THE PROSPECTIVE ADVANTAGES 
-OF- 
Baltimore as a Medical Centre. 
BY 
JOHN VAN BIBBER, M. D. 
heprmt from The Maryland Medical Journal for Aprils 1880. 
BALTUIO RE: 
J. W. BORST & CO., PRINTERS, 
No. 9 S. Charles Street. 
1 880. THE PROSPECTIVE ADVANTAGES OF BALTIMORE 
AS A MEDICAL CENTRE. 
JOHN VAN BIBBER, M. D. 
In a worldly point of view it is probably as wise to prepare 
ourselves by education and culture to reap the advantages of 
prosperity, as it is by habits of prudence and economy to secure 
ourselves against the privations and anxieties of adversity. In the 
latter case we are spared much suffering by our foresight, but in 
the former by thus preparing ourselves, we are better able to en- 
joy the privileges afforded by our position, and in every way 
better able to make use of the power for doing good, which 
prosperity, in some shape or form, always brings with it. 
If this is true of an individual or family, it is equally true in regard 
to society in general, and eminently so in regard to those who by 
interest and employment are bound in some manner together. 
I have been led to these considerations in thinking over the 
condition of affairs in relation to the medical profession of this city, 
and particularly concerning the advantages that may accrue to it 
by the final establishment here of three large endowments, whose 
interests are identical with the progress and development of medical 
science. And I have thought it might not be uninteresting to con- 
sider the increased medical prosperity which will be brought about 
in Baltimore by these new institutions, and to lay before the pro- 
fession, in a somewhat digested form, the advantages that will un- 
doubtedly be derived from such enlarged facilities for observation 
and clinical instruction. 
Following the general law of extension of facilities, or the 
gradual development of resources, or the annual growth of 
charities, we might hope in time, and after much labor to have 
the institutions which now, by the liberality of three philan- 
thropists, are thrust simultaneously upon us, and which are soon 
to commence operations in their respective departments. It 
is a matter for congratulation that these several important 2 
Prospective Advantages of Baltimore as a Medical Centre. 
institutions are to have ample means to carry out their various 
purposes on a large scale, and being entirely untrammelled and 
independent, the probable results of their administrations are likely 
to be worthy of the enlightened time in which they are to be in- 
augurated. 
Without further introduction I will say I allude to the Medical 
School ofthe Johns Hopkins’ University, which in connection with 
the Hospital, was endowed by the philanthropist whose name it 
bears, and intended by him in this double relationship to be a 
model as an educational and clinical school; to the Sheppard 
Asylum for the Insane, designed by its founder, the late Moses 
Sheppard, to be a hospital for curable cases of insanity; and to 
the Sanitarium for Children, endowed by the late Thomas Wil- 
son as a retreat for the sick children of the poor during the 
summer months. 
To show that the time is peculiarly ripe for the development 
of these institutions, and that their progress, if properly directed, 
can be made interesting to the entire profession of this country, 
I will say that current medical literature shows that there exists 
a disposition to reform the present system of medical educa- 
tion, and to make its standard higher; also, a disposition on the 
part of some prominent men to criticise and reform the manage- 
ment and care of the insane; also, a lively interest, both pro- 
fessional and lay, in regard to the mortality of young children in 
large cities during the summer months, and the means most 
likely to avoid this evil. 
The first of these subjects has grown out of the numerous new 
medical schools which have been established all over the country, 
and the natural consequence of an injurious system of competition 
by which many schools, in order to attract students, have short- 
ened their courses of instruction and reduced their fees. The 
imperfections of the cheap and hasty education thus afforded are 
apparent to every one, and the movement towards reform has so 
far taken shape that some of the best schools of the country have 
adopted a higher standard of requirements. 
The second question has grown out of the unsatisfactory man- 
agement of Insane Asylums, and of the fact that the superintendents John Van Bibber. 
3 
are too much engrossed in the details of the domestic affairs of 
their institutions to give the proper care to their patients which 
such an important condition requires, that the proper distinction 
is not made between the curable and incurable cases, and that in 
many asylums the treatment consists chiefly of incarceration and 
neglect. 
The third of these subjects has grown out of the terrible mortality 
among young children in our large cities during the summer months. 
