THE PLANS AND PURPOSES OF THE 
JOHNS HOPKINS HOSPITAL. 
An Address delivered at the opening of the Hospital, 
May 7, iSSg. 
BY 
JOHN S. BILLINGS, M.D., 
SURGEON V. S. ARMY. 
FROM / 
THE MEDICAL NEWS, 
May u, 1889. [Reprinted from The Medical News, May n, 1889.] 
THE PLANS AND PURPOSES OF THE JOHNS 
HOPKINS HOSPITAL. 
An Address delivered at the opening of the Hospital, May 7, 1889. 
By JOHN S BILLINGS, M.D., 
SURGEON U. S. ARMY 
The third paragraph of the letter of instructions com- 
municated by Johns Hopkins to the Trustees whom he 
had chosen to carry out his plans for a hospital in the 
city of Baltimore, states that “it is my wish that the 
plan . . . shall provide for a hospital which shall, 
in structure and arrangement, compare favorably with 
any other institution of like character in this country or 
in Europe.” What do you suppose the writer was 
thinking of when he penned that sentence ? Had he in 
view any definite ideal, any mental picture of the insti- 
tution which he proposed to establish, or was it merely 
an expression of a desire to give to his city the best 
thing that could be devised? I have read that letter 
many times, have heard much of the ideas, hopes, and 
wishes which were expressed in the numerous conversa- 
tions which preceded its preparation, and it seems to me 
that the writer had an ideal, and not a mere vague 
desire—an ideal which was no doubt somewhat misty, 
but which did not correspond to any existing hospital, 
and one which he did not attempt to define except in a 
few prominent points to which I shall presently refer. 
In most respects Johns Hopkins took the same course 
with his hospital which he did with his University, and 
deliberately refused to trammel with specific directions 
those whom he had chosen to carry out his plans; but 
this letter of instructions indicates, neverthelesspa-eon- 2 
BILLINGS, 
ception of much more definite character, and one which 
had been the subject of more discussion and reflection, 
than his scheme for an university. Whether this be so 
or not, I am at all events sure that his Trustees have en- 
deavored to comply with this letter of instructions, and 
to do so in the broadest and best sense of the words. 
The beginning of the results we have before us 
to-day; results which even now are not confined to 
these particular aggregations of bricks and mortar, as 
will be presently explained, and the end of which will 
be, as we hope and believe, to make life happier for mil- 
lions now living and yet unborn. Only those who took 
part in the early deliberations of those charged with this 
trust can fully realize the anxieties, the doubts, the man- 
ifold perplexities which at first attended their decisions 
and movements. Only one or two of them had any 
knowedge of hospital matters; most of them were busi- 
ness men, bankers, lawyers, judges, railway managers, 
men who knew something of the management of men 
and money, but who were now brought face to face with 
a new problem, viz., how to build, organize, and manage 
a hospital so that it should compare favorably with any 
other hospital in this country or in Europe. 
To “ compare favorably with,” what does that mean? 
It is a peculiar phrase, which, coming from a shrewd 
business man and a member of the Society of Friends, 
signifies, I think, to excel, if possible; at all events that 
is the safest interpretation. And it was not this or that 
hospital which was to be surpassed or equalled, but all 
other hospitals in this country or in F,urope ; Africa, 
Asia and Australasia being put out of the question. It 
was a large contract. 
The location was fixed—that had been done by Johns 
Hopkins, but they had to decide whether the structures 
to be erected should be temporary or permanent, of 
wood, brick or marble, in one large building or in THE JOHNS HOPKINS HOSPITAL. 
3 
many, and many other like points, before even the pre- 
paration of plans could be commenced. They followed 
the instructions of the donor and got advice; of which 
a great abundance was available. They visited the 
large hospitals of our eastern cities, employed five men, 
supposed to be skilled in hospitals, each to write an 
essay giving his plans and suggestions, published these 
essays in a book which had a wide circulation, and 
studied the criticisms and reviews to which this book 
gave rise. 
