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School of Medicine
What Hopkins Built, and Where
Johns Hopkins had no intention, at first, of putting his Hospital on the site of Maryland's debt-ridden insane asylum, where in the end it landed.
What Hopkins had in mind was a peaceful retreat, a pavilion-style hospital surrounded by well-kept gardens and wrought-iron fences on his 330-acre country estate. So when state lawmakers approached him about buying the asylum site (patients were being moved to a new hospital in Spring Grove, near Catonsville), he at first turned them down. Hopkins was familiar with the 13-acre property at the crown of what was then called Loudenschlager's Hill; he had helped manage the asylum for two decades as one of his many philanthropic projects. And, in fact, the site had an even older history as a general hospital, built not only to handle mental disorders but to cope with a staggering epidemic of yellow fever, which killed 1,200 people in Baltimore in 1798. (As it happened, the scourge was over by the time the original hospital was completed in 1807, so it was used mostly to treat seamen, those who had no one to care for them at home, alcoholics and the mentally ill.)
Johns Hopkins changed his mind and paid $150,000 for the site, two miles due south of Clifton, his estate, when the 12 Hospital trustees he had chosen to help shape and guide his project - many, like him, were Quakers - pointed out that if he wanted to help the poor, he ought to build his hospital closer to where they lived. (That foresight has borne out perhaps more than they expected; in fiscal year 1999, Johns Hopkins Medicine provided $150 million in uncompensated care). Some historians have suggested that the founder also was encouraged to build the Hospital on high ground, as the Jones Falls flood that demolished much of the center of the city around Gay Street was then still fresh in local memory.
When Hopkins died on Christmas Eve, 1873, much of the site had been razed, but he never got to see so much as a blueprint. Eager to get a plan in motion when Hopkins' willed fortune became available, the trustees turned to five well-known hospital planners and settled on the advice of one: John Shaw Billings of Georgetown. A skillful surgeon, and at that time a major in the U.S. Army, Billings had established himself as an expert in hospitals and public health after the Civil War by writing scathing reports about the inadequate construction and management of military hospitals. In coming up with a plan for Hopkins, Billings turned to leading hospital authorities in England, Scotland, Germany and Austria.
Excavation of the property, to which another acre was added shortly after Hopkins' death, finally began in 1877. Seventeen hospital buildings, completed 12 years later, sat pavilion- style - meaning they were arranged around an open courtyard. The structures included a centerpiece Administration building, two private wards, four regular wards, an isolation ward, an amphitheater, bathhouse, kitchen, laundry, dispensary, apothecary building, pathology building, a home for nurses and a stable.
Only three of the Hospital's historic structures, added to the National Register of Historic Places in 1976, still stand: the Queen Anne-style domed Administration Building (now named for Billings), flanked on either side by what were matching men's and women's private wards that face west on Broadway. (Originally called "pay wards," today they house major portions of the Brady Urological Institute and the Wilmer Eye Institute.) All the structures were made of red brick, trimmed with Cheat River stone - a blue sandstone from West Virginia and moulded terra-cotta, and were designed by the Boston architectural firm of Cabot and Chandler, who completed the initial plans prepared by architect John Niernsee. Glass for the windows was imported from France, and all the buildings, though gas-lit, were prewired for incandescent electric lamps and had telephone service.
The buildings took so long to finish primarily because the $2 million project was funded solely by interest from Johns Hopkins' $3.5 million endowment; the trustees were not permitted to dig into the principal bank stock and rental warehouses and homes. So year after year, the trustees dutifully let construction proceed only to a certain point and then had to halt it and calculate how much they could afford the next year. Another complicating factor: construction crews found quicksand and veins of water running through the property, and had trouble at first laying stable foundations. By the time the Hospital was completed, only six of Hopkins' 12 handpicked trustees were still alive.
The Hospital was the first in the country equipped with central heating, thanks to Billings. The physician was a pioneer not only in heating and ventilation, but in sanitation, and though some people have since labeled him a bit of a fanatic, his ideas were quite progressive. Billings wanted, for instance, every inside corner of the proposed hospital to be rounded to avoid buildup of dust, dirt and dead insects in crevices. That wasn't completely possible, but Billings hinted the day the Hospital opened that he was pleased with what his builders had accomplished.
"Corners are to a great extent done away with, and easy curves given in their place," he told a gathering of 600 who filled the rotunda to hear what went into building the structures.
"Even at the junction of the floor and walls there is a curve instead of the usual right angle, and I advise you to look at it and see how it has been produced, for it ought to become fashionable and take the place of the old mopboard in all well-constructed homes."
