The beginning of medicine at Duke dates back to the mid-1920's and the final years of a man named James Buchanan Duke. An extremely talented businessman, Duke built his fortunes in the tobacco and textile industries. In 1924, he used $40 million to establish the Duke Endowment and directed that 6 million be used to transform Trinity College into Duke University. The next year, upon his death, he made an additional bequest to the Endowment and the University, including $4 million to establish a medical school, hospital and nurses home.
One of Duke's primary motivations in establishing the Endowment and Duke School of Medicine was the improvement of health care in the Carolinas, a relatively poor region of the country at that time, lacking in physicians, hospitals and medical schools. Duke's bold dream was to create what he hoped would become the best medical institution between Baltimore and New Orleans. Indeed, less than four years after the new school and hospital opened in 1930, an accreditation committee of the American Medical Association placed Duke among the top 20 schools in the country.