Having duly considered the multifarious and widely 
divergent suggestions thus obtained, they finally selected 
one of the essay writers and asked him if he was satis- 
fied with his own plans now that he had seen the others 
and the published criticisms upon them. He promptly 
said that he was not, whereupon they asked him to try 
again and do better. He set to work, aided by the archi- 
tect of the Board, and the result was a set of sketch plans 
which he took abroad and obtained much counsel and 
criticism on, examining at the same time the model hos- 
pitals of Europe. He was much less satisfied with the 
sketch plans when he came back than he was when he 
started, and again the Building Committee, the architect, 
and himself reviewed the whole matter, and finally set- 
tled on the general arrangement which you will see to- 
day. Many details remained to be worked out; even the 
facades had not yet been designed; but the general 
schem§ was settled, and the rest was comparatively easy 
for the time being. 
Let us now for a few moments consider the broad gen- 
eral principles which governed the Trustees in the adop- 
tion of this plan. The first hospitals were established to 
give shelter and food to the sick poor, especially those 
who gathered in cities. Gradually physicians found that 
they could learn much in these aggregations of suffering 
and that they afforded the means of teaching others ; but 4 
BILLINGS, 
this last use of them is only about two hundred years old. 
Gradually, also, it came to be known that the knowledge 
thus obtained in the care of the sick poor was of use in 
treating the diseases of the well-to-do ; and finally, within 
the last twenty-five years or so, people are beginning to 
find out that when they are afflicted with certain forms 
of disease or injury they can be better treated in a prop- 
erly appointed hospital than they can be in their own 
homes, no matter how costly or luxurious these may be. 
In the hospital they can have not only all the comforts 
of home, but more ; not only skilled medical attendance 
and skilled nursing, but the use of many appliances and 
arrangements specially devised for the comfort and wel- 
fare of the sick which can hardly be found in any private 
house, and also freedom from noise and many petty an- 
noyances, including in some cases too much sympathy 
and in others too little. This hospital, then, is to provide 
for the rich as well as for the poor; for those who can, 
and ought to, pay for the help given, as well as for those 
who cannot. 
A second cardinal principle to be observed in such a 
hospital as this is, that it shall do as little harm as possi- 
ble. A hospital may do harm by its foul air, by spread- 
ing contagious disease among its inmates, by neglect or 
carelessness of its nurses or attendants ; and in years 
gone by hospitals have, no doubt, caused nearly as much 
sickness as they have relieved. This is now rarely the 
case, and in this hospital the arrangements for ventila- 
tion, isolation, and nursing are such as to do away 
entirely with this danger. There is another danger con- 
nected with free hospitals and dispensaries which is of 
quite a different kind and to which I can here only al- 
lude, namely, the danger of promoting negligence, shift- 
lessness, laziness, and vice by offering free relief from 
their consequences—the danger of pauperizing people. 
This is a danger connected with organization and man- THE JOHNS HOPKINS HOSPITAL. 
5 
agement rather than with construction, and I can only 
say here that it has been foreseen and will be, as far as 
possible, guarded against. 
The third principle to be kept in view in such a 
hospital as this is, that it should provide the means of 
giving medical instruction, for the sake of the sick in the 
institution as well as of those out of it. It is well known 
to those familiar with the subject that the sick in a hos- 
pital where medical instruction is given receive more 
constant, careful, and thoughtful attention than do those 
in a hospital where no such instruction is given. The 
clinical teacher must do his best; keen eyes will note 
every error in diagnosis, every failure in results of treat- 
ment. Moreover, the very act of teaching clarifies and 
crystallizes his own knowledge; in attempting to explain, 
the dark places become prominent and demand investi- 
gation, and hence it is that those cases which are lectured 
on receive the best treatment. I need say nothing here 
on the other side of the question, the value of properly 
trained physicians to the community and the necessity 
for hospital instruction in such training; Johns Hopkins 
understood all this and specially directed that “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 the University.” 
