This Month in Duke History

January 15, 1936

The early days of Duke Hospital saw rash of postoperative infections, some fatal, in patients with large, “clean” surgical wounds. Duke surgeons investigated this puzzling problem. Tests showed the cause of the infections to be staphylococcus aureus. They focused their investigation on how the bacteria got into the operating rooms, as all personnel followed prevailing aseptic procedures for themselves and the patient, as well as sterilization of all equipment used in operations. They found that surgical staff brought the bacteria into the operating room on body hair, particularly in the nose. The most careful scrubbing didn’t eliminate all the bacteria on a person’s body.

To combat the problem, Hart’s team turned to ultraviolet lights. They determined the exact power needed in UV lights to kill the bacteria in the operating field with the least risk for operating room personnel. Surgical staff, because they frequently worked under UV lights, had to wear protective clothing with visors to shield their eyes. The patients were safe as they were in the operating room only once.

Results were seen immediately. Patients experienced less post-operative pain, and, most important, infections fell from 33 percent to 3.8 percent, with no fatalities. Other hospitals following Hart’s lead experienced the same results. The cost for this improvement was minimal: UV lights sold for less than $10 each from retail outlets.

This research garnered national attention for the new Duke Hospital.

February 10, 1929

Dean Davison based his plan for faculty recruitment on the experience of three medical schools that had opened in the early twentieth century: Ford Hospital (1919), University of Rochester Medical School (1922) and Vanderbilt University School of Medicine (1925). These schools had recruited promising young men for their medical faculty, mostly from the Hopkins staff, rather than professionals already established in their field.

The idea was based on the experience of Hopkins, where an original faculty of young, able men was recruited to staff the hospital and medical school and quickly established Hopkins as the premier medical school in the nation. Medical schools such as Hopkins drew many students from the South, where there were few good medical schools. Davison recognized that these Hopkins-trained Southern doctors could be persuaded to return to their roots in the interest of contributing to Southern medical education.

The plan called for the selection of one faculty member at a time. Davison then consulted with the newest faculty member to select the next member. Thus, Davison and Amoss consulted to recruit Deryl Hart, MD, a native of Georgia, as professor and chairman of surgery. Then Davison, Amoss and Hart worked together to recruit Wiley Forbus, MD, a native of Mississippi, as professor and chairman of pathology, and so forth. The plan produced a young, energetic, able faculty who worked hard to make Duke University Hospital and School of Medicine the best institution of its kind in the South.

March 6, 1931

The Bulletin of the new Duke University School of Medicine included this statement: “All entering medical students are required to sign an Honor Code attesting to high ethical standards in school performance.”

Wilburt C. Davison, MD, then dean of the Duke University School of Medicine, instituted the honor system because he remembered what a difference it made when he first experienced it in 1909 while taking the Princeton entrance examination.

Proctors had monitored his classes in all previous examinations, and cheating was rampant. He was surprised at Princeton when the instructor in charge passed the tests out, explained the honor system to the students, told them to put their tests on the front desk by noon and left them alone. Students who had used “crib notes” in previous examinations, and who were prepared to use them there, didn’t do so when put on their honor.

Davison was favorably impressed by his observation. Twenty-two years later he put the students at Duke University School of Medicine on their honor for all schoolwork, counting on the ethics all physicians must have to keep their standards of behavior on a high plane.

April 13, 1950

The Duke Hospital Women’s Auxiliary (now known as the Duke Hospital Auxiliary) was created in the early 1930s and dissolved in 1947.

Just three years later, in April 1950, the Women’s Auxiliary of Duke Hospital was reorganized under the leadership of Harriet Carter and Gin Eagle, both wives of prominent doctors in the hospital. Although the women’s auxiliary was open to members of the community, a large percentage of the early gatherings consisted of faculty wives.

The auxiliary and its youth volunteers provided encouragement to Duke patients by aiding in navigating the hospital, pushing wheelchairs, writing letters dictated by patients, selling candy and goods from snack carts, and other activities. Some services started by the auxiliary, like occupational therapy, were eventually taken over by trained professionals.

The auxiliary also organized fundraisers, including a circus, to raise money for various hospital causes: medical school and nursing scholarships, the purchase of departmental equipment, aid to the chaplain service, building efforts and other necessities.

Since the 1950s, the auxiliary has grown in scope and influence. It has distributed a newspaper for Duke University Medical Center employees, given financial support for the construction of Duke Hospital North, and operated hospital gift shops.