The buildings all were designed to prevent spread of disease, as late 19th century hospitals were still known as unhealthy breeding grounds for pestilence. In Hopkins' day, the term "germ" had been coined, but most people were not quite sure what it meant or how such invisible particles traveled and transmitted disease. It was still widely supposed that many illnesses were caused by miasma, poisonous vapors rising from the soil.
While it is unlikely Billings held that view, he zealously guarded patients from contaminated air by designing unusual but precisely calculated ventilation systems. For instance, he arranged for air in some rooms of the isolation ward first to pass over heating coils in the basement, causing it to rise through holes in the floor and be pulled up through the patient's private chimney. The point, said Billings, was to "supply a large amount of air, about four cubic feet per second, to each inmate, and to have this air pass constantly upwards, so that no portion of this air shall be rebreathed or come a second time in contact with the patient, thus placing him in the condition of being out-of doors in a very gentle current of air."
To keep contaminated air from one ward from permeating the next, Billings laid out the wards one behind the other like a series of brick barracks, instead of stacking them in a many-storied building, which would have been cheaper. Billings made sure no air could travel even through the basement corridor that connected the wards, by designing stairways that opened to the outdoors instead of directly into the wards. A doctor making rounds through this corridor had to climb a winding staircase, at the top of which he found himself outside on the corridor's open-air roof, facing a ward's closed door. Patients on stretchers were carried up the same way; there were no elevators. Billings believed digging elevator shafts would only give infectious airborne particles a new path of entry, and he wanted to take no chances.
Lithographs that ran in the local newspapers the morning the Hospital opened show an open rotunda, with octagonal design work in the center of the floor. Soon after, that centermost spot was covered over by a 10 1/2-foot Carrara marble Christ statue that has stood there ever since. Donated in 1896 by William Wallace Spence, a Scottish immigrant and one of the wealthiest businessmen in Baltimore, the statue is an exact copy of the Christus Consolator that Danish sculptor Bertel Thorwaldsen executed for Copenhagen's Frue Kirke in 1821.
Why the nonsectarian Hospital acquired the religious symbol is open to speculation, but the day Hopkins opened, University President Daniel Coit Gilman publicly asked for someone to come forward and donate a copy of Thorwaldsen's work. It is believed the gift was sought to offset criticism from the more conservative element in late 19th century Baltimore that the Hospital had no religious affiliation. Whatever the case, getting the artwork in place was a major feat.
"Jesus came in through the north door,"according to the Hospital's first door man, William Thomas, who remained with the Hospital until he died in 1958. The statue had been pulled from the wharf on a wood sled drawn by four horses, all the way up Broadway to the Hospital's north entrance, then slid down a short corridor to its present position. Through the years, Hopkins employees have rubbed the statue's toes in passing, and patients often pray before it. It has become a symbol of compassion and hope.
On the terrace just outside the Broadway entrance stands another object that has taken on similar, though lesser, emotional significance since George McGaw, a Hospital trustee, had it placed there in 1905. One of Adolf Meyer's more prominent psychiatric patients credits a sundial, designed by Albert Crehore of Yonkers, N.Y., with spurring him to improve his outlook and get on with what turned out to be a highly successful career. The dial's weatherworn inscription reads, "One hour alone is in thy hands, the hour on which the shadow stands."
On the other side of the Hospital is the original Henry Phipps Psychiatric Clinic, dedicated in 1913. Named after the Pittsburgh steel magnate who paid for its construction, the five-story red brick building has been carefully preserved, though psychiatric care and research have since 1982 been conducted in separate, modem quarters. Designed by architect Grosvenor Atterbury and renovated in 1983 by RTKL Associates, the Edwardian-style building's two wings partially overlook Fells Point and form a U around a garden court complete with its own fountain, boxwood and trees. Zelda Fitzgerald was among the many patients treated in what was the first psychiatric clinic in the country associated with an academic medical center.
Today's complete Hospital complex, replete with some 74 elevators connecting medical units stacked up to 15 stories high, infection controlled through more sophisticated means than Billings ever knew - sprawls over 22 acres. World-renowned specialty centers - minihospitals in their own right - have risen from the site, including the Wilmer Eye Institute, the Adolf Meyer Center for Psychiatry and the Neurosciences, the Brady Urological Institute, the Heart and Vascular Institute, the Sidney Kimmel Comprehensive Cancer Center, the Children's Center, the Meyerhoff Center for Digestive Diseases, and the A. McGehee Harvey Teaching Tower and Russell Nelson Patient Tower. Each major center is designed not just for diagnosis, treatment and care of patients, but to accommodate research and education to advance each field.
Clifton, Johns Hopkins' much loved estate, remains largely preserved as a public park and golf course. His home is now the pro shop.