Now there are medical schools and medical schools, 
and in obeying this direction of the donor the Trustees 
had to consider what sort of a medical school this school 
of the University was likely to be. As the majority of 
the Trustees were also Trustees of the University, they 
knew well the principles which underlie the organization 
of that institution and that the same principles would 
govern the organization of the medical department when 
that came to be taken in hand. One of these principles 
is the thorough teaching of that which is known, another 6 
BILLINGS, 
is to increase that which is known, and to furnish the 
men and means for doing this. So also the hospital 
should not only teach the best methods of caring for the 
sick now known, but aim to increase knowledge and 
thus benefit the whole world by its diffusion. Another 
point which had to be kept in view was the direction of 
Mr. Hopkins that there should be established, “in 
connection with the hospital, a training school for female 
nurses, not only to care for the sick in the hospital but 
to benefit the whole community by supplying it with a 
class of trained and experienced nurses.” 
It is also highly desirable that a hospital of this kind 
should have connected with it a well-appointed dispen- 
sary for the treatment of those who need medical aid but 
not a bed in the hospital. Through such a dispensary 
much good can be done at small cost, the selection of 
proper patients for the hospital is facilitated, the means 
of medical investigation and teaching are greatly ex- 
tended and the scope of the nursing system can be made 
to reach the poor and ignorant in their own homes. 
The last point to which I shall refer, which was kept 
in view by the Trustees in deciding upon the plans, was 
the general appearance of the buildings and grounds. 
Mr. Hopkins gave no specific directions as to the 
buildings, but he directed that the grounds should be 
properly enclosed by iron railings, and so laid out and 
planted as to be a solace to the sick and an ornament to 
the city, and it was evident that the buildings should be 
of the same character so far as their purpose would ad- 
mit. It was therefore decided that, while no utility should 
be sacrificed for the sake of architectural ornament, and 
the main purpose which I have referred to should be 
fully worked out in the plans before any attention was 
paid to external appearance, it was fit and proper that 
the buildings should form an ornament to the city, and 
a suitable monument to the memory of the donor. THE JOHNS HOPKINS HOSPITAL. 
7 
Bearing in mind, then, these main principles, to pro- 
vide for the proper care of the sick, both rich and poor, 
to provide for the highest class of medical education, to 
increase and diffuse knowledge, to provide trained nurses 
for both hospital and city, to provide a dispensary, and 
to make the buildings and grounds ornamental and at- 
tractive, let us see how the problem has been thus far 
worked out. 
I will begin with the arrangements for securing that 
article of prime necessity in a hospital, viz., pure air. 
Air supply and ventilation in this climate are inseparably 
connected with heating for a considerable portion of the 
year, for comfortable warmth must be secured, and on 
the means of doing this must largely depend the methods 
of ventilation and their success. The temperature of 
Baltimore may vary from 103° in the shade to 170 below 
zero F., hence its perfect hospital must be one which 
would answer for the tropics or for Northern Russia. To 
secure this, double walls, with air spaces, were given to 
the buildings, and a system of heating by the circulation 
of hot water was adopted for the wards. This system 
consists of central boilers, from which flow and return 
pipes extending beneath every building, connected with 
heating coils, of which there is one for every two beds in 
the ward above. The temperature in these coils can be 
exactly regulated to any temperature between 150° F. 
and the temperature of the external air by simply regu- 
lating the velocity of the flow of water by the valves at- 
tached to each coil, and thus it is quite possible to give 
one pair of beds a temperature of 70° and another pair 
in the same room, at a little distance, a temperature of 
6o° F., to suit the needs of different cases. The 80,000 
gallons of water contained in this heating apparatus go 
round and round, carrying heat from the furnaces to the 
wards, but every building has its own independent means 
of ventilation, and it is not possible to go from one ward 
into another without going into the open air on the way, so 8 
BILLINGS, 
that foul air, if any forms, cannot spread from one build- 
ing to another. Nevertheless, the buildings are so con- 
nected by corridors and underground tunnels that in 
passing from one to another there is no exposure to rain 
or snow, and the least possible to cold air, while the food 
is not exposed at all. This is not the place to describe 
the ventilation. I will only call your attention to the 
fact that the temperature of the incoming air by any bed 
is easily changed by turning a valve, while the quantity 
of air is not changed; to the arrangement for taking foul 
air from either the bottom or top of the ward, or from 
both, and to the fact that all this has been thoroughly 
tested during two winters and found to give the results 
hoped for. 