This fact has claimed the attention of all classes of the commu- 
nity, but more particularly of physicians who see not only the 
ravages and sorrow it causes during each heated term, but appre- 
ciate also the fact that many of these little patients who escape 
the immediate calamity of death, are doomed to carry through 
life the mark and imperfections of their disease. 
Of course as these questions are being agitated it is a 
matter of national concern to find their solution, and the city that 
can offer the best advantages, and the most reasonable prospects 
of coming to some result in their investigation, will excite com- 
ment and claim attention. In order to make it apparent that in 
Baltimore our means are ample to aid materially in these inves- 
tigations, it will not be out of place to give a short account of 
the scope and possibilities of the three institutions above alluded 
to, and to show in what way the execution and development of 
their uses can be of service in the effort to solve these problems 
of the medical profession. 
The Wilson Sanitarium — One of the latest and best of our 
medical journals has for its motto this sentence of Descartes— 
“ S’il est possible de perfectioner l’espece humaine, c’est dans la 
medecine qu’il faut en chercher les moyens.” This is indeed the 
highest aim of medical science, not to cure disease, but to prevent 
it, and before it has commenced its work to make the body strong 
enough to escape its curse or its infection. And nowhere does 
it seem to me that this, the best development of medical power, 
can show itself so strong as in the successful management of an 
institution like the Wilson Sanitarium for children, the object 
of which will be not only to remove the sick to more favorable 
climatic conditions, and to restore them to health, but also by 4 
Prospective Advantages of Baltimore as a Medical Centre. 
proper food and hygienic care to improve the sanitary condition 
of all those who come under its administration. 
The total mortality of the city of Baltimore for the summer 
months of 1876, ’77 and ’78 was as follows: 
Year. 
June. 
July. 
August. 
1876 
1001 
909 
776 
1877 
937 
889 
725 
1878 
688 
673 
634 
Of this total the number of deaths of children under 5 years 
of age were as follows: 
Year. 
June. 
July. 
August. 
1876 
657 
543 
411 
1877 
601 
597 
436 
1878 
363 
344 
303 
Dr. J. W. Toner in an article on “ Free Parks and Camping 
Grounds ” (Sanitarian May iSyj), says : 
“ A careful examination of the published reports of the Boards of 
Health of the cities of New York, Chicago, Philadelphia, Boston, 
Baltimore, and of several other cities, shows that about one-half of all 
deaths occurring are of children under five years of age. It is also 
noticeable that a large per cent, of these deaths take place during the 
heated term, and are attributed to cholera-infantum and other summer 
complaints almost peculiar to the United States.” 
These statistics certainly show what an important sanitary 
question has grown out of the care of young children in large 
cities during the summer, and it can be readily understood, even 
by an unprofessional observer, that a disease which causes such a 
fearful mortality among the children of our cities, must leave a 
decided impression on the physical condition of those who sur- 
vive such attacks, and any physician will testify to the number of 
paralyses, deformities, and diseased conditions which date their 
commencement from a summer attack. Hence while the direct 
effect of such a sanitarium will be to prevent sickness and reduce 
this excessive mortality, its indirect result in saving the community 
the care and onus of numerous crippled and deformed children 
will be almost equally as valuable. 
I can not better describe the origin and scope of this institution 
than by quoting from a letter of the trustees lately sent to several 
distinguished medical gentlemen. John Van Bibber. 
5 
“The Thomas Wilson Sanitarium for Children of Balti- 
more City,” was incorporated, July the second, 1875. 
“ For the purpose of securing a Summer Retreat for Sick Children 
from the heat and unhealthfulness of the City, and for such other kin- 
dred purposes as may be hereafter determined upon by the Corpora- 
tion.” 
“His Will, executed on the seventh day of February, 1879, 
provides as follows : 
“ I have observed for many years, with much concern, the great and 
alarming mortality which occurs each Summer among young children 
deprived, by misfortune of their parents, of all opportunity for re- 
moval from the heated and fatal atmosphere of the City. 
“ God, in his providence, did not spare to me my children, to be the 
solace of my declining years, but my pity for the sufferings of little 
children, and of their parents, is none the less, and I do not think that 
I can make a better use of some of the means of which God has made 
me the steward, than in the alleviation of the pains, and in the pro- 
longation of the lives, of those of whom Our Saviour said ‘ Suffer 
little children to come unto me, for of such is the kingdom of heaven.’ 
