On one of my return visits to duke I made sure that a nice room would be assigned to me in a well-ventilated and quiet area of the residents’ quarters. This was quite an improvement over the internship year. I also found that while I was at Yale, the house staff at Duke had rebelled against the twenty-four-hour oncall schedule patterned on the Johns Hopkins model. Instead, the house staff was now on call every other night and every other weekend. This was a lark compared to the old schedule. My duties as a senior assistant resident placed me in charge of one ward each month, supervising the work of the interns; teaching the assigned medical students; making certain that work rounds and attending rounds were well attended, efficient, and stimulating; and responding to my rotation for medical consultations on the other services of the hospital. In addition, afternoons were devoted to ambulatory patients in the outpatient clinics. Since Duke Hospital was in its infancy, the outpatient clinics were being gradually developed and there was considerable room for expansion and innovation. I have already described the “L” Clinic (Luetic Clinic), one of the largest and busiest. With my experience in New Haven I was well prepared to help expand the diabetic clinic, where I soon applied much that I had learned from Dr. Peters. One problem at Duke was that most of our patients had to come from quite a distance. It was not unusual for them to have to travel 100–200 miles for their appointments. As I recall it, the clinic visit was paid for with a fifty-cent piece—this was frequently canceled for tenant farmers or share-croppers who seldom saw any cash. Patients often came to Duke without any appointments, arriving late at night, expecting to be admitted to a hospital already filled to the rafters. This took careful triaging by the house staff and around-theclock attention of the social-service people, plus a great deal of understanding, compassion, and simple patience on the part of the house staff.

Since the Duke Endowment paid one dollar a day for an inpatient, a substantial contribution in those days, and was committed to serve the poor of North Carolina and South Carolina, we had our hands full. Duke Hospital, in keeping with the customs of its community, was a segregated institution, and this led to further problems.