One of the peculiarities of the wards is that all the 
service rooms are collected at the north end, leaving the 
south end free from obstruction and fully exposed to the 
sun, the end of the ward being a large bay window look- 
ing out on the central garden, and with a floor which can 
be warmed so that the patients, able to sit there, can be 
thoroughly comfortable. Another peculiarity of the sick 
wards is the arrangements for easy cleansing, and to 
prevent possible accumulations of dust in corners and 
crevices. Corners are to a great extent done away with, 
and easy curves given in their place, even at the junc- 
tion 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 fashion- 
able, and take the place of the old mop-board in all well- 
constructed houses. So, also, the doors have not the 
usual moulding about the panels, giving recesses which 
it is almost impossible to clean. 
One of the wards is especially arranged for cases which 
may be either contagious or offensive. In this building 
each patient is in a room by himself, and all these rooms 
open into a corridor through which the wind is always THE JOHNS HOPKINS HOSPITAL. 
9 
blowing. There are many details about this isolating 
ward which are worth looking at, but which I have not 
time now to refer to, and I must omit details about the 
pay ward, the octagon ward, and the peculiar fittings 
and conveniences of the kitchen, laundry, apothecaries’ 
building, etc., for the same reason. 
Let us pass now to the second object of the hospital, 
the giving means for higher medical education, and see 
what has been done for that. In the first place, there is 
a large amphitheatre with appended rooms for the recep- 
tion of accidents and emergencies of all kinds. In the 
second place, provision is made for at least thirty students 
to reside constantly in the hospital and devote themselves 
under proper guidance to the study of disease and the 
practical care of the sick. It is intended that these 
places shall be open only to those who have had a 
thorough previous training, and who have shown them- 
selves to be fitted to undertake this important part of 
their studies. As a rule, not more than five per cent, of 
medical graduates have had any opportunities worth 
speaking of to study and treat diseases in the living man 
when they receive their diplomas. They have to get 
this experience on their first patients, and sometimes 
the experience is rather hard—for both doctor and pa- 
tient. This hospital has provided for the class of the 
medical school in the last year of their studies good 
rooms with bath-rooms, a dining-room, and other con- 
veniences, and here they can be taught the actual daily 
work of a physician, for which all their previous studies 
are only preparatory. Many of the arrangements of the 
hospital have been constructed with reference to this 
instruction; it is a great laboratory for teaching the prac- 
tical applications of the laws of hygiene to heating, ven- 
tilation, house drainage, and other sanitary matters. All 
pipes and traps are either exposed to view or can be 
seen by merely opening a door, and in the tunnel be- 
* B I LLINGS, 
neath the corridor you can study at your leisure the 
complicated and yet simple arrangement of pipes for 
gas, steam, water, sewage, etc., which are usually buried 
and remain a profound mystery to every one except the 
plumber, and often puzzle even him. 
Closely connected with this subject of teaching is that 
of increasing our knowledge of the causes, symptoms, 
results, and treatment of disease ; in fact, one cannot be 
thoroughly and well done without the other, and hence 
many of the provisions for the one are also useful for the 
other. For example, to go back to our system of heat- 
ing and ventilation, there are many points connected with 
it which are destined for experimental work, to compare 
steam with hot-water heating, to determine the velocity 
of water at different temperatures, to compare ventilation 
by aspiration with that by propulsion, or by upward cur- 
rents with those drawn downward. 