I therefore give, devise and bequeath unto ‘ The Thomas Wilson 
Sanitarium for Children of Baltimore City.’ a corporation created un- 
der the provisions of the Maryland Code of Public General Laws, in 
relation to Corporations, under my own supervision, 
in all a bequest of Five Hundred Thousand Dollars.” 
“ The Trustees to whom the execution of the above mentioned 
trust has been committed, desire to furnish themselves with the 
results of the experience and views of those whose attention and 
studies have been devoted to the Sanitary Care and Treatment of 
Children, and their Diseases. The Trustees, therefore, at their 
first meeting, preliminary to the formation of any definite plan of 
procedure, determined. 
“To correspond with a few persons at home and abroad, who are 
eminent for their experience and success in the treatment and care of 
sick children, and to obtain Essays from them, to be published for the 
benefit of this and similar institutions.” 
“The Trustees wish your suggestions in reference to the most 
practicable means of lessening the risks and dangers incident to 
children exposed to the heated and impure atmosphere of a large 
city during the summer months, also your views as to the best 
methods of extending a general knowledge of simple hygienic 
rules for the treatment of children at home among the poorer  Prospective Advantages of Baltimore as a Medical Centre. 
classes. In the fulfillment of their duties they hope at least “to 
show a model of experiment,” which may prove of value as a 
contribution to the best means of lessening the mortality and 
promoting the welfare of young children here and in other large 
cities.” 
It will be seen by this extract that the Trustees have deter- 
mined to commence their work by publishing whatever informa- 
tion they obtain in regard to the management of their hospital, and 
that from the first this sanitarium shall be an instruction and an 
example. When it develops into active operation, this influence 
will be varied and important, for what can be done for the poor 
will be instruction for the rich, and what can be done in this city, 
if it shows good results, will be of advantage to the medical pro- 
fession of the country. 
« The free excursions for children in New York, Philadelphia 
and Baltimore have done much in the past few years to alleviate 
the sufferings of the children of the poor during the heated term, 
and the beneficial results of these charities have fully ,shown 
what a career of usefulness is open to the wider object of the 
Wilson Sanitarium. In fact St. John’s Guild, of N. Y„ after 
organizing for several years summer excursions for children, 
finally developed their effort into a “ Floating Hospital.” The 
Guild in an appeal for aid in carrying on their object, says: 
“ The Floating Hospital of St. John’s Guild has rescued thousands 
of little ones from disease and death by affording them the opportunity 
of inhaling life-giving, invigorating ocean breeze.” 
And further on it states: 
“ For some time past, the Guild has contemplated the estab- 
lishment of a Sanitarium in connection with the existing system, 
and funds only are needed—and we hope will soon be supplied— 
to carry the plan into efficient operation.” 
If so much good can be accomplished by the fluctuating gifts 
of charity, how much greater in every way, and particularly in 
a medical point of view, will be the possibilities of an institution 
richly and permanently endowed. The trustees who are charged with 
the organization of the Wilson Sanitarium seem determined to spare 
no effort in their endeavor to make the institution a success. They John Van Bibber. 
7 
have invited information from the best authorities, which will be pub- 
lished, as they say, for the benefit of this and similar institutions. 
They have carefully sought out high and healthy situations for a site, 
and they have found that by two railroads running out of the city they 
can reach an elevation of 800 feet in 40 minutes. In addition to 
these preparations they will be careful to see that the physicians who 
are appointed to manage the institution appreciate fully that their 
work will be of the most vital importance to the community, and will 
be closely watched in its results by the public and the profession. This 
fact alone would have a beneficial influence on the work of the medical 
staff, but besides this, it is well known that there is no better stepping- 
stone to a medical reputation than the successful treatment of the diseases 
of children, for their ailments constitute the chief factor in the sickness 
of every family. The children who are to receive the benefits of this 
summer sanitarium will be physically of a much higher grade than the 
foundlings usually met with in our asylums, and hence for experiments 
in regard to the utility of various plans of treatment for the invigora- 
tion of delicate children, and in regard to diet, and the effect of food 
on bony development, this institution will offer a valuable and inte- 
resting field. 
