Gray School A Medical 'Miracle'

by Chester Davis, Winston-Salem Journal-Sentinel, September 10, 1961

COY C. CARPENTER has been the dean of a medical school since 1936 and, as the saying in that craft goes, "Old deans never die. They simply lose their faculties."

But no one, not even-his detractors (and of these he has a gracious plenty), suggests that Dr. Carpenter has lost much of anything over the past 25 years. His greatest faculty — and it's as sharp as the legendary serpent's tooth — is finding things, and this faculty he most certainly has not lost.

As a matter of fact, Coy Carpenter found a shoestring 20 years ago and over the past two decades he has built a shoe to go with it. Succinctly stated, that sums up the tale of the magic cobbler who stuck to his last until he built the Bowman Gray School of Medicine.

Dean Carpenter tells the story in quite different words. Looking back over the past 20 years he shakes his head sadly and says, "I was a fool optimist....a damned fool optimist at that." There is a good deal to be said for this point of view.

The story begins, as so many stories about doctors do, with the American Medical Association. In the mid-1930s the Association was greatly grieved that the public could not afford to pay for medical services. Times were hard for the medicine men, and the head shamans of the AMA concluded that in order to make the profession a profitable dodge it would be necessary to reduce the number of doctors.

This could be done either by cutting the size of the classes in the four-year medical schools or by eliminating the two-year medical schools then operating in the nation. The AMA zeroed in on the two-year schools. For them it was either close up shop or shift to a four-year basis.

For understandable reasons the decision caused consternation in the heart of Coy C. Carpenter, then dean of the Wake Forest College School of Medical Science. Like the medical operation at the University of North Carolina, this was then a two-year school and, as such, it was high on the AMA's list for extinction.

Mere item of 10 Million

And extinction is not too strong a word. In the late 1930’s the AMA, while holding a pistol to the head of two-year schools, comforted the victims by telling them that it would cost no more than 10 million dollars to shift over to a four-year basis. For the Wake Forest School of Medical Science, this was somewhat impractical advice. Founded in 1902, the school began life with a staff of one (salary $1,000 a year) and $700 worth of equipment. By the mid-1930’s, when Dr. Carpenter (Wake Forest publications regularly referred to him as "the popular pathologist") became dean, the school really was short of money.

But the work of shamans is a wondrous thing. The edict of AMA triggered a set of developments which, to this very day, Dr. Carpenter recalls with bemused astonishment.

To start things off, the trustees of the Bowman Gray Foundation in Winston-Salem, alerted by the AMA’s edict, offered to give all (principal and accumulated interest) to the University of North Carolina if that institution would (1) move its medical school to Winston-Salem and (2) enlarge it into a four-year operation. The trustees of the University gave that proposition a very short shrift. They preferred poverty in Chapel Hill to gold in Winston-Salem.

When Coy Carpenter heard of this incomprehensible development, he hustled up to Shelby where he met with Odus M. Mull, one of Wake Forest’s truly valiant alumni (a crack politician to boot) and Governor Clyde Hoey. The dean’s proposition was just what you suspicioned: get the Gray family to hold out the same offer to Wake Forest and see if they could withdraw their hands from the bait before they were fanged.

A Prompt Acceptance

On August 2, 1939, the trustees of the Bowman Gray Foundation made their offer; move the two-year Wake Forest School of Medical Science to Winston-Salem and enlarge it to a four-year operation and you get the principal and the accumulated interest in the Bowman Gray Foundation.

The Grays must have been flabbergasted at the alacrity with which their offer was snatched. By Aug. 3, the deal had the approval of the trustees of both Wake Forest and the Baptist Hospital in Winston-Salem.

But their astonishment was pale indeed when compared with the jolt Coy Carpenter received when he first peeked into the books of the Bowman Gray Foundation. The Dean, always the optimist, had been thinking in terms of say, five million in principal and, say, a few round hundreds of thousands in accumulated interest.

What he found was $600,000 in principal and $150,000 in accumulated interest. This was a far cry from what he had looked forward to with such slavering anticipation and it wasn’t within a long hoot and an even longer holler of the 10 million the AMA suggested as a minimum for the establishment of a new four-year medical school.

But it was all there was and Dean Carpenter, in the "make-do" tradition that built North Carolina, accepted the shoestring in the hope that he later could find a shoe to fit it. In so doing he perpetrated what is probably the classic understatement of modern medical science. Asked by Gordon Gray, a trustee of the Bowman Gray Foundation, if it was possible to establish a four-year medical school on such a modest sum, the Dean said, "We’ll do it by not spending money we don’t have." At the time this meant not spending just about all the money there was in the world.

