In making a program or programs for the European field in the Medical Sciences, I think there are some primary considerations which are worth elaboration in order to clarify my own point of view.  It is understood that such programs would in general lie within the field outlined in the considerations of January 1929 which were presented to the Trustees and which while reserving some freedom of action, laid emphasis, however, upon the importance of research work and acquiring new knowledge in the medical sciences.
It is desirable, I think, at the outset of any consideration of policies, to examine the role of the R.F. and the special qualifications which it may possess as an agency in furthering the discovery and application of new knowledge in the medical sciences.  What can we do that no one else can do?
What qualities has the R.F. which are not characteristic of governments, private universities, national societies, or individual philanthropists?  What among our qualifications are likely to be useful and therefore give us at least the possibility of making a contribution that may be both valuable and unique?
The intrinsic and essential qualifications of the R.F. are: first, that it disposes of large sums of money which can be both rapid and certainly mobilized or directed; secondly, the expenditure of its money is virtually under the control of technical advisers and administrators who are able to travel anywhere and who, thanks to a number of reasons, are practically assured now of favorable and intelligent cooperation in any part of the world; thirdly, the Foundation has a policy which is neither inflexible nor obligatory for an indefinite period of time.  The only stricture is in effect an extremely broad one since the policy of the R.F. at any given time is really an interpretation of an extremely broad and supple principle (i.e. welfare mankind throughout the world).  These, then seem to me to be the essential characteristics of the R.F.
In comparing the R.F. with other organizations one is immediately aware of the fact that the sums of money at the command of the R.F., although sometimes as large or larger than funds obtainable from governments for a certain object, are in fact subjected to a more intelligent examination and a control that is less partisan or regional in sympathy than is the case with the money spend by legislatures in most governments in the world.  For example, supposing that there is a question of support from a certain government for malaria control, it is unlikely that the legislatures are as well informed as the board of scientific directors of the I.H.D. and it is similarly unlikely that any special committee appointed by a legislature will have control over large sums of money with the same freedom as that which exists in the R.F.  To make another comparison the R.F. possesses greater elasticity in changing its policy than does a university or a special institution since universities or special institutes are usually confined by pre-determined obligations and definitions of their permanent and special interests.  If one compares the R.F. with the activities of an individual millionaire or philanthropist one is inclined to believe that the advantage possessed by the R.F. lies in the fact that its activities can be more sustained, better balanced and more thoroughly reasoned and advised than would be likely to be the case with an individual donor.  IT would be admitted by many also that the present position and past history of the R.F. is a distant advantage in comparison to the position that might be occupied by any individual new-comer in our fields of activity.  Perhaps the closest analogue to the R.F. is a national society or organization such as the National Research Council, the Kaiser-Wilhelm Gesellschaft, etc., but here a definite advantage is possessed by the R.F. in the fact that its interests and its work are not limited to any national boundaries.
The relation of the Foundation to the recipients of its gifts, though not unique, is nevertheless characterized by certain features which are worth keeping in mind.  First, it is certain that there is no other organization in the world with as wide an experience of public health work and medical education.  The singular feature of this experience is that a relatively small group of men has a familiarity with a very wide and varying range of conditions and tendencies.  Perhaps also it might be said that it is not merely the accumulation of information but also administrative experience in dealing with institutions and individuals in many parts of the world.  Secondly, the position of the R.F. is frequently considered to be impartial in the sense that its officers cannot possibly have become partisans in many of the quarrels and questions which in different parts of the world are sometimes submitted to us for opinion.  Thirdly, I have been impressed by the fact that occasionally aid from the Foundation, even if it be very small in amount, gives great moral support since it implies the approval of an impartial and experienced outside opinion.  In fourth place, the position of the Foundation is so completely independent that it is possible for it to add individuals and at the same time decline request from other people apparently in a similar position - a course of action often impossible for a government, a ministry, and national society or a university.
Reverting to the intrinsic qualifications of the Foundation it seems to me that it would be wise for us to take advantage of these qualifications which are unique - in a word to play our long suits.  These enable us to consider undertakings which are new; which are large; which require technical advice and intelligent administration; which are benefitted by the experience gleaned from many lands; which do not commit or involve the Foundation for an indefinite period of time.  It would seem to me to be logical to adopt toward our programs the attitude one must have towards  an experiment - namely, careful planning in advance; courage to take some risks; the decision to follow with great care and honesty the evidence provided by the experiment; definite and clear-cut provision must be made for its termination.
I have stated that these special qualifications of the Foundation since to fail to bear them in mind would be to expose ourselves to drifting into the acceptance of innumerable demands which could be just as well met by governments, universities, national societies, special institutes or private individuals.  It seems to me that the characteristics the Foundation fit it therefore for activating and giving initial support to developments that give reason for us to expect that they will later be self-regulating, self-supporting and of continued value.  We can undertake experiments on a scale larger than can usually be afforded.  We can co-ordinate and converge effort and experience in many parts of the world of mutually useful fields of activity, and thanks to our carter we can avoid a permanent immobilization of our resources or fixation of policy in any one field.
Now, the defects of these qualities, especially perhaps for Americans, seem to me to be the temptation to expand our field of effort too greatly; to undertake certain enterprises without sufficient study and reflection; to be too readily off with the old love and on with a new; to assume initial responsibilities in a tentative program without clear-cut ideas as to how it is to end and when or how our obligations are to terminate; and lastly, to be so occupied with the study and consideration of new undertakings that our observation of current programs is inaccurate or inadequate.  Freedom to take up new activities means nothing more than danger unless we take time to study and reflect upon them.  The power conferred by a large income means nothing good unless a proportionate amount and quality of thought is possible.  Now, pressure of correspondence, of small details, of many visitors and, not least, of frequent field trips in which almost every minute is taken, reduces to a very great extent the opportunities for solid reading, careful discussion and reasoned reflection upon the validity and usefulness of our activities, and their adaption to the various conditions we meet.  Seven years experience has proved to me that we are constantly in danger of being in the thick of thin things - thin not in amount but in quantity and significance.