Thus the Wilson Sanitarium brings within the reach of 
our limits the opportunity of studying the summer diseases 
of children under the influence of good hygienic conditions, 
and under the observation of men especially appointed 
for that purpose. If in the management of many thousand 
cases of cholera infantum and other diseases of children, some 
new facts shall be elaborated, and if such extended observation 
shall bring the result we hope for, it will be a triumph for the 
institution, and for the medical profession of Baltimore, to have 
shown what could be done in reducing the alarming summer 
mortality of children, and in successfully combating with diseases 
heretofore so difficult to manage. 
The Sheppard Asylum.—The agitation known as the “ Insane 
Asylum Reform,” has now been actively going on for the past 
few years, and during this time many papers have been pub- 
lished in the medical journals setting forth the views and inten- 
tions of those interested in the movement. The titles of these 8 
Prospective Advantages of Baltimore as a Medical Centre. 
papers* (given in the foot note) show that the authors have en- 
tered very thoroughly into the subject and seem determined to 
effect their object, and make asylums more efficient in the care 
of their patients, and more exacting in their medical attendance. 
The “ Petition ” of the Neurological Society of New York, to 
the legislature of that state in 1879, was one °f the results of the 
discussion brought about by these papers. In this petition it was 
set forth, among other things, that,—“l. Superintendents of 
insane asylums are, nearly without exception, not chosen from 
among medical men who have pursued special studies in neurol- 
ogy at home and abroad, and who are well-trained physicians, 
but from among assistant physicians of asylums who, after having 
been badly chosen {vide infra), have passed a number of years 
immured in an institution. 
2. Assistant physicians of asylums (future candidates for the 
position of superintendent) are nearly always men just issued 
from our too elementary medical schools ; men who have not 
served in civil hospitals (which can be entered only by severe 
competitive examination) ; their qualifications are not submitted 
to any test; when in the institution they are not furnished with 
means of study (medical journals, books and instruments) ; and, 
inevitably, as years go by, they forget what general medicine 
they knew on graduating.” 
After enumerating many just causes for complaint the petetion 
concludes thus : “ In view of the above numerous reasons for 
*“ Governmental Supervision of the Insane," May I, 1875, by H. B. Wilbur, M. 
D. “Buildings for the Insane,” 1877 (read before the Saratoga Conference of 
Charities), by H. B. Wilbur, M. D. “ Extracts from the Twentieth Annual Report 
of Commissioners of Lunacy of Scotland, for the year 1877,” with an introduction 
by H. B. Wilbur, M. D. (no date). “ Management of the Insane in Great Britain.” 
by H. B. Wilbur, M. D., 1877. “ Reform in Scientific Psychiatry,” Am. Journal of 
Mental and'Nervous Diseases, April, 1878, E. C. Spitzka, M. D.; read before the 
New York Neurological Society, March 4, 1878. “Merits and Motives of the 
Movement for Asylum Reform,” E. C Spitzka, M. D.; reprinted from Journal of 
Mental and Nervous Diseases, October, 1878. “ The Non-Asylum Treatment of 
the Insane,” (read by invitation, before the Medical Society of the State of New 
York, and reprinted from the Transactions), by Wm. A. Hammond, M. D. 1879. 
“ The Construction, Organization, and Equipment of Hospitals for the Insane,” 
by Wm. A. Hammond, M. D.; read before the Connecticut Medical Society, May 
29, 1879. Lunacy Reform: I. “Historical Considerations,” Archives of Med., 
Oct., 1879, E. C. Seguin, M. D. Lunacy Reform: II. “ Insufficiency of the MedL 
cal Staffs of Asylums,” Ibid., Dec. 1879, E, C. Seguin, M. D. John Van Bibber. 
9 
believing that there exists gross mismanagement in the medical 
administration of insane asylums in this State, your petitioners 
respectfully request that your honorable body appoint a commit- 
tee for the examination of the management of all institutions, for 
the care of the insane of the State of New York.” 
