Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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quite astute. Davison had noted in the 1927 yellow pages that there were twice as many lawyers as physicians in Durham, so he obtained malpractice insurance even before the hospital opened. He was also adept at avoiding time-consuming impositions by the law. A pressing engagement once forced him to avoid a subpoena. After his secretary recog- nized that the deputy sheriff was delivering a subpoena, Davison escaped through an open window to elude the sheriff and catch his out- going flight. On July 1, 1930 the new building was com- pleted, and on Sunday, July 20, a very hot, humid summer day, the hospital was opened to the public. Davison reportedly lost 6 pounds and ruined a white linen suit showing visitors through the building and repairing over- loaded elevators. Davison set prices at S3 per day for ward beds, SA for semiprivates, and S5 to S9 for The Nearly Completed Duke Hospital lSouthJ privates. These prices did not include X-ray or lab charges. Outpatient clinics opened four and a half hours each day, blacks and whites having separate hours. Each patient was ex- pected to pay part of the projected expense ahead of time. Davison was faced with the problem of financing a medical faculty and medical school on a limited budget. His desire to place the faculty on a full-time salary could not be fulfilled. However, under the recommendation of Dr. Hanley Cushing from Harvard Medical School, he instituted a policy whereby faculty members received a part-time salary and the right to conduct a private practice and charge fees at Duke Hospital. This private practive was to be restricted to Duke Hospital so that the residents and students could benefit from the larger patient population. The depression of the 1930's made it difficult even for private patients to pay their fees. ln addition, the physicians at Duke were so in- volved with their research and the care of the ward patients that they were unable to main- tain the percentage of charges collected so as to make their practices rewarding. Also, without the benefits of clinical experience ac- quired over the years, the young clinicians found it necessary to consult with each other in difficult cases thereby complicating the prob- lem of distributing the receipts acquired from private patients. ln September of 1931, Deryl Hart proposed to the executive committee a solution to the problem. He proposed the crea- tion of a voluntary cooperative program to include all the members of the clinical staff. This organization was to insure the best possi- ble diagnosis and treatment for the patient through wide consultation and laboratory work up. The consultation fees, were low to encour- age the use of the consultation services by the primary physician. When the patient could pay 11

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f - '5 PfF .J w Dr. Wilburl C. Davison created as a perpetual foundation for the ben- efit of orphanages, hospitals, educational in- stitutions, and the Methodist Church. The en- dowment was valued at 40 million dollars with twenty percent to be set aside until another forty million accumulated. Trinity College was to receive thirty-two percent if and when its name was changed to Duke University. The endowment trustees were instructed to set aside six million dollars for the building of the new university. Thirty-two percent of the en- dowment was set aside forthe support of every hospital in the Carolinas not operated for pri- vate gain. Each hospital was allotted up to one dollar per day for every day of care given to a charity patient. This was a substantial donation considering that the average cost per hospital bed was three dollars per day in 1925. During the summer of 1925, James B. Duke suffered from a severe illness. He was di- agnosed as having pemicious anemia and died on October 10, 1925. ln his testament, Mr. Duke left 51,326 shares of preferred stock of the Aluminum Company of America for the con- struction ofa medical school. Dean William P. Few of Trinity College carefully searched for a Dean for the new medical school. After many months of scrutiny, he selected Wilburl Cornell Davison, then Assistant Dean of the Johns Hop- kins School of Medicine. Dean Davison, the son of a Methodist minis- ter, was bam in Michigan and educated at Princeton. While at Princeton, he was awarded a Rhodes scholarship and traveled to Oxford where he studied under Sir William Osler. Davi- son studied at some of the leading schools of Europe and during the war he volunteered to senfe with the French Army. Davison returned to 10 America in 1916 to join the senior class at Johns Hopkins where under the influence of John Howland he entered the field of Pediatrics. From 1919 to 1927, Davison held teaching and administrative positions in the Department of Pediatrics at Hopkins and after 1925 he was appointed assistant to the Dean. On his arrival to Duke, Davison was faced with the enormous task of building a medical school. He was in charge of designing a curric- ulum, gathering a faculty, and, to a large ex- tent, designing the building and organization of the entire medical complex. His dynamic character and work capacity were great assets in winning the support ofthe local and state medical community. Davison traveled around the state consulting friends and experts ofthe medical community onthe construction of the new hospital. He collected books and joumals for the library and, together with Dean Few, made plans for selecting the chairmen of the basic and clinical departments ofthe new medical school. Davison's first appointment was Harold L. Amoss, then Associate Professor of Medicine at Hopkins for Professor of Medicine. Julian Deryl Hart was recommended forthe professorship in surgery. Hart, a native of Georgia where he obtained his M.D., was in the eighth year of his residency at Hopkins at the time of his appoint- ment. Wiley D. Forbus, an Associate Professor in Pathology at Hopkins, was selected to head Pathology. Following these appointments the work load on Davison's shoulders eased somewhat and the team tumed to the task of equipping the new hospital. The department heads were given authority for final selection of their new staff. Since Amoss, Hart, and Forbus were still at Hopkins, they were able to serve as on the ground recruiters. Alfred R. Shands of Hopkins was appointed Attending Orthopedic Surgeon. Robert J. Reeves, instructor in Roent- genology, was chosen from the faculty at Co- lumbia. Francis H. Swett of Vanderbilt was selected as Professor of Anatomy: George S. Eadie of Hopkins as Professor of Physiology. Also from Hopkins came Instructor Roger D. Baker in Anatomy, Frederick Bernheim in Physi- ology, surgical resident Clarence E. Gardner, Jr., and Robert R. Jones, pathology resident. Bacteriologist David T. Smith, a Hopkins gradu- ate, became Duke's Professor in charge of bacteriology with a joint appointment as Associate Professor of Medicine. Bayard F. Carter, Professor of Obstetrics at the University of Virginia, was designated head of that de- partment. After the appointment of the new faculty members and the opening of the medical school, there was a power struggle between Dr. Harold Amoss and Dean Davison. Dr. Amoss was Davison's senior by about six years and the only member of the young faculty that held an appointment as Professor at Hopkins before coming to Duke. The power struggle ended in the joint submission of resignations by Dean Davison and Dr. Amoss to the Board of Trustees. The board accepted the latter's resignation and rejected the former's and Davison re- mained as Dean of the Medical School. ln legal matters, Dean Davison was also Dr. Deryl Hart in his Laboratory 3. x 'X 1- 4