One structure is very largely devoted to and fitted for 
experimental research, and that is the pathological labo- 
ratory, where the causes, processes, and results of dis- 
ease are to be studied. Upon the results obtaiqed in 
that laboratory may yet depend the saving of many 
lives, the relief of unspeakable agony, the warding off of 
pestilence from the city, and, to put it in a strictly busi- 
ness light, the value of real estate and the rate of taxa- 
tion of this community. We are on the verge of great 
advances in our knowledge of the causes and methods 
of disease, and I feel sure that these will be only prelimi- 
nary steps to far greater and better knowledge of how to 
prevent or to treat them than we now have. The prob- 
able length of life of the newborn infant to-day is not 
much more than half what it ought to be; the practical 
productive period of the life of our men and women is 
shortened and interrupted by unnecessary disease and 
suffering; but remember, if these things are to be 
amended, it is not merely by teaching old doctrines; we THE JOHNS HOPKINS HOSPITAL. 
must open fresh windows and let in more light, so that 
we can see what these obstacles really are. It is in this 
work of discovery that it is hoped that this hospital will 
join hands with the University, and it is in this hope that 
some of the structures around you have been planned 
and provided. 
A word now on the fourth object kept in view in this 
hospital, viz., the Training School for Nurses. 
Some of you probably have had some personal experi- 
ence of the difference between an educated, properly 
trained female nurse, and one of the old-fashioned sort, 
but if you have not, it would take much more time than 
I now have to describe it. I can only say, that in many 
cases a competent trained nurse is as important to the 
success of treatment as a competent doctor, and that one 
of the greatest difficulties in treating well-to-do patients 
in their own homes in this city is the want of proper 
nurses. Affection and zeal may do much, but they can- 
not take the place of knowledge, and this kind of knowl- 
edge is not to be acquired in a day or in a month. It is 
a work best carried out by women, though not one woman 
in ten is fit for it, or should undertake it. But the woman 
who is fit for it, who has physical health and strength, 
sound sense, loving kindness, patience and tact, and who 
has been thoroughly taught the art of nursing the sick, 
with all its thousand details, has the power of doing good 
and increasing happiness to a degree which few others 
possess. In a properly conducted hospital ward she is a 
necessity, but her field of usefulness and helpfulness is 
by no means limited to that. She is needed outside the 
hospital, in the home of the rich to nurse and care for 
the sick; in the home of the poor, to teach prevention 
as well as nursing. To gather here such women, to have 
them thoroughly instructed, to furnish 4 them with the 
attractive and comfortable home which they deserve, and 
to send them where they are most needed, with provision 12 
BILLINGS, 
for their return when the work is done, is the object of 
the training school of this hospital. 
For this purpose the Trustees have provided a large 
and handsome building, separated from the others, and 
exclusively appropriated to the female nurses, where each 
can have her own comfortable room, and where a common 
parlor, library, dining-room, bath-rooms, and, in short, 
the arrangements of a first-class hotel are provided for 
their use. Here also is a training-kitchen and a lecture- 
room to aid in the work of instruction. The intention is 
that when the nurse has finished her six or eight hours’ 
tour of duty with the sick, she shall come quite away 
from the ward and all that pertains to it, and take her 
rest and recreation in a totally different atmosphere, and 
special effort has been made to have this home attractive 
and pleasant. 
The fifth object which I mentioned as having been 
kept in view in the plan and construction of these build- 
ings is the Dispensary. This is a large building on the 
north front, consisting of a large central waiting-room, 
surrounded by a number of smaller rooms for the use of 
the physicians and surgeons who are to examine and pre- 
scribe for the patients, and having bath-rooms, and a 
small apothecaries’ establishment for the issue of the medi- 
cines ordered. This building is connected with the am- 
phitheatre by a short covered corridor, and is specially 
arranged with reference to teaching. It, as well as the 
amphitheatre, is heated by steam instead of hot water, 
partly because they are not in constant use, and a rapid 
means of warming is desired, partly for the purpose 
already referred to of giving the means of experimental 
comparison of the two systems. The means of supply 
of fresh warm air in these two buildings, and of removing 
the air made impure by exhalations are somewat peculiar, 
and merit examination. 
With regard to the architectural design and external THE JOHNS HOPKINS HOSPITAL. 
13 
appearance of the buildings, and the laying out and 
ornamentation of the grounds, I can only say that you 
must see and judge for yourselves whether Mr. Hopkins’ 
wish that they should be an ornament to the city has 
been successfully complied with. So far as external 
ornamentation is concerned, it is confined almost entirely 
to the large buildings on the west, or Broadway, front, 
which it was felt should harmonize in style of decoration. 