This petition caused a legislative investigation, but the neuro- 
logical society, being dissatisfied with the report of the investi- 
gating committee, published an answer to this report in which it 
was charged that the report was made altogether in the asylum 
interest and without any regard to a truthful statement of the 
case. This answer, however, concludes by saying that since the 
appearance of the petition, many changes have been made for 
the better in the management of asylums, and that the “ society 
although temporarily interrupted in its main object through the 
coalition of elements of a questionable character, points with 
some satisfaction to the good work already accomplished. It 
accepts this as the augury of a more thorough and lasting reform 
in the near future, and as a justification of a further continuance 
in its labors.” 
Of course the movement embraces many items of reform in 
management, in questions of restraint &c., &c., but the most 
interesting to the profession are the purely medical criticisms 
which have appeared in some of these articles. 
Dr. E. C. Seguin in his paper on “ Lunacy Reform—Historical 
Considerations,” says : 
“ I have no hesitation in declaring that not one of the lew American 
contributions to the scientific aspects of insanity has been meritorious, 
and has been quoted with praise by competent critics. Indeed it is 
necessary to add that in the various European works on insanity, 
hardly an American physician’s name is cited except that of the cele- 
brated Rush. Besides, no treatise on insanity, and no important 
monograph upon one of its forms has appeared in this country.” 
Dr. Wm. A. Hammond in his article on the “ Non Asylum 
Treatment for the Insane,” gives a similar opinion on this subject. 
“ But it must be confessed that up to the present time, so far as our 
own country is concerned, the contributions to the science of the 
mind in health or disease, from medical officers of asylums have been 
ew, and for the most part of little value.” 
From these imperfect extracts it will be seen that there is a 10 
Prospective Advantages of Baltimore as a Medical Centre. 
decided and widespread dissatisfaction in regard to the medical 
work done in asylums, not only in relation to the performance of 
duty, but also in regard to the neglect of opportunities. Hence 
it is that just at this time a new institution, if properly organized, 
can profit much by the suggestions growing out of this contro- 
versy, and may take some important steps in reforming a system 
that has caused so much complaint. And in order io show that 
the Sheppard Asylum of Baltimore, from the plan of its organi- 
zation, occupies a position peculiarly adapted to the demands of 
this reform, I will briefly refer to its history and present status. 
The Sheppard Asylum was founded by a bequest of the late 
Moses Sheppard, more than twenty years ago. The original 
endowment was $568,000, and during these years the trustees, 
in accordance with the wishes of the testator, have devoted the 
income derived from this sum to the erection of buildings and the 
projection of improvements, until now $575,000 has been ex- 
pended, and the endowment has been increased to $600,000.* 
Mr. Sheppard says in his letter of instructions to his trustees, 
“ My leading purpose is to found an institution to carry forward 
and improve the ‘ameliorated system’ of treatment for the insane 
irrespective of expense.” 
He further says “that the increased cost of preparation and 
attendance will limit the number of patients: * * * that each 
patient shall have an attendant when it may appear useful, an ex- 
perimental establishment * * Let all that is done be for use 
strictly and not for show.” 
It was designed by the founder to be a hospital for the cure of 
the insane, and not an asylum for the care and protection of those 
suffering from various grades of dementia or imbecility. To carry 
out this plan it is intended that it shall be so governed that a case 
will be treated for a reasonable length of time, and if at the end 
of that period it is determined that the case is incurable, the 
management reserve the right to discharge the patient, in order to 
make room for one which can more thoroughly carry out the 
*1 have been kindly furnished with these data by Mr. J. Saurip Norris Presi- 
dent of the Board of Trustees of the Sheppard Asylum. John Van Bibber. 
11 
intentions of the institution. In this it will be a unique hospital, 
and being intended as an institution for curable cases only, it will 
be able to offer inducements for the treatment of such cases that 
no other asylum can afford to give. On the principle that there 
is no charity in giving to the rich, this class will be made to pay 
for these advantages, but for the poor no expense will be spared, 
or no luxury denied which can in any way aid in restoring the 
patient to integrity of mind. 
In order to show that the Sheppard Asylum if organized in 
strict accordance with the wishes of its founder, is precisely the 
end and aim of all the discussion on asylum reform, I will 
quote again from Dr. E. C. Seguin, of New York, who in a pub- 
lished letter in regard to asylum reform in Connecticut, comes to 
this conclusion: 
“ The acute, curable cases of insanity require much better care 
than they now receive in our asylums. It is for them that it is eco- 
nomical and humane to spend money freely, in order to facilitate 
recovery. The curable insane need the highest medical skill which 
a large salary will attract, a much larger number, proportionately, cf 
assistant physicians selected by severe examinations, many real nurses, 
not mere attendants or guardians. They require the best of food, 
with the liberal use of costly medicine, wine, brandy, changes of 
clothing, etc.” 