To make matters even more unfathomable, Dean Carpenter entered this venture with his eyes as wide open as a startled owl’s. He says:

"At no time did the Gray family indicate to me that more money would be forthcoming. They were very frank about this. The $750,000 was it."

At the time – and you may be sure that he rues this recollection – it didn’t even occur to the dean to tap the local Chamber of Commerce for a contribution. "Years later," he recalls with a sigh, "I was told that Charlotte would have raised more than a million to get the medical school. In Winston-Salem this possibility didn’t occur to me until it was too late."

But, country boy as he was in some respects (and you can bet this was only a passing phase), the dean was a canny operator in most others. He’s probably the only man in the world who built a medical school out of a shoestring and then saved the shoestring.

The trustees of Baptist Hospital, as part of the move of the Medical School, agreed to raise the money necessary to enlarge their plant from 82 to 200 beds. (Actually the hospital was enlarged to 300 beds when it developed, as it swiftly did, that the new medical school was not going to be able to rely on the 400 beds of the City Memorial and Kate Bitting Reynolds Hospitals.) The trustees also provided a site on the hospital grounds for the new medical school.

Some Financial Juggling

Dr. Carpenter put up the $18,500 shares of R.J. Reynolds in the Bowman Gray Foundation as collateral for a loan of $431,187. He got the loan at 1 per cent (later 1 ½ per cent) and he collected 5 per cent in stock dividends. In this manner he kept his stock, got his medical school, and earned some interest in the process.

It was just over two years from the day Coy Carpenter accepted the Gray family’s offer to the day – Sept. 10, 1941, just 20 years ago – the first 73 students began to dissect cadavers in the new Bowman Gray School of Medicine.

In those 25 months Coy Carpenter saw at least the first glimmerings of the error of his ways. For the next 20 years those glimmerings developed to a point where they became positively incandescent.

Even today the best of the medical schools have difficulty recruiting – and keeping – a full time staff. In 1939-41 the Bowman Gray school was little more than a figment of the dean’s feverish imagination. Any man joining the staff of that school was not only taking a gamble but, in the opinion of the best medical minds in the business, he was embarked on a hopeless gamble at that.

But Coy Carpenter recruited his staff. He drew on the following sources:

1. In July 1940 he brought the following men from Wake Forest to Winston-Salem: Camillo Artom, Loren Chastain, E. King, Roland Miller, Robert P. Morehead, N. C. Thomas, H. M. Vann and Herbert Wells. This was the nucleus.

2. Then he relied heavily on the loyalty of Wake Forest alumni. Dr. Wingate Johnson and Dr. Felda Hightower were recruited largely on this basis.

3. Breathing enthusiasm and selling faith Dr. Carpenter enlisted young men willing to take a gamble. If the gamble paid off the Bowman Gray school offered a short cut to academic advancement. Dr. Howard Bradshaw (surgery) and Dr. Fran Lock (obstetrics) are examples of men willing to move to Winston-Salem and take the risk.

4. The Dean searched the medical schools of the country for experienced men who were dissatisfied with their present post and willing to gamble in order to get change. Dr. Tinsley Harrison came to Winston-Salem in this basis.

But most of all, Coy Carpenter relied on doctors already practicing in Winston-Salem. In 1939 Carpenter said, "It is our hope an belief that a medical school can be established in Winston-Salem and staffed primarily with members of the medical profession already there."

Dr. Carpenter invited all of the members of the Forsyth County Medical Society to become staff members. Sixty-three of the local doctors were elected to the school staff in 1941. Of these, 25 served on the instructional staff over the school’s first 10 years. The list included men like Fred Garvey, James Harrell, Arthur Valk, J. P. Rousseau, Robert McMillan and Roscoe Wall.

The Young and Faithful

The accent was on youth, for only the young and naïve are equipped to allow faith to triumph over experience. And, to be very fair about it, there were times when the staff – gaining experience every day – grumbled and became weak in the faith. But, year after year enough of them stayed on to keep the school in business.

From the outset one of the critical problems confronting Dean Carpenter was the maintenance of pleasant working relations with the native Winston-Salem doctors.

The bringing of a medical school into this community meant two things: (1) Greatly intensified competition for a local medical dollar and (2) a sharp rise in medical standards.

From the very beginning the dean had trouble. When the move to Winston-Salem first was proposed he foresaw a medical school that was based on the beds in the Baptist, Kate Bitting, and City Memorial Hospitals. But this did not materialize. Dr. Carpenter and Dr. J. B. Whittington, director of the city’s two hospitals, never were able to work together. The doctors in the community divided into two camps and a town and gown controversy that was to smoulder for years began.

In 1940, when asked by a reporter what Winston-Salem needed most in the new year, Coy Carpenter said, "Unity in the medical profession. In 1941 we will begin to feel growing pains that may irritate." This was another example of the dean’s masterly skill at understatement.

