In the years after 1965, expansion leveled off for NIH as a whole. A mature institution emerged, with a fresh overlay of training and education responsibilities added by the administration of Lyndon B. Johnson.90 For the Clinical Center this meant growing interaction with regional clinical research centers, partially funded by the NIH Division of Research Resources, as sources for patient referrals and opportunities for clinical trials. Johnson reorganized the PHS to put NIH directly under White House control, and he also recruited Masur as a Great Society spokesman to promote the acceptance of Medicare and to push for a greater distribution of the fruits of medical research.91

Visiting the Clinical Center on August 9, 1965, Johnson publicly signed the Health Research Facilities Amendments Act, which allocated $230 million for research contracts and construction grants to regional medical centers.92 Subtly, the Clinical Center adopted the administrative requirements involved in servicing the expanded health system. The 1967 mission statement promised “opportunities for young physicians and other professionals to prepare for careers in medical or related research.”93 The hospital continued to grow, as 24 beds were added for the new National Institute of Child Health and Human Development between 1966 and 1968. But some NCI patients were now housed in local motels, family-style meals were being replaced by tray service on the wards, and nurses noted “a great many more sick patients in the house.”94 Slowly the hospital was becoming more of a service center and less of a self-contained chronic care community.

The critical point in this transformation came in 1968, as the Vietnam War reached its crisis and President Johnson announced his intention to leave office. The administration could not fund its Great Society programs for fiscal 1969. In July the budget was reduced from $30 billion to $24 billion, and a 10 percent surtax was imposed to keep the government solvent. Masur’s staff recognized that federal services would be reduced, that personnel vacancies at the hospital would go unfilled, and that a period of “lean years” lay ahead.95 With the retirements of Dr. Shannon as NIH director in September and Senator Hill as chief sponsor of medical research in November, the federal science enterprise was for the moment a political orphan.96 Dr. Masur’s sudden death from acute myocardial infarction on March 8, 1969, was a tragic loss, which closed two decades of political good fortune, scientific brilliance, and clinical elan. No other director would style himself “superintendent of the hospital,”97 and no other hand would influence as critically the institution’s development and daily life. In a time of great turmoil in American society at large, his passing left the Clinical Center a future replete with both promise and uncertainty.