The Duke University Health System is a staple of North Carolina health care today, but when crews began construction on Duke Hospital in 1927, many asked, “Why here?”

Durham — a city with a population of 47,000 — already had two hospitals. Why did it need another? How could a small population support a teaching hospital?

Faculty leaders were thinking much bigger than Durham, though. They envisioned a future where the university was a medical hub that treated patients and trained doctors for a state that lacked enough hospitals, physicians, and medical schools to prepare them.

James B. Duke pushed the first domino toward a solution in 1925 by willing $4 million to establish a medical school, nursing school and hospital at Duke. The new facilities, staff and students would turn the tide of medical care in North Carolina.

Wilburt C. Davison, founding dean of the Duke School of Medicine and Duke Hospital, anticipated the hospital caring for half a million people living within 50 miles of Durham, even if they couldn’t pay the full bill.

“In the opinion of many medical authorities, the new Duke Hospital will be the best and most completely equipped hospitals in the United States,” the Duke Chronicle reported on May 21, 1930. “This vast 1,100 room structure, the largest hospital in the South, will serve not only Durham but all the citizens of North and South Carolina, and it is believed, will establish itself in the future as one of the great medical centers of the United States.”

Duke Hospital started in the current Duke Clinic on July 21, 1930, boasting 31 full-time medical staff, 88 affiliated physicians, and 50 other employees.

As the largest general hospital in the area, it featured space for roughly 400 beds and an outpatient clinic offering a wide range of services, from dentistry and orthopedics, to pediatrics and general medicine.

In its inaugural year, the hospital served 91 patients each day and performed 623 surgeries. The care surged to 5,170 procedures in 1936 and an average of 330 daily patients in 1937. People from across North Carolina, traveling an average of 71 miles, sought treatment. Duke Hospital's early challenges included caring for patients with various diseases, including syphilis, tuberculosis, typhoid, and nutritional deficiencies.

A growing staff of 100 doctors, residents and interns; 250 nurses, technicians and administrators; and 200 orderlies, maids and cooks supported the efforts by the mid-1930s. Among them was Sallie Wells Lee, who began working as a hospital nurse in 1932. Her granddaughter, Anna Collins, now works in the same hospital halls, carrying on the legacy of her family and the nearly century-old hospital.

“To think about her being in this building, taking care of patients, and now me being in the same building, taking care of patients,” said Collins, a clinical nurse at Duke University Hospital since 2022, “it definitely makes this job much more special, to know it has a deep connection with my family.”

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