For most of the past 20 years many members of the local medical lodge distrusted and detested Coy Carpenter. Justified or not, this was a cross the dean had to shoulder. Irrespective of the merits of this prolonged and bitter squabble, the clear fact is that Dr. Carpenter rode out storms – some of them severe – that would have capsized a less stubbornly optimistic and skillfully opportunistic man.

Except for chronic problems of financing and the difficulties of recruiting a staff, the initial years were relatively smooth. From the outset there was no difficulty in obtaining top flight students. With the outbreak of war, Uncle Sam ordered an accelerated program of medical education.

The Bowman Gray school went on war footing (all but 14 per cent of the student body was in uniform) and new classes were rammed through the school with frightful speed. This haste did little to enhance medical education but it did assure enough students (at $2,500 a head in federal funds) to ease, at least temporarily, the school’s financial pinch.

But when the war ended and the school went back to a one-class-a-year basis, that financial pinch became a savage, gnawing pain.

Tuition – $450 a year in 1941 and $350 a quarter in 1961 – did not begin to meet operating costs. At Bowman Gray a student pays only 34 per cent of the costs of his education. The difference is made up by the school. In 1959-60 that difference ran to about $7,000 for each student over the four-year period. In short, each graduating class cost the school something like $375,000 over and above the amount collected in tuition.

The cost of a medical education causes gray hairs even in well-endowed universities. At Bowman Gray, where the endowment was less than one million dollars for a number of years, it was a problem that had no immediate solution except hat- in-hand panhandling.

Short on Research Space

And this financial problem was aggravated by the lack of physical facilities. In the postwar years, when big grants – both federal and private – began to flow into the medical schools for research purposes, Bowman Gray had to turn down more money than it accepted. There simply was no space for additional research.

The plant built in 1941 was designed to accommodate a two-year medical school. As the school was expanded to four years, the plan was to tack on additional new facilities. But those facilities were not built. First, the war shut down all construction. After the war, the plans for removing Wake Forest College to Winston-Salem claimed all the charitable dollars this community could raise. There was little left over for the medical school.

From 1941 until 1957 the school continued to operate in its original quarters. And from 1943 until 1957 those quarters, designed for a two-year school, housed a four-year operation.

Matters were further aggravated by the reluctance of the Baptist State Convention to accept federal money for the expansion of the Baptist Hospital or the medical school. This refusal to mix the affairs of church and state – a refusal that continued until 1957 – cut the school off from increasingly liberal federal grants.

These problems, always stimulated by the local town and gown controversy, kept the Bowman Gray School of Medicine in a constant state of crisis for most of the first 20 years of its existence.

But there were factors working in the school’s favor. Ultimately they – combined with the dean’s diligence in fending off bankruptcy in the interim – called the turn.

The chief of these factors was the plain need of North Carolina – and the nation – for another four-year medical school. The wartime demand for more doctors continued into the period of postwar prosperity. The school had a product that the public wanted.

Added to this was the fact that the war and postwar circumstances enabled the Bowman Gray School of Medicine to build solid professional reputation in an amazingly short period. This resulted from a combination of factors:

Because applications from prospective students ran 10 to 20 times over acceptances the school was able to select students capable of becoming first-rate doctors.

An acute shortage of interns developed during the war. As a result Bowman Gray graduates had no difficulty finding positions in the best of the nation’s hospitals and medical centers. This provided those graduates with the opportunity to prove their merit and that of their school.

The young staff recruited by Dr. Carpenter regularly moved on and up to better opportunities: Dr. Tinsley Harrison left Bowman Gray to become dean of a medical school in Texas, Dr. George Harrel became dean of the new University of Florida Medical School and there were many others like them. Their success helped establish the reputation of Bowman Gray at the national level.

These same young men – each one filled with vim and vinegar – began to produce significant papers in the medical journals and their research began to attract national attention.

Because the school had to "play it by ear" (improvisation regularly was used in lieu of cash) Bowman Gray experimented where older and established medical schools often were handicapped by tradition. In 1946, Dr. Victor Johnson, then secretary of the Council on Medical Education of the AMA, said of the Bowman Gray Medical School: "This school is conducting an educational program that all of the medical schools recognize to be the most progressive. But it is not done by other medical schools because of the shackles of tradition."

Help From Many Sources

These were the things – a first rate product on the market at a time of maximum demand – that turned the trick. Help came from many – and, sometimes, unexpected – sources.

The first of these was Winston-Salem itself. It is doubtful if this school could have been established under the same circumstances in any other city of similar size and still have succeeded. In time Winston-Salem’s acute pride in its own came to embrace Bowman Gray School of Medicine.

The initial gift that brought the school to Winston-Salem was only $750,000. Until the end of the war, private gifts to the school were few in number and limited in size. But then the flood gates opened.

