DESCRIPTION 
OF 
The Johns Hopkins Hospital PUBLICATIONS 
OF THE 
JOHNS HOPKINS HOSPITAL 
DESCRIPTION 
OF 
v 
The Johns Hopkins Hospital 
BY 
JOHN S. BILLINGS, M. D. 
BALTIMORE 
1890 PRESS OF ISAAC FRI EDEN WALD 
BALTIMORE MINUTE ADOPTED BY THE BOARD OF TRUSTEES OF THE 
JOHNS HOPKINS HOSPITAL, MAY 13, 1890. 
“Dr. John S. Billings, the Medical Adviser to the President 
and Building Committee, presented to the Board the description of 
the Hospital which he had prepared, in compliance with the 
request made to him by the resolution heretofore passed to that 
end. In adopting it as a full and accurate account of the methods 
of construction of the Hospital, the arrangement of the wards and 
service buildings, and the system of heating, ventilation, plumbing, 
water supply and drainage, the Board desires to acknowledge and 
record that whatever excellence the institution can claim as an 
advance in hospital construction is due to the great and deserved 
eminence in medical and sanitary science of Dr. Billings, and his 
familiar knowledge of hospital relief of suffering, obtained 
through his Governmental service in that department in the late 
war; his extensive and discerning research in what has been done 
elsewhere, and his aptitude in appreciating, perfecting and con- 
structing all appliances for the proper nursing and cure of disease 
in public institutions; and the watchful zeal with which he has 
directed every step from the beginning. 
“ For all this the Board hereby tenders to him its thanks for the 
results which are embodied in the book now submitted and 
approved.” CONTENTS. 
Introductory : 
Letter of Dr. John S. Billings, 9 
Letter of Johns Hopkins to the Trustees, 11 
Preparation of Plans, 15 
Addresses at the Opening of the Hospital: 
Address of Francis T. King, 23 
Address of John S. Billings, 29 
Statistics of Construction, . . . . . . . . . .50 
The Hospital Grounds, 53 
General Arrangement of Buildings on Grounds, 59 
General Construction of Buildings : 
General Statements, 63 
Heating and Ventilation, 66 
Water Supply, 76 
Sewage Disposal and House Drainage, 77 
Lighting, ............. 80 
Clocks, 81 
Telephones, 81 
The Administration Building, ......... 81 
The Pay Wards, with one woodcut, ....... 84 
The Common Wards, 86 
The Octagon Ward, 92 
The Isolating Ward, 94 
The Kitchen Building, with three woodcuts, . . . . .97 
The Nurses’ Home, 101 
The Amphitheatre and Dispensary, ....... 104 
The Pathological Building, with five woodcuts, ..... 106 
The Laundry, x . .114 
The Bath House, 116 4 
CONTENTS. 
PLATES. 