These central buildings, consisting of the administration, 
with the one pay ward on either side, are constructed 
of pressed brick with ornamentation of a dark blue, fine- 
grained, hard, and durable stone, known as Cheat River 
stone, and of moulded terra-cotta of the color of the 
brick. The external designs for these, as f<5r all the 
other buildings, were furnished by Messrs. Cabot & 
Chandler, of Boston, and I think we have good reason 
to be well satisfied with the results they have produced. 
The grounds are laid out and planted in accordance with 
designs furnished by Mr. E. W. Bowditch, of Boston. 
As regards construction, I do not hesitate to affirm that 
these are the best built buildings of their kind in the 
world. The material is the best, the most skilled and 
careful workmen were employed, and, above all, the 
work received the most careful, conscientious, and in- 
telligent supervision as it progressed. For this super- 
vision we are indebted to Mr. John Marshall in the 
beginning and to Mr. William H. Leeke for the remainder 
and conclusion of the work ; and we are also indebted to 
the latter for many valuable suggestions as to modes and 
details of finish which are so important in a hospital. 
The details of the complicated and extended system of 
heating, ventilation, and plumbing were designed and 
the work executed by Messrs. Bartlett, Hayward & Co., 
of this city. I should like to go on and mention a num- 
ber of other names of persons who have done good work 
here, but want of time forbids. I will only say that these BILLINGS, 
buildings embody the counsels and suggestions of many 
men and women in this country and abroad, but among 
them all there is no one who from the very beginning of 
the conception of the idea of this magnificent gift in the 
mind of Johns Hopkins down to this present moment 
who has had more to do with shaping the results, who 
has furnished more valuable suggestions, who is more 
thoroughly acquainted with all that has been done, and 
why it has been done, who has worked so unselfishly, 
and who more deserves honor in this connection than 
the President of the Board and Chairman of the Build- 
ing Committee through the whole progress of the work, 
Mr. Francis T. King. 
Briefly 'and incompletely as I have sketched these 
salient points of the plans and purposes of this hospital, 
I hope I have, nevertheless, shown you that it is intended 
for other purposes besides providing shelter, food, and 
drugs for the sick. In saying this I have not the least 
wish to undervalue or disparage those institutions which 
do make this their main or only object. There is abund- 
ant need of their existence and work also; but this 
institution should not be judged by the rules which 
apply to them ; it cannot be managed after their fashion : 
if it does not produce results different from theirs it is a 
failure and the expenditure upon it a mistake. 
Thus far I have been speaking of the buildings only, 
and trying to give you some idea of the motives which 
led to their being as they are, and what they are, and 
not otherwise. From the beginning, however, it has 
been recognized that the buildings and machinery are 
only means to an ends, tools which must be handled by 
skilled workmen to produce the desired result; and 
throughout all these years of planning and building, the 
question of organization and of the sort of men and 
women who were to use and work with these things has 
not been lost sight of. It is true that no attempts were made to select and engage individual members of the 
hospital staff until quite recently; but there was, never- 
theless, a tolerably definite conception as to the ideas, 
mode of work, character, and wants of those who are to 
constitute this staff, and when the time came for select- 
ing, it was made by this standard. 
THE JOHNS HOPKINS HOSPITAL. 
On the philanthropic, social, and religious aspects of 
this great trust I do not propose to touch, but I wish to 
say a very few words of the hopes and wishes of scien- 
tific men and physicians with regard to it. From the 
time of the first announcement of the Hopkins bequests 
to the present, these men, all over the world, have been 
keenly interested in the plans and methods adopted in 
carrying them out. Whenever and wherever the prob- 
lems of higher medical education have been discussed 
within the last ten years, there has been speculation as 
to the probable course of the Johns Hopkins medical 
department, and the influence it would have upon the 
standard. I may even say that some of this influence 
has been exerted in advance, has been discounted, as it 
were, for the plans of this hospital have stimulated 
changes in some of our best medical schools, and have 
been copied with more or less modification in some of 
our latest hospitals. 
