Johns Hopkins

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Hopkins had an elaborate conception of what his hospital would be. In March, 1873, he set down his vision in a letter to the twelve trustees: It is my wish that the plan thus chosen shall be one which will permit symmetrical additions to the buildings which will be first constructed, in order that you may ultimately be able to receive four hundred patients; and that it shall provide for a Hospital, which shall, in construction and arrangement, compare favorably with anyother institution of like character in this country or in Europe. … The indigent sick of this city and its environs, without regard to sex, age, or color, who may require surgical or medical treatment, and who can be received into the Hospital without peril to the other inmates, and the poor of this city and State, of all races, who are stricken down by any casualty, shall be received into the Hospital, without charge, for such periods of time and under such regulations as you may prescribe. … It will be your special duty to secure for the service of the Hospital surgeons and physicians of the highest character and greatest skill. … I wish the large grounds surrounding the Hospital buildings … to be so laid out and planted with trees and flowers as to afford solace to the sick and be an ornament to the section of the city in which the grounds are located. … In all your arrangements in relation to this Hospital, you will bear constantly in mind that it is my wish and purpose that the institution shall ultimately form a part of the Medical School of that University for which I have made ample provision by my will.

He died of pneumonia nine months later at the age of seventy-eight, never to see the ground broken.

It was two years before the trustees sent out invitations to several wellknown authorities on hospital planning, asking them to come up with ideas for the construction of the hospital. The job eventually went to John Shaw Billings, a veteran army doctor and sanitation expert whose concept was the pavilion arrangement: a main building with separate wards branching out from it. Billings was named medical adviser to the hospital, and construction began in 1877 on a thirteen-acre lot that was previously the site of the Maryland Hospital for the Insane. Because the principal of the bequest was not to be invaded, however, and annual interest was only $125,000, it was twelve years before the hospital was completed.

In June of 1883 the trustees told Billings, in his role as medical consultant, to set about the business of selecting the staff of the hospital and future medical school. He had once met William Welch in Germany and been quite impressed with the young pathologist. It was Billings’ recommendation to the president of the new university, Daniel C. Oilman, that he offer the first professorship, that of pathology, to Welch, thus luring him away from Bellevue in New York.

Welch was the son, grandson, and nephew of country doctors in Norfolk, Connecticut. Entering Yale at the age of sixteen, he had been a brilliant student—but in the classics. In fact, he had always had an aversion to things medical as a youth, saying he couldn’t “bear the sight of blood and the sight and sound of pain.” He wanted to teach the classics at Yale, but the coveted position went to a friend. So after a bit of fatherly pressure he entered Columbia University’s College of Physicians and Surgeons in 1872, graduating in 1875. (The standard medical-school curriculum at that time was three years, with no admissions requirements, no grades, and only one final examination.) Wisely assessing the profession and its practitioners in the United States, Welch realized that the best clinical research was going on in Europe, especially Germany and Austria, and knew that he could perfect his craft only by going there to study. He spent the best part of the next two years abroad, working under some of the foremost medical scholars of the age. He returned to New York in 1878 and remained there working in his laboratory at Bellevue and doing part-time teaching until he received the summons from Gilman in 1883. He did manage to squeeze in one more year in Germany before finally delivering himself to Hopkins, and thus was well founded in the latest techniques and theories of bacteriology and pathology. He was especially impressed with John Shaw Billings’ assurance that the laboratories under construction were to be on the German model and that the medical school, when completed, would have high admission standards.