Today the Duke Hospital Auxiliary and its junior volunteers manage three gift shops and a snack bar, staff roving book and shop carts, coordinate special projects, assist pediatric and emergency departments, and continue to raise funds to support special projects.

May 1948

In May 1948 two children were admitted to Duke Hospital within two days, one two and the other four years old. Each had eaten a full bottle of the newly developed St. Joseph’s flavored aspirin for children as if the pills were candy. Both died from aspirin poisoning, as did more than 400 children across the nation in two years.

Jay M. Arena, MD, professor of pediatrics at Duke and a relentless advocate for children, called Abe Plough, the president of Plough, Inc., makers of St. Joseph’s aspirin, to talk with him about the deaths he had just witnessed.

When Plough said that he had heard rumors that children had died from their product, Arena exploded into the phone that it wasn’t a rumor but a sad fact. Their flavored aspirin was a wonderful product, but it caused problems everywhere, and the answer might be as simple as developing safety closures for aspirin bottles.

Plough ordered his company to develop safety caps, which Arena tested with the families of his young patients in Durham. He recommended the one cap he believed was best, and Plough followed his advice.

Children’s deaths from aspirin poisoning fell immediately. Later Arena convinced Plough to lower the number of tablets in each bottle from 100 to 35 and to reduce the dose in each tablet down to 1 1/2 grains, making an entire bottle non-lethal for a child of two.

Their work led to Congress enacting laws in 1972 requiring that all medications be put in bottles with safety closures unless a consumer requested otherwise. The law also mandated that all household products be sold in containers with safety closures and proper labeling. Arena considered the legislation his most satisfying accomplishment.

June 8, 1932

The first graduating class came to Duke in 1930 as third-year transfer students. A distinguished member of the first class was Jay M. Arena, MD, who was appointed an associate in pediatrics at Duke in 1937. Arena became a well-known advocate for children, but was especially noted for his campaign to alert parents to the hazards of toxic household products. He set up the nation’s second poison control center in 1953 at Duke and was its director until 1979.

Under the direction of Wilburt C. Davison, MD, dean of the School of Medicine, and an excellent original faculty, the School of Medicine graduated top-notch young men and women. No less than 12 graduates from the first 10 classes were entrusted with faculty appointments in the rising new School of Medicine, with most remaining at Duke their entire careers.

July 21, 1930

Some medical experts questioned the wisdom of building a major medical center in Durham, North Carolina. They saw Durham as a small town amidst the sparsely populated hills of North Carolina, lacking the major population centers necessary to support such a large hospital.

Wilburt C. Davison, MD, then dean of the School of Medicine and Hospital, had answered that question for himself by mapping a circle with a 50-mile radius around Durham. Davison found that more than 500,000 people lived within that circle. He also realized that the roads linking Durham with nearby cities and towns were good roads, without the congestion of those in large urban centers.

Davison’s thinking was right on target. Seventeen patients were registered the first day; 12 were admitted to the hospital. The number of patients at the hospital rose steadily. After six weeks, more than 1,500 patients had registered at the hospital, 254 had been admitted, and 121 operations had been performed (of which 77 were major surgeries).

Duke University Hospital was up and running, on its way to fulfilling Duke University founder James B. Duke’s dream of being “the best medical center between Baltimore and New Orleans.”

August 5, 1933

Watts Hospital and Duke University Hospital sponsored the plan for the North Carolina Hospital Care Association, which was the first insurance group in the nation to successfully gain statewide acceptance, according to Wilburt C. Davison, MD, then dean of the Duke School of Medicine.

As medical science made great leaps in the identification and treatment of health problems, people sought the benefits of discoveries that decreased the crippling effects of disease and injury. As hospital use increased, the question of how people could meet the cost of medical care was becoming more important.

The Hospital Care Association’s plan helped participants pay for health costs by requiring them to make regular, fixed payments to a common fund. Members would apply for the cost of health care only as needed. Like modern insurance groups, the association supposed that a healthy population could sustain such a plan.

Three thousand North Carolina residents showed interest in the plan by enrolling that first year. The association’s membership increased to 22,500 by 1936, and it started earning a profit in 1940.

September 15, 1931

With the nation in the midst of the Great Depression, people in the rural South were hard-pressed to pay even the most basic living expenses. The medical profession was hit hard by these circumstances. When Duke Hospital opened in 1930, few Americans had health insurance to defray the cost of a visit to the doctor, and some were unable to pay anything for treatment.