1. Front view of buildings from northeast. 
2. Block plan. 
3. Rear view of buildings and grounds from southeast. 
4. Corridor. Interior view, looking south from kitchen. 
5. General heating plans, with sections. 
6. Pipe Tunnel. Interior view looking east. 
7. Pipe Tunnel. Interior view showing expansion joint. 
8. Administration Building. Main floor plan. 
9. Administration Building. Second floor plan. 
10. Administration Building. Longitudinal section. 
11. Administration Building. Transverse section through rotunda. 
12. Administration Building. Transverse sections through north and east wings. 
13. Administration Building. View in trustees’ room. 
14. Pay Ward. Main floor plan and transverse section through centre. 
15. Pay Ward. Longitudinal and transverse sections. 
16. Pay Ward. View in rooms. 
17. Octagon Ward. Basement and first floor plans. 
18. Octagon Ward. Longitudinal and transverse sections. 
19. Octagon Ward. Interior view. 
20. Octagon Ward. View from southeast. 
21. Common Ward. Main floor plan and sections. 
22. Common Ward. Basement and attic floor plans. 
23. Common Ward. Longitudinal section, north and south. 
24. Common Ward. Interior view. 
25. Common Ward. View from southeast. 
26. Isolating Ward. Plans and transverse section. 
27. Isolating Ward. Longitudinal section. 
28. Isolating Ward. View from northeast. 
29. Kitchen Building. Main and second floor plans. 
30. Kitchen Building. Basement floor plan, with section of cold rooms. 
31. Kitchen Building. Section east and west. CONTENTS. 
5 
32. Kitchen Building. Section north and south. 
33. Kitchen Building. View in kitchen. 
34. Kitchen Building. Plan of cellar and vaults. 
35. Kitchen Building. View in boiler room. 
36. Nurses’ Home. Basement floor plan. 
37. Nurses’ Home. Main floor plan. 
38. Nurses’ Home. Second and third floor plans. 
39. Nurses’ Home. Section north and south. 
40. Nurses’ Home. Section east and west. 
41. Nurses’ Home. View from northeast. 
42. Nurses’ Home. View in main hall. 
43. Nurses’ Home. View in parlor. 
44. Apothecary’s Building. Plans and sections. 
45. Apothecary’s Building. View from southeast. 
46. Dispensary. Plan and sections. 
47. Dispensary. View in waiting room. 
48. Amphitheatre. Plan and section. 
49. Amphitheatre. View in lecture hall. 
50. Dispensary and Amphitheatre. View from north. 
51. Pathological Building. Main and second floor plans.. 
52. Pathological Building. Longitudinal and transverse sections. 
53. Pathological Building. View in bacteriological rooms. 
54. Laundry. Basement and main floor plans. 
55. Laundry. Longitudinal and transverse sections. 
56. Bath House. Plans and sections. INTRODUCTORY Washington, D. C., January 1, 1890. 
Francis T. King, Esq., 
President of the Board of Trustees, The Johns Hopkins Hospital. 
Dear Sir:—In accordance with a request to that effect from the 
Board of Trustees, I have the honor to present herewith a descrip- 
tion of the Johns Hopkins Hospital, with plans, sections, and other 
illustrations. The preparation of this work has brought vividly 
to mind the many conferences which we have had over the prelimi- 
nary sketches and estimates and the finished drawings of which 
many of these are reproductions, and the gradual development of 
the ideas which are now embodied in the group of buildings, and 
the arrangement of the grounds which are here described. 
Permit me to express my high appreciation of, and sincere 
thanks for, the honor of having been called upon by the Trustees 
to act as their medical adviser in this important work, and for the 
great courtesy and kindness with which my recommendations 
have uniformly been received and considered. The plans of these 
buildings embody the counsels and suggestions of many men and 
women, both in this country and abroad, but among them all there 
is no one who has had more to do with shaping the final results 
than yourself, and it is proper that this fact should be distinctly 
stated and recorded. In the preparation of this paper I am much 
indebted to Mr. W. H. Leeke, the Superintendent of Construction, 
and to Dr. Hurd, the present Superintendent of the Hospital, for 
data and suggestions, and to Mr. George Archer for the very 
careful drawings from which the illustrations have been prepared. 10 
THE JOHNS HOPKINS HOSPITAL. 
Hoping, and believing, that the work of this Hospital in relieving 
suffering and preventing death, in educating physicians and nurses, 
and in increasing knowledge, will in the future more than justify 
the labor and money expended upon its construction, 
I remain, with great respect, 
Yours very sincerely, 
John S. Billings. LETTER OF JOHNS HOPKINS TO THE TRUSTEES. 
Baltimore, March 10, 1873. 
To Francis T. King, President, and John W. Garrett, Hon. George 
W. Dobbin, Galloway Cheston, Thomas M. Smith, William 
Hopkins, Richard M. Janney, Joseph Merrefield, Francis 
White, Lewis N. Hopkins, Alan P. Smith, and Charles J. 
M. Gwinn, Trustees of “ The Johns Hopkins Hospital.” 
Gentlemen:—I have given you, in your capacity of Trustees, 
thirteen acres of land, situated in the city of Baltimore, and 
bounded by Wolfe, Monument, Broadway and Jefferson streets, 
upon which I desire you to erect a Hospital. 
It will be necessary to devote the present year to the grading of 
the surface, to its proper drainage, to the laying out of the grounds, 
and to the most careful and deliberate choice of a plan for the 
erection and arrangement of the buildings. 
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 any other institution of like character in this country or in 
Europe. 
It will, therefore, be your duty to obtain the advice and assistance 
of those, at home and abroad, who have achieved the greatest 
success in the construction and management of Hospitals. 12 
THE JOHNS HOPKINS HOSPITAL. 
I cannot press this injunction too strongly upon yon, because 
the usefulness of this charity will greatly depend upon the plan 
which you may adopt for the construction and arrangement of the 
buildings. It is my desire that you should complete this portion of 
your labor during the current year, and be in readiness to commence 
the building of the Hospital in the spring of 1874. 
It will be your duty, hereafter, to provide for the erection, upon 
other ground, of suitable buildings for the reception, maintenance 
and education of orphan colored children. 
I direct you to provide accommodation for three or four 
hundred children of this class; and you are also authorized to 
receive into this asylum, at your discretion, as belonging to such 
class, colored children who have lost one parent only, and, in 
exceptional cases, to receive colored children who are nQt orphans, 
but who may be in such circumstances as to require the aid of the 
charity. 
I desire that you shall apply the yearly sum of twenty thousand 
dollars, or so much thereof as may be necessary of the revenue of 
the property which you will hereafter receive, to the maintenance 
of the Orphan’s Home intended for such children. 
In order to enