Johns Hopkins Hospital: Past and present

Johns Hopkins, a wealthy Baltimore merchant and businessman, hoped to build a hospital that would “compare favorably with any other institution of like character in this country and Europe.” 

Hopkins initially opposed ideas from the Board of Trustees to build the new hospital on the lot of an abandoned mental asylum and hoped to build it on his country estate in Clifton, Maryland, approximately two miles from where the hospital sits today. He changed his mind when trustees pointed out that, if the aim of his hospital was for “the good of all who suffer” and to help the poor, he should locate it closer to where the poor actually lived. 

Hopkins died in 1873, prior to the planning of the hospital. Before his death, he called for the grounds of the hospital to be filled with trees and flowery landscapes to provide solace to those who were sick. 

The construction of the hospital took over 12 years to complete before its opening in 1889. The design of the hospital was led by Cabot and Chandler, a Boston-based architectural firm, with the original design focused on 17 hospital buildings around an open courtyard and red brick and glass imported from France. 

The now famous rotunda was present when the hospital opened, and — shortly after, in 1896 —William Wallace Spencer, a businessman in Baltimore, donated a 10.5-foot-tall Jesus Christ statue that remains in the hospital to this day. 

While the hospital was established as secular, University President Daniel Coit Gilman publicly requested the statue, which is speculated to have been intended to counteract criticism from conservative actors over the hospital’s lack of Christian affiliation.

Surgeon John Shaw Billings made efforts to enhance public health safety. Billings laid out the building with isolation wards behind one another instead of on top of each other to prevent air from rising. In the initial construction, there were no elevators, owing in part to Billings’ belief that elevators were dirty and would lead to contamination.

The medical curriculum developed at the hospital would be the basis for the Flexner Report in 1910, which reformed all medical schools in the United States. William Osler pioneered a new method of teaching medicine at Hopkins that included bedside teaching, where medical students in their third and fourth year would work alongside physicians in supervising and managing patients, a practice which thereafter become the standard.

In 1893, the Johns Hopkins Medical School opened on the same campus. Among the initial requirements for medical students were that they had to know French and German and have an undergraduate degree. Notably, Hopkins was the first medical school in the nation to admit women on the same basis as men. 

From the time it opened, the hospital was open to Black and White patients, although they did not permit non-White medical students or physicians until the second half of the 20th century. In addition, despite their admitting patients of color, the hospital was segregated by race, having White wards and “colored” wards until the 1950s. 

The hospital’s relationship with the surrounding community in East Baltimore has been historically tumultuous. In an interview with The News-Letter, Jeremy Greene, a professor of Medicine and the History of Medicine at Johns Hopkins Medicine described the hospital’s position.

“There are folks living... in the immediate vicinity of the Johns Hopkins School of Medicine at Johns Hopkins Hospital who have had their lives transformed in positive ways by engagement with world-class clinical care that has made a huge difference in our lives,” he said. “But there are also many folks living in the vicinity of East Baltimore who have had their lives uprooted.” 

Greene described how during the tuberculosis epidemic in the 1900s, the hospital’s engagement with the community resulted in the disproportionate displacement of Black residents. 

“As Hopkins physicians studied tuberculosis and moved out in public health squadrons to map tuberculosis through the city, they were focusing on historically Black neighborhoods, like one neighborhood on the west side of Baltimore that got famously categorized as the lung block,” he said. “The study of these high rates of tuberculosis in this community then justified basically razing the neighborhood and displacing the Black residents elsewhere.”

In recent years, the University has participated in the East Baltimore Development Initiative (EBDI), an effort to expand the medical campus into a biotech hub for Hopkins affiliates. EBDI has faced criticism for its displacement of Black residents in the Middle East neighborhood. 

Today, the hospital campus has expanded to cover 22 acres, with only three of the historical buildings still standing: the domed administrative building with the rotunda, the Brady Urological Institute and the Wilmer Eye Institute. 

Johns Hopkins Medicine ranks consistently as one of the best hospitals in the nation in multiple specialties. Greene acknowledged this legacy.

“Johns Hopkins Hospital and Johns Hopkins School of Medicine are perhaps some of the most mythologized institutions in American biomedicine,” he said.