What is it, then, that the physicians want ? Is it more 
physicians, more family practitioners, more surgeons, 
more specialists ? Not at all. They know very well 
that there is no danger that the supply will not be equal 
to the demand; when they become overburdened with 
practice they do not at present find it difficult to obtain 
assistants; they have no fear lest the seventy or eighty 
medical schools of this country should fail to produce a 
sufficient number of medical practitioners to meet the 
wants of our increasing population ; and they know also 
that the medical schools of Great Britain and Germany 
are sending to us quite as much of their product as we can BILLINGS, 
conveniently dispose of. They hope that the Hopkins 
medical school and hospital will do two things. The 
first is, that it will demand of those who propose to be- 
come its students evidence that they have a sound basis 
of preliminary education before they commence, and 
that its standard in this respect shall be little below that 
of the requirements for granting the degree of bachelor 
of arts in the University. It is hoped that the men thus 
selected will go through a carefully graded course of 
study, including actual work in properly fitted labora- 
tories, and that after this they will be brought into con- 
tact with the sick, and thus obtain practical experience 
of the duties and responsibilities of the practitioner of 
medicine before they offer their services as such to the 
public. 
So much our physicians desire of every medical school, 
for the sake of the honor and dignity of the profession, 
and for the good of the public, and they desire especially 
that this school shall form an example to which they can 
point as showing how medical education should be con- 
ducted, and what should be required of the candidate for 
the degree of doctor of medicine. 
The very general interest in the combined Hopkins 
trusts felt by physicians and scientific men not only of 
this country but of the whole civilized world, is largely 
due to the belief that the relations which will here exist 
and be maintained between the University as a whole 
and its medical department, of which this hospital is to 
be an important part, will be close and intimate, so that 
the true University spirit will pervade, stimulate, and 
encourage the hospital work. In this country medical 
schools have either had no connection with Universities 
properly so called, or the connection has been slight and 
nominal, such as depends upon the formal conferring of 
medical degrees by the University. Here, however, 
through the influence of the biological department, there THE JOHNS HOPKINS HOSPITAL. 
17 
are secured common interests and mutual influence, and 
it is hoped therefore, that the necessary details of techno- 
logical instruction will be arranged in accordance with 
and subordinate to the broad principles of scientific cul- 
ture upon which this University is organized. 
It is because it is believed that this will be the case 
that there is a widespread hope and expectation that 
these combined institutions will endeavor to produce 
investigators as well as practitioners, to give to the world 
men who can not only sail by the old charts, but who can 
make new and better ones for the use of others. This 
can only be done where the professors and teachers are 
themselves seeking to increase knowledge, and doing 
this for the sake of the knowledge itself;—and hence it 
is supposed that from this hospital will issue papers and 
reports giving accounts of advances in, and of new 
methods of acquiring knowledge, obtained in its wards 
and laboratories, and that thus all scientific men and all 
physicians shall share in the benefits of the work actually 
done within these walls. But, however interesting and 
valuable this work may be in itself, it is of secondary 
importance to the future of science and medicine, and 
to the world at large, in comparison with the production 
of trained investigators, full of enthusiasm, and imbued 
with the spirit of scientific research, who will spread the 
influence of such training far and wide. It is to young 
men thus fitted for the work that we look for the solution 
of some of the myriad problems which now confront the 
biologist and the physician. 
Do I seem to ask too much ? to be too sanguine as to 
what human thought, and study, and skill may accom- 
plish ? to forget that there is one event unto all; that the 
shadow of pain and death comes on the wise man as on 
the fool ? I have two answers. As surely as our im- 
proved methods of prevention and treatment, based on 
the advances in knowledge of the last fifty years, have 18 
BILLINGS, 
already extended the average duration of life in civilized 
countries nearly five years, have prolonged thousands of 
useful and productive lives, and have done away with 
the indescribable agonies of the pre-anaesthetic period, 
so surely we are on the verge of still greater advances, 
especially in the prevention of infectious and contagious 
disease, in the resources of surgery against deformities 
and morbid growths, and in the mitigation of suffering 
due to causes which cannot be wholly removed. But 
the second answer is more important, and it is this : It 
is our duty to try to increase and diffuse knowledge ac- 
cording to the means and opportunities which we have, 
and not to rest idle because we cannot certainly foresee 
that we shall reap where we have strewn. “ It is not in- 
cumbent on thee to finish the work, but thou must not 
therefore depart from it,” says the Talmud, and “Of him 
to whom much is given much shall be required,” says 
the Scripture. 
