Foundations for Excellence: 75 Years of Duke Medicine (review)

This is a superb book for anyone interested in the development of medical schools, teaching hospitals, and academic medical centers. Understandably, it will particularly appeal to alumni and aficionados of Duke medicine, and to those who want to know more about the sometimes troubled relationship of a famous university with its renowned medical center. Ironically for a medical school and university hospital, it was tobacco—the longtime (though no longer) premier industry of the Durham region—that built Duke: the principal founder, James Buchanan Duke, was the exceedingly rich president of the American Tobacco Company. Duke University is the successor to Trinity College in Durham, North Carolina, which agreed to change its name when the Duke family offered to fund a university if the family name were given to the venture. A new campus, which was built in the English Tudor or Gothic style, included the original medical school and hospital buildings that, from the outside, look like a group of college dormitories.

Though the medical school and hospital only opened in 1930, they steadily became among the most respected medical institutions in the country. According to the much-touted ranking of research awards granted to medical schools by the National Institutes of Health, Duke stood fifth among 123 schools in 2005, bested only by institutions of significantly older vintage. How Duke reached its enviable standing is the story that Walter Campbell, an American historian with particular interest in business, technology, and race relations, comprehensively tells.

Among the topics that the author discusses: (1) The controversy produced by the conflicting visions of Wilbert Davison, the first dean, who favored the school's producing primary care physicians for North Carolina, and the medical scientists who emphasized specialty training and research. Davison's desire to become the university president aroused significant and eventually successful opposition from some of the leaders in the medical school. (2) The development and importance of the PDC, the Private Diagnostic Clinic, that senior doctors established and directed to manage the clinical faculty's private practices. Although the PDC has contributed millions of dollars to the improvement of patient-care facilities and the development of research at Duke, it has never been organizationally a part of the university. The author describes, enthusiastically and fully, the absorbing politics of the PDC versus the medical school and university. (3) The ups and downs of the academic departments at Duke, with particular attention to psychiatry. (4) The concern of some of the university leaders and faculty that the burgeoning medical enterprise would overwhelm Duke—a problem faced by other eminent institutions in which the medical school and hospital are regarded as more powerful and respected than the rest of the university. (5) The conflicts between faculty and administration at the university versus the directors of the Duke Endowment, the gift that established and sustained the modern university, at "30 Rock," the endowment's offices in Rockefeller Center in New York City.

Among Duke medicine's more controversial actions and customs that the author describes were its efforts to prevent the full realization of the medical school at the nearby University of North Carolina (UNC), and the significance of race. For decades, Duke wards were segregated. On the "colored" as well as the white wards, the only doctors and nurses were white. Black employees were restricted to menial tasks with limited opportunities for advancement. The hospital had no private accommodations for black patients who could pay for them. Duke did not admit its first black medical student until 1963; UNC had done so twelve years earlier.

The text proceeds smoothly until the final chapters, when rather lengthy quotations interrupt the flow of some of the narrative. The author devotes paragraphs to recording what his interviewees said, where a sentence or two, perhaps including a pithy quote summarizing what he was told, would have sufficed. This reservation, however, will not discourage readers from...