Johns Hopkins Hospital

Johns Hopkins (1795–1873), a Baltimore merchant and banker, left an estate of approximately $7 million (US$173.84 million in 2022[11]) when he died on December 24, 1873, in his city mansion on West Saratoga Street, just west of North Charles Street, at the age of 78. In his will, he asked that his fortune be used to found two institutions that would bear his name: "Johns Hopkins University" and "The Johns Hopkins Hospital." At the time that it was made, Hopkins' gift was the largest philanthropic bequest in the history of the nation.[12]

Toward the end of his life, Hopkins selected 12 prominent Baltimore residents as trustees for the project. A year prior to his death, he sent each a letter telling them that he was giving "thirteen acres of land, situated in the city of Baltimore, and bounded by Broadway, Wolfe, Monument, and Jefferson streets upon which I desire you to erect a hospital." He wished for a hospital that "shall, in construction and arrangement, compare favorably with any other institution of like character in this country or in Europe" and directed his trustees to "secure for the service of the Hospital, physicians and surgeons of the highest character and greatest skill."[12]

Hopkins instructed the trustees to "bear constantly in mind that it is my wish and purpose that the hospital shall ultimately form a part of the Medical School of that university for which I have made ample provision in my will." By calling for this integral relationship between patient care, as embodied in the hospital, and teaching and research, as embodied in the university, Hopkins laid the groundwork for a revolution in American medicine. Johns Hopkins' vision, of two institutions in which the practice of medicine would be wedded to medical research and medical education was revolutionary.

Initial plans for the hospital were drafted by surgeon John Shaw Billings, and the architecture designed by John Rudolph Niernsee and completed by Edward Clarke Cabot of the Boston firm of Cabot and Chandler in a Queen Anne style.[13] When completed in 1889 at a cost of $2,050,000 (US$50.8 million in 2022[11]), the hospital included what was then state-of-the-art concepts in heating and ventilation to check the spread of disease.

The trustees obtained the services of four outstanding physicians, known as the "Big Four," to serve as the founding staff of the hospital when it opened on May 7, 1889. They were pathologist William Henry Welch, surgeon William Stewart Halsted, internist William Osler, and gynecologist Howard Atwood Kelly.[14]

In 1893, Johns Hopkins University was one of the first medical schools to admit women.[15] The decision to begin coeducation was a result of a shortage of funds, as the Baltimore and Ohio Railroad stock that was supposed to cover cost was used up in building the hospital in 1889 and the medical school had not yet been built. Four of the original trustees' daughters offered to raise the money needed to open the school, but only if the school agreed to admit qualified women to the university. After several discussions, the trustees agreed to their terms and accepted the financial help of these four women with only one of the doctors, William H. Welch, resisting. Eventually, even Welch changed his views on coeducation, "The necessity for coeducation in some form," he wrote later, "becomes more evident the higher the character of the education. In no form of education is this more evident than in that of medicine ... we regard coeducation a success; those of us who were not enthusiastic at the beginning are now sympathetic and friendly."[16]

Osler, the first chief of the Department of Medicine, is credited with originating the idea of a residency, in which recently graduated physicians receive advanced training in their specialty while treating patients under supervision; then, as now, residents comprise most of the medical staff of the hospital. He also introduced the idea of bringing medical students into actual patient care early in their training; at the time medical school consisted almost entirely of lectures. Osler's contribution to practical education extends to the creation of "grand rounds", the practice of leading physicians discussing the most difficult cases in front of assembled medical students, for the benefit of patients and students.[17] The term “rounds” derives from the circular ward where bedside teaching occurred.[18] He once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching."[14]

Halsted, the first chief of the Department of Surgery, established many other medical and surgical achievements at Johns Hopkins including modern surgical principles of control of bleeding, accurate anatomical dissection, complete sterility, and the first radical mastectomy for breast cancer (before this time, such a diagnosis was a virtual death sentence). His other achievements included the introduction of the surgical glove and advances in thyroid, biliary tree, hernia, intestinal and arterial aneurysm surgeries. Halsted also established the first formal surgical residency training program in the United States.

Kelly is credited with establishing gynecology as a true medical specialty. He created new surgical approaches to women's diseases and invented numerous medical devices, including a urinary cystoscope. He was one of the first to use radium to treat cancer.[14]

Welch was responsible for training many of the outstanding physicians of the day, such as Walter Reed. He also founded at Hopkins the nation's first Public Health school, now known as the Johns Hopkins Bloomberg School of Public Health.[14]

A notable sight at the hospital is the marble statue Christus, a Carrara marble statue in the Billings Administration Building rotunda of the resurrected Jesus based on the 1833 original by Bertel Thorvaldsen, which was a gift by Baltimore merchant William Wallace Spence; it is a replica of the original by Danish sculptor Bertel Thorwaldsen in Copenhagen. Unveiled in 1896, the statue brings comfort to many, the hospital has said.[19][20]

Original hospital, the Billings Building, in 2019

In 1903, Harriet Lane Johnston left a sum of over $400,000 at her death in 1903 to establish the Harriet Lane Home for Invalid Children as a memorial to two sons who had died in childhood. In October 1912 the Harriet Lane Home officially opened. It was the first children's clinic in the United States that was associated with a medical school, first run by John Howland. Eventually treating over 60,000 children a year, the Harriet Lane Home became a pioneer treatment, teaching, and research clinic, and the first to have subspecialties in pediatrics as created by Edwards A. Park.

Between 1930 and 1963, Helen B. Taussig, who helped to develop the blue baby operation, headed the pediatric cardiac clinic. Child psychiatrist Leo Kanner did studies of autistic children. Lawson Wilkins established an endocrine clinic that developed procedures used universally to treat children with certain glandular disorders, including dwarfism. John E. Bordley and William G. Hardy made strides in detecting hearing impairments in very young children.[21]

In 1912, Diamond Jim Brady donated $220,000 to the hospital, which created the James Buchanan Brady Urological Institute.[22] Ophthalmologist William Holland Wilmer opened the Wilmer Eye Institute at the hospital in 1925, and its building was completed four years later. Wilmer received a medical degree from the University of Virginia School of Medicine in 1885 and later worked in New York City, Washington D.C., and Baltimore, where he established the institute.[23]