To you, the officers of this institution, and to you, men 
and women of Baltimore, there is now given the oppor- 
tunity of giving powerful aid in this increase and diffu- 
sion of knowledge of the laws of human life, disease, 
and death. Surely, those who are working in the wards 
and laboratories of the hospital and University will do 
their best; surely, also, the citizens of this great city of a 
great nation, which at no distant day will take the lead 
in scientific work, will encourage, sustain, and sympa- 
thize with these workers. I would have this hospital 
become famous, not for fame’s sake, but because this 
will be evidence of the good work which has been done 
in it; but we must not be impatient. There are difficul- 
ties to be overcome, delays which must be submitted to. 
We cannot at once have the medical school which is 
essential to the plan which I have sketched; but there 
is plenty to do for the present, and I am certain that in THE JOHNS HOPKINS HOSPITAL. 
19 
time all these present obstacles to full development will 
be happily overcome. 
Success in this, as in all other enterprises in this world, 
is to be obtained by unselfish work for the good of others, 
by wise counsel, by cooperation, and by persistent effort. 
A hospital is a living organism, made up of many dif- 
ferent parts, having different functions, but all these must 
be in due proportion and relation to each other, and to 
the environment, to produce the desired general results. 
The stream of life which runs through it is incessantly 
changing; patients and nurses and doctors come and go; 
to day it has to deal with the results of an epidemic, to- 
morrow with those of an explosion or a fire; the reputa- 
tion of its physicians or surgeons attracts those suffering 
from a particular form of disease, and as the one changes 
so do the others. Its work is never done; its equipment 
is never complete; it is always in need of new means of 
diagnosis, of new instruments and medicines ; it is to try 
all things and hold fast to that which is good. 
“ Et quoniam variant morbi, variabimus artes.” 
It has been said that “hospitals are in some sort the 
measure of the civilization of a people, but a hospital of 
this kind should be more than an index. It should be 
an active force in the community in which it is placed. 
When the mediaeval priest established in each great city 
in France a Hotel Dieu, a place for God’s hospitality, it 
was in the interests of charity as he understood it, 
including both the helping of the sick poor and the 
affording to those who were neither sick nor poor an 
opportunity and a stimulus to help their fellow-men ; and 
doubtless the cause of humanity and religion was ad- 
vanced more by the effect on the givers than on the 
receivers. It is the old lesson so often expounded, ap- 
parently so simple and yet so hard to learn, that true 20 
THE JOHNS HOPKINS HOSPITAL. 
happiness lies in helping others ; that it is more blessed 
to give than to receive. 
In some respects we to-day have a much wider out- 
look than the men of a thousand years ago. This hos- 
pital is designed, as I have told you, to advance medical 
science as well as to give relief to the sick poor, but the 
fundamental motive is the same—to help others. 
We have here the beginning of an institution which 
shall endure long after the speakers and the audience of 
to-day shall have finished their life-work and have passed 
away. Founded in the interests of suffering humanity, 
intimately connected with a great university, amply pro- 
vided with what is at present known to be essential to its 
work, we have every reason to predict for it a long and 
prosperous career, with steadily progressing improve- 
ment in its organization and methods, and enlargement 
of its activitv and influence. 
Let us hope that before the last sands have run out 
from beneath the feet of the years of the nineteenth 
century it will have become a model of its kind, and 
that upon the centennial of its anniversary it will be a 
hospital which shall still compare favorably, not only in 
structure and arrangement, but also in results achieved, 
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