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

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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 - -

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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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Dr. Eugene Stead being one of the most efficient units. Although the war was a very unsettling expe- rience for the medical center, the postwar years were remarkable forthe expansion ofthe center's facilities and its recognition as one of the top academic institutions in the United States. The clinical departments at the Medical Center were launched into the forefront of ac- ademic medicine thanks to the active leader- ship of a younger generation of men who ar- rived at Duke some years after the establish- ment of Duke as a tertiary regional center. These men were relieved of the responsibility of establishing Duke's reputation as a referral center and could dedicate their time to the promotion of research and academic com- petitiveness within their departments. Dr. Eugene Stead was brought to Duke from Emory in 1947 to succeed Dr. Hanes after his sudden death in 1946. Dr. Stead is known for his tremendous working capacity and is responsi- ble for leading Duke into the arena of aca- demic excellence. His unyielding pursuit of ex- cellence, his dedication. and above all his love for medicine and patient care have won him a national reputation as one of the best clinicians of all times. The Department of Surgery was led for many years by Dr. Clarence Gardner who was among the first surgical residents trained at Duke by Dr. Hart. His contributions were sub- stantial and the surgery department soon rose to national recognition under his leadership. Dr. Gardner was also instrumental the founda- tion of the Durham Cerebral Palsy Hospital. The Department of Pediatrics was headed by Dr. Jerome Harris from 1954 to 1968. Psychiatry was headed by Dr. Richard Lyman from 1940 to 1951, then by Dr. Lowenbach until 1953 when Dr. Ewald Busse. who later became Dean, was invited from Colorado to occupy the chair. In 1937, Dr. Deryl Hart recruited a very talented young man trained at Harvard and Johns Hopkins as chairman of the department of neurosurgery: Dr. Barnes Woodhall. Dr. Woodhall had a remarkable ability as an organizer. After getting the neurosurgery de- partment on its feet, he became involved with the administrative aspects of the medical cen- ter where his foresight was considerable and his contributions many. Woodhall became the second Dean of the Medical School in 1960 after Davison's retirement and he held sequen- tially the offices of vice provost of health affairs, 1960-67, associate provost, 1967-68, and chancellor pro team from 1969-70. One time he remarked facetiously that it was always dif- ficult for him to keep the same job. Among his contributions are the construction of the Barnes Woodhall building lor Red Zonej connecting the Gerontology and Diagnostic and Treat- ment Building with the rest of the hospital, the implemention of the new curriculum, the long range plans for the expansion of the medical center including the Research Drive building, and the conceptualization of Duke Hospital North. During the mid-1960's a number of depart- mental chairmen reached retirement age, opening their positions to generation of men. Dr. David Sabiston, Jr., was invited from Johns Hopkins in 1964 to replace Dr. Clarence Gard- ner. Dr. James B. Wyngaarden replaced Dr. Stead in 1967, Dr. Roy T. Parker became chair- man of Obstetrics and Gynecology in 1964, and Dr. Samuel Katz of Pediatrics in 1968. Dr. Joseph A.C. Wadsworth was invited back to his alma mater in 1965 to replace Dr. William B. Anderson inthe Department of Ophthalmolo- gy. Dr. Wadsworth is well-known for his fine work in the field of ocular pathology and ocu- lar surgery. His presence at Duke culminated in the creation of the Duke Eye Center which stands out for its beauty and for its excellent delivery of patient care. Dr. William Anlyan, a thoracic surgeon by training, also became a member ofthe execu- tive committee formed by the younger faculty members of the 1960's. Dr. Anlyan was identi- fied early on by Dr. Woodhall for his brilliance and leadership capabilities. He was appointed Vice President of Health Affairs in 1969 when Woodhall became Chancellor of the University. Dr. William Anlyan desenfes credit for his active role in the promotion of academic excellence inthe institution and for his arduous and relentless participation in the planning and construction of Duke Hospital North. The late Dr. Thomas D. Kinney also came to Duke in 1960 to replace Dr. Wiley D. Forbus as chairman of the Department of Pathology. Dr. Kinney was well known to students for his love of teaching. His talents as an educator led to his appointment as Dean of the Medical and Allied Health Education Program. Dr. Kinney came from Case Western Reserve, an institu- tion unique at that time for departing from the traditional curriculum taught at Johns Hopkins. instead of having different departments teach the same subjects. Case Western organized its basic science material into organ systems. In this manner, the anatomy, physiology, and biochemistry of each organ could be taught in unison rather than independently and without cohesiveness. Dr. Kinney, together with Drs. Stead, Harris, Handler, and Sieker, was in- strumental in organizing and implementing the new Duke Curriculum, one of the major de- velopments within the medical school in the 1960s. ln its early years the Duke Curriculum allowed nearty half i46O!oJ of the students stud- ies to be in elective courses. Unfortunately, as medical knowledge burgeoned over the next three decades, the faculty instituted more re- quired time at the cost of the elective time. The zenith of this trend was reached in 1955 when, of the 5,148 teaching hours over the four years, only 17 were elective time! The chart below depicts this progression of declining elective time: YEAR PERCENTAGE OF PERCENTAGE OF HOURS IN HOURS IN REQUIRED COURSES ELECTIVE COURSES 1930 54 46 1935 72 28 1940 83 17 DI. BGFIIES Woodhall 14 13