The Role of NIMH,
The path of medical sociology was not a smooth and easy one.
—Robert H. Felix,
first director of NIMH
At midcentury, the institutions responsible for higher education in the United States were poised for a radical transformation. The changes that followed the war appear at first to pick up and continue the prewar trends, but they were both more fundamental and more diverse. For example, the scientific function of the medical school that Abraham Flexner had recommended in 1910 had been gradually realized during the next two decades. By 1930, as Stevens has so clearly documented, “the faculties in the best schools had become scientific investigators. ” 1 However, the role of such faculty investigators did not radically change during the thirties. Support for research projects occasionally received earmarked foundation grants, but “in large part, medical schools made no distinction between teaching and research. ” 2 Following the war, the research function became dominant, reflecting a structural change that altered the social environment of medical schools in a way that no one had predicted, not even the ubiquitous Flexner.
Most obvious was the replacement of private foundation grants by the federal government as the main outside source of research support, but the significance of the change went beyond that. The primary sources were the National Institutes of Health (NIH). Some trace the origins of NIH to 1887 when a laboratory for bacteriological studies was created within the PHS. However, the contemporary model began only in 1930, and it was not until a congressional act in 1937 that NIH developed “specialist research programs focused on specific conditions or diseases. ” 3 At first these were predominantly on-site research and training at the national capital, but gradually extramural research grants to individuals and institutions were added. The latter grew rapidly to change the balance between the medical school functions of teaching, research, and service. This process started during the war: “An accelerated, focused program of medical research, sponsored both by private organizations and by various governmental departments for wartime needs, led to separate accounting for research in the schools, and thus to a separation of the research function from the regular expected role of teaching. ” 4