Book excerpt: Karen Sacks offers the first detailed account of the hospital industry's nonprofessional support staff---their roles in day-to-day health care delivery, and why they fought so tenaciously throughout the 1970s to unionize. This case study of the relationships between work life and unionization in Duke medical Center highlights women's activism in general and black women's leadership in particular. In addition to an analysis of the dynamics of women's activism, Caring by the Hour provides a comparative study of Duke Medical Center's treatment of both black and white female workers. Sacks links patterns of racial segregation in clerical jobs to the relationship between race, working conditions, and unequal opportunities for black and white women, and to their differing work cultures and patterns of public militance. She also discusses recent changes in service, clerical, and professional work and their effects on white and black women, placing them in the context of national changes in health funding and policies.