Mrs. Nathalie Bernard gave the Graylyn estate to the Bowman Gray School. James A. Gray gave the school almost $1 million for its endowment. Bowman Gray Jr. And Gordon Gray each gave the school $125,000. (This was the first of several sizable gifts by Bowman Gray.)

"These gifts," Dr. Carpenter says, "saved the school from sinking downhill and probably saved it from extinction."

Endowment Is Increased

Since then other private gifts (the latest: $500,000 from Bernard and Mrs. Anne Reynolds Tate) have raised the school’s total endowment to between six million and seven million. And, for so long as it continues, the annual $150,000 in scholarship aid from the Z. Smith Reynolds Foundation represents the equivalent of an additional four million endowment.

The second tremendously important factor in the school’s crawl to financial security resulted form the fact that Bowman Gray’s first 20 years coincided with what probably is the most expansive two decades in medical history. Money for research – both federal and private – began to flow into the medical schools in a golden stream in this period. Bowman Gray swam smack into the center of that stream.

Before the school’s physical facilities were expanded (first by the addition of the James A. Gray building in 1957, and later, by the addition of the seven story research center in 1960) the total research grants didn’t average more than $300,000 a year. Today they are running close to $1.5 million a year.

The bulk of this money – almost 75 per cent – came from various federal agencies. But large grants – $1.6 million for the endowment from the Ford Foundation in 1959, for example – came from private foundations too. (In 1941 some of these private foundations laughed out loud at the very idea of attempting to establish a four-year medical school on $750,000.)

A third factor in the bounce of the Bowman Gray School out of the morass resulted from the coming of Wake Forest College to Winston-Salem and in the establishment of a graduate program at both the college and the medical school. Besides easing administrative problems for Dean Carpenter and President Harold Tribble, these changes enhanced the prestige of the medical school. In the formal fields of medicine, prestige is almost as valuable as cash in the bank. In fact, the one leads to the other.

A Pride of Achievement

Looking back over the past 20 years, Coy Carpenter is understandably proud of what has been accomplished. He is, of course, aware that he is a controversial character. (Men who have had dealings with him are inclined to either like or dislike him intensely. There are few neutrals.) Perhaps it couldn’t be otherwise.

Coy Carpenter is the man who built the Bowman Gray School of Medicine. He did the job with the tools he possessed. There are men who do not approve of the way he sometimes used these tools. But few men question the fact that he used them diligently and effectively. The results of 20 years of work leave little room for doubt on that score. Consider, for example, these items:

The physical facilities of the Bowman Gray School of Medicine have expanded from 76,240 square feet to 184,282 square feet between 1941 and 1961. In this same period the Baptist Hospital has expanded from 82 to 530 teaching beds.

The school’s medical library – 2,500 dog-eared volumes in 1941 – now contains almost 35,000 volumes. (Just purchasing back issues of certain medical periodicals cost $200,000.)

It cost $100,000 to operate the medical school in 1941-42. This year’s budget is $3.6 million.

In the 20-year period the full-time teaching staff has increased from less than 50 to almost 110. In the medical school, the student body had grown from 73 to 210. (When you include courses for medical technicians and graduate students, the total student body is close to 700.)

In 1941 Bowman Gray was the struggling branch of a small college located more than 100 miles away. Today it is a proud unit of a sparkling new university located in Winston-Salem. (In 1942 Dean Carpenter, trying to raise money for the medical school, visited the late W. N. Reynolds. In effect Mr. Reynolds told him, "The Grays will take care of the medical school. But what about using Reynolds money to bring the college to Winston-Salem?" This conversation planted the seed that resulted in the removal of Wake Forest College to Winston-Salem in 1956.)

Beginning to See Daylight

Perhaps the meaning of these changes is best summed up by Coy Carpenter’s comment, "I don’t like a one-man operation. Bowman Gray is no longer that. I could pass out of the picture tomorrow and it would make no difference in the operation of the school.

This does not mean, of course, that after 20 years the Bowman Gray School of Medicine is home free. As Executive Dean Manson Meads says, "We still have to run full speed just to stand still."

But, as Dean Carpenter says, "Until 1960-61 every year was one of almost day-to-day scrabbling. This year, with the $500,000 gift from Mrs. Bernard and Mrs. Tate (used to endow three of the school’s 13 departmental professorships) we began to see daylight for the first time."

That’s a sort of light no one really expected Coy Carpenter would live to see. For, as the late Dr. Fred Hanes of Duke University said when he received the first honorary degree ever given by the Bowman Gray School, "In 1941 I knew dammed well that it couldn’t be done. In 1951 – now that it has been done – I don’t believe it.

In 1961 Coy Carpenter isn’t so sure he believes it either.