Deryl Hart, MD, chairman of Surgery at Duke, was aware of patients’ financial situations. He proposed a partnership that would benefit both the patient and the physician: the Private Diagnostic Clinic.

In this plan, doctors worked together in clinics that had a central office. Here, office managers and secretaries could do time-consuming clerical work, thus freeing the doctors to see more patients. The PDC also employed lab technicians to perform technical work that could support many physicians at one time. When further expertise was needed, patients were referred to specialists in Duke Hospital who charged a percentage of the money collected from a patient rather than a set fee.

The PDC streamlined medical care for physicians and patients alike. The idea was not only popular at Duke, but replicated at hospitals across the nation that wanted to serve patients in an efficient, cost-effective way.

October 17, 1940

After World War II started in Europe, the Duke University School of Medicine faculty asked the Surgeon General of the Army to authorize a general hospital staffed with personnel from North Carolina. The 65th General Hospital, an affiliate of Duke University School of Medicine, was authorized two days later.

The directors of the program spent the next 20 months organizing the medical and surgical staffs for the unit. On July 3, 1942, the medical unit received orders to report to Fort Bragg, NC, for training in military procedures.

After 15 months of training, the unit members were transferred to Blackmoor Park, Malvern, Worcestershire, England. They arrived on October 20, 1943 and stayed nearly five months. On March 4, 1944, they were transferred to Redgrave Park, Botesdale, Suffolk in East Anglia, England, to the newly created general hospital that was to serve the 8th U.S. Air Force.

The airmen of the 8th Air Force made daily bombing runs over Germany, encountering anti-aircraft fire and German fighter planes. The planes that made it back to the unit often had wounded men needing immediate surgical and medical attention.

By the end of the war, the 65th General Hospital had treated more than 17,250 patients. For those admitted with fresh wounds, the mortality rate was very low, only 0.04 percent. For their excellent service, the 65th General Hospital received commendations from General Dwight D. Eisenhower, Supreme Allied Commander, and from other offices of the U.S. Army Air Force in the European Theater of Operations.

November 1960

A closed-circuit television teaching system with seven single-channel systems was first installed at Duke University in the Department of Anatomy and Physiology.

Joseph E. Markee and Sam A. Agnello planned the system and continued to work throughout the 1960s on the development of television as a medical tool for teaching and research.

By the end of 1961, a total of 42 teaching programs had been broadcast over television to a variety of students: first- and second-year medical students, physical therapy students, anatomy graduate students, and Duke University Hospital and Watts Hospital nursing students.

The programs included demonstrations of biological systems using cadavers and live subject motion studies. For Gross Anatomy demonstrations, one half of a class would work in a laboratory while the other half watched the activity on a screen in another room.

This television system allowed for greater flexibility in the classroom: professors could present materials to an entire class at one time by remotely projecting selected teaching slides, enlarge and examine prepared specimens, and use pre-recorded visual materials for student testing.

Duke continues to harness new technologies to improve health care education today, making extensive use of Internet-based teaching tools, patient simulators, and other technological marvels.

December 1944

Julian Ruffin, MD, and David Cayer, MD, both of Duke University School of Medicine, published a study on the effects of vitamins in humans at the request of the U.S. Army.

Following a month of testing on 200 students, Ruffin and Cayer issued a report in which they declared that they found no apparent difference in the health of students taking vitamins versus those taking placebos.

For years, the vitamin industry had advertised that vitamins give all people, deficient or not, a sense of well-being and greatly improve one’s ability to perform work. Vitamin advocates, concerned for their huge base of faithful customers, expressed outrage at Ruffin’s and Cayer’s report. One advocate claimed, “The tests were all wrong. The doctors, not the students, needed the vitamins,” declaring that he was going out to purchase a fresh supply of vitamins A, B, C, D, and E, adding for emphasis that he would like to try vitamins F, G, and H.

Ruffin and Cayer stood by their research. They stated: “As pointed out by the council on food and nutrition and on industrial health (of the AMA) there is at present no conclusive evidence to substantiate this point of view” that vitamins give improvement to the quality of life of users with no vitamin deficiencies.

Did this settle the argument concerning the need for vitamin supplements? Hardly! Today, 60 years later, consumers are bombarded with advertisements touting the positive effects of vitamin usage from an industry that provides a continuous supply of its products for the shelves of stores.