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only part of his treatment charges, the doctors and hospital agreed to accept just their per- centage of the amount collected. Thus was created the Private Diagnostic Clinic and the separation ofthe billing and delivery of medi- cal care at Duke Hospital. Dr. Fredrick M. Hanes, Chairman ofthe Medi- cine Department, created the Department of lntemal Medicine Fund. Under this plan the entire department pooled income collected from private patients. Hanes, an independent- ly wealthy man, took no percentage for himself but all the other members annually received a percentage of the pool proportional to their contribution physician during the preceding year. This system allowed each member one month a year for study and one for vacation while rewarding personal industry at the same time. Eventually, this fund became the source of research money and the mechanism for guaranteeing a competitive minimum income to new faculty members. Today, the PDC has become the main source of money for expan- sion of the center's facilities. On October 2, 1930, 30 first year students and 18 third year students began their medical stud- ies at Duke. James B. Duke requested 'that great care be exercised in admitting as stu- dents only those whose previous record shows a character, determination, and application evincing a wholesome and real ambition for life. Dean Davison felt that the ideal medical student and physician should have all of the following virtues: honesty, intelligence, mem- ory, accuracy, application, intellectual curios- ity, charity, faith, humility, hope, compassion, and patience. He said the master word of medicine is work. He was not kidding. The students found the work hard and the standards high. After two quarters, almost half the first year class received strong warnings to improve. Most of the other first year class re- ceived mild wamings. One in four of those admitted for the first five freshman classes failed to finish the medical course at Duke, most because they were asked to withdraw by the faculty. Initially, a large majority of students were from the South, including many from small towns and rural areas. As the Duke's reputation grew, the proportion of rural students fell, until, in 19410, they made up only rm of the class. Over this same period, students had increased their premed education from two orthree years of college to the equivalent of a bachelors degree. At the same time the failure rate dropped significantly. Duke was the only school in the country tc require two years of lntemship before award- ing the M.D. degree. Seventeen others re- quired one year. Despite vigorous protests by the first graduating class in 1932, students were awarded only certificates on graduation day 12 to be exchanged for degrees after the two year requirement was completed. Hospital teaching was the first priority of the faculty of Duke during the thirties. They felt that this not only met Duke's responsibility for improv- ing medical care in the Carolinas, but also led to higher quality graduates by whom Duke would ultimately be judged. Learning by doing was the principle that united the curricu- lum. Just as important as the organization of the curriculum was the attitude and example of the faculty, which was almost without excep- tion biased towards specialization. Duke pro- fessors were all specialists, the house staff was mostly interested in specialty training, and Duke had only straight intemships. Davison, himself, noted that residents already in spe- cialty programs discouraged interns who showed an interest in general practice after lntemship. Residency programs were opening up all over the country, and it was well known that a specialist could look fonfvard to eaming more than a generalist, so the emphasis and orientation were toward specialization. Later on, another contributing factor to the increase in specialization by Duke graduates was the fact that a large proportion ofthe alumni were in the senfice during WWII. ln the military they noted that specialists received higher rank and pay, which tended to steer them in that direction. Thus it is no surprise that greater than 601, of the students entering Duke during the thirties eventually entered into the practice of a specialty. By 19410, Duke had grown in size and reputa- tion. The contributions received from private enterprises and research foundations helped expand the center's facilities and research laboratories. The clinical practices were very successful and the patient population con- tinued tc grow. Modem trends in delivery of medical care were adopted rapidly placing Duke Medical Center in the forefront of medi- cal science. However, the next few years were accompanied by the gloomy specter of war. ln 19411, the medical center was organized into the 65th General Hospital when the pros- pect of war was inevitable. Dr. Elbert L. Persons, Jr., Assistant Professor of Medicine was appointed unit director. Dr. Clarence Gardner, Jr., Professor of Surgery, became chief of the surgical senfice. Students took accelerated courses through the summers and the number of students in each class was increased. Many members of the house staft were forced to enlist, trimming hospital personnel to skeletal proportions. For example, Bemard Fetter, who was an intern in surgery, was forced to leave the center to join the armed forces After the war, he returned to Johns Hopkins where he completed his residency in Pathology. Follow- ing an appointment at Vanderbilt, Fetter was invited by Dr. Forbus to join the faculty of the Duke Pathology Department where he re- mains today as the most versatile surgical pathologist in the center and as an eloquent teacher. The 65th General Hospital was even- tually transported to England where it senfed with distinction and gained the reputation of Participants in the First Autopsy Per- formed at Duke Hospital 'l FJ- - N HN' , - .xgL..A...! 'g1- .1:f:.....Jtq-:r:,...- A.,--A th sh beds i 5.5, kevin. . ffabwfxhii Ctrwlmligfdp- 11-1 4 't':'- Ask, 'J' - K-MANLU .A Q 1.1 i X 3 - -