention than it seems to re-

ceive,  There are not enough Trustees who brood over the affairs of our

institutes.

do not have in m-fnd.

Now blooding as a word may connote to some of you meanhgs I

I do not mean by brooding fussy and officious

12

interference, nor gloomy preoccupation wfth problems that ?a" t he

briskly solved, nor plausible arguments that the ship is sinking and

should be scuttled in favor of some coracle made of balsa wood,, No,

By brooding I mean first a thorough working knowledge of the insti-


tute's affairs and then what Its problems are, what we  the unseen

needs it could be meeting, what is dubfous and what is certain in its

future, and especially whether in objective, as well as in performance,

the institute is striking the right balance be-bween stability and ad-

justability, between unflinching adherence to ex-lstfig purposes and a

suppleness of adaptation to a constantly chmging world of knowledge

and of need.

against what could be, the steady, quiet evaluation of the potentialf-

ties as well as the actualities of the institute. A good brooder is at

home in the subjunctive, in the language of" unreality, for the future

almost by definition is not yet real,

By brooding I mean the constant weighing of what &

Using such criteria we come to  face the undeniable fact that

the quality of trusteeship in ow institutes deserves itself some brood-

ing.

Too vague, perhaps, too general and too inclusive. So let me close in

a contrasting vein of specific, local and exclusively historical fact,

Indeed brooding has been the key in which this talk is written,

En but very few if any of the enterprises to which The Rocke-

feller Foundation has been privileged to contribute in the last twenty

years have the results equalled those you have created here in this

Neurologfcal Institute,

the Medical Sckaces Division of the Foundation has made since 1931

that I consider ideal fn purpose9 in performance, fi local response

If I weye asked to name a single grant that

13

and in national and international influence,  and In the character of

our relationships maintained from the very beginning, I would say

without a moment's hesitation the grant to the Neurological Institute

of McGill University.  But that is only one way and perhaps a trivial

one of expressing the admiration and the satisfaction The Rockefeller

Foundation has for what you have created here.

compliment I would offer you, not without some fear that it will fail

its target, in saying that in this Neurological Institute, the Staff,

the Chief and the Trustees are so beautifully fused Into one shining

amalgam that if I were to name one to thank I: would be naming you all

who have worked with him, for him and through him,  and if I were to

name all of you it would come to  the same thing - for you are all the

Neurological Institute of McGill University, each to the other, re-

sponsible, essential and inseparable.

More rare still is the

(signed) Alan Gregg