Reforms are always slow in their progress and difficult to bring 
about, and it may be some years before the agitation now pend- 
ing will produce any decided change in the management of 
asylums that are already in operation. It is for this reason that 
I have been led to think that our prospective asylum here, being 
nearly ready to commence its career, and being untrammelled in 
every respect, and new in its organization, might take a foremost 
position in regard to this very necessary and interesting contro- 
versy. The study of insanity is the field, of all others, in medb 
cal literature, which is most barren of results, and any man of 
talent and enthusiasm, who, in the light of the recent advances 
in brain physiology, cultivates its dark expanses, may gain the 
reward of a name, and the satisfaction of having done a good 
and necessary work. It may be that the trustees of the Sheppard 
Asylum, if they are wise and fortunate in the selection of this 
man to guide their institution in its high purposes, will be able to 12 
Prospective Advantages of Baltimore as a Medical Centre. 
add something valuable to the knowledge of insanity out of the 
administration of their advanced institution. 
Taking into consideration the present state of public opinion 
on this subj'ect, and in the face of such extracts as I have just 
quoted, who will say that the Sheppard Asylum has not a golden 
opportunity to set an example, to work a reform, and to achieve 
a reputation. 
The Medical School of the John s Hopkins University.—Every 
year the necessity 01 a decided reform in medical education 
becomes more and more apparent as the number of stu- 
dents increases, and as the misplaced ambition oi medical men 
in various parts of the country urges them to develop new schools 
under a system of lax and imperfect teaching. 
The results of such a medical education, if it can be so called, 
in a new country where a university, or even a collegiate course, 
is not held in its proper estimation, can only be fully understood 
when we take into consideration that no requirements are neces- 
sary to enter most medical schools, and that the course required 
for graduation does not extend over a period of more than ten 
months actual instruction.* 
Hence the road made easy, the prospects for a professional life, 
and the possibility of making money call to these schools many 
students, who, if some reasonable requirements were exacted, 
would be unable to embrace the calling to which they are now 
invited by a cheap and speedy system of graduation. The best men 
in the profession have wraked up to the fact that the evils arising 
out of the too rapid multiplication of medical schools must be in 
some manner checked, that there must be some movement made 
by the more prominent medical schools to show that the study of 
medicine is not a trifling or easy undertaking, and that the attain- 
ment of a degree shall demand the expenditure of more time, 
energy, and money than is now required by the vast majority of 
♦Adiliess on Higher Medical Education, by Wm, Pepper, M. D., Phila., 1877. 
Address before University Pennsylvania, by S. Wier Mitchell, M. D., Phila., 1878. 
Future influence of Johns Hopkins Hospital on Medical Profession of Baltimore, 
by John Van Bibber, M. D., Baltimore, 1879. Report on Higher Standard of 
Medical Education—Transactions Illinois State Med. Soc., Chicago, 1879. John Van Bibber. 
13 
our institutions. This feeling is now widespread and sincere, and 
in addition to the examples of Harvard University and the Uni- 
versity of Pennsylvania, two of the schools of New York, the 
College of Physicans and Surgeons and the Bellevue Hospital 
Medical College have lately adopted new regulations in regard to 
requirements for matriculation, length of courses, and methods 
of examination. It is also a matter for congratulation, to notice in 
the Maryland Medical Journal, that the University of Maryland 
has adopted a series ot resolutions in regard to raising the stand- 
ard of instruction, and the requirements for graduation. 
To show that these schools which have adopted a higher 
standard will work together for a common cause, I need only 
refer to the circular of the Bellevue College, which states that in 
matriculating students who have attended lectures in other insti- 
tutions, “ it makes a distinction in favor of students from those 
schools which have a compulsory graded course.” 
From these changes it can be readily seen that the desire 
and necessity for higher medical education is earnest, and 
that the reform that has already commenced will continue 
from year to year to become more and more pronounced. 
At this stage of the movement it should be particularly grati- 
fying to the profession here, that we are to have in our city a 
school, whose resources and equipments will be strong enough 
to make it an important factor in this national reform, to push it 
ahead of the schools in larger cities, and to give it an opportu- 
nity of taking the lead in the cause of higher medical education. 
It is with some regret that I come to the consideration of the 
most interesting part of this paper with the space alloted me almost 
entirely taken up; but the bequests of the late Johns Hopkins are 
now so well known, that a mere passing allusion to our new school 
and hospital will be sufficient to prove that, in their dual relation- 
ship, they are destined to become a means of developing the medical 
interest of Baltimore to a very important and decided extent. 
The Medical School of the Johns Hopkins University will be 
organized under the pressing influence of a necessity for a more 
thorough education in the science that it is to teach, and its 
government, bound by no restrictions, but on the contrary given 14 
Prospective Advantages of Baltimore as a Medical Centre. 
every latitude to do what is wisest and best, will certainly not fail to 
make use of the advantages at its command. To sum up these 
advantages, I may say: 
ist. That the school will be able to impose requirements for 
matriculation, to lengthen its courses of instruction, and to raise 
its standard of graduation without any regard to the pecuniary 
loss from small classes of students. 
2nd. That it will have ample means to carry out any plan of 
teaching that, with the improvements of science, may be developed. 
3rd. That it will have as part of its curriculum the care and 
management of a model hospital, built and arranged especially 
for clinical purposes. 
4th. That the buildings being erected especially for the pur- 
poses of a medical school, they will be supplied with all 
modern appliances for laboratory instruction and original in- 
vestigation. 
5th. That it will have available the laboratories and expensive 
apparatus of the biological and chemical departments of the 
university. 
6th. That it will have the training school for nurses, which will 
be made an especial feature of the hospital. 
Each item in this summary is important, and taken together, 
in their total significance, they give the ground work necessary 
for a high grade of medical school. That the embodiment of 
these advantages into one curriculum will prove attractive to the 
better class of medical students there can be no doubt, and it is 
equally as reasonable to suppose that the course of instruction, 
adopted by the Johns Hopkins school, will establish an example 
which should exert a beneficial influence on the medical schools 
throughout the country. 
And now, having given this short account of the three institu- 
tions which are soon to commence their career in our midst, 
it only remains for me to call attention to the advantages that 
may be derived from this triple increment to our medical resources. 
The foregoing considerations will, I think, show the truth of 
what I said in the commencement of this paper concerning the 
peculiar adaptability of these endowments to the present wants of John Van Bibber. 
15 
the medical profession. The development of their separate 
purposes will give the profession of Baltimore the oppor- 
tunity of working up under very propitious surroundings, and 
with very substantial aid, three questions which are now being 
agitated in the journals of the country, and it may be that their 
solution, or many collateral improvements will result from the 
activity and usefulness of these institutions. 
It will be admitted by every one that it has never before oc- 
curred to any city to be on the eve of inaugurating into activity 
such important and rich bequests; bequests which seem so to fit 
the wants and interests of the times, which will be of such signal 
use to medical men separately, and if worked together will make 
a strength and power for the advancment of medical science, 
which is enjoyed by no other city in this coutry. 
To discuss further the medical advantages of Baltimore, which 
in common with other large cities are great, would be out of the 
scope of this article. It is intended only to show what opportu- 
nities our new school, asylum, and sanitarium will bring us, what 
invitations they throw out to the profession for interest and sup- 
port, what positions they will develop for us, and what may be the 
literary results of their respective administrations. The other 
institutions of Baltimore are well known, they have existed for 
years, and they will no doubt continue to grow in prosperity and 
influence, adding the value of their prestige to the vigor of newer 
institutions, and in many ways each can supplement the other in 
their various roles. 
With this outlook we can scarcely fail to realize what good 
fortune seems to hold out to us, the possibility that Baltimore 
may become celebrated as a city of model institutions, and as an 
important centre of education and medical learning. The future 
indeed looks fair, and it remains to be seen if we shall act with 
energy in the present, if the weeks, months and years will add 
their necessary sum of work to the attainment of this ambition, 
to the developement of such grand prospects into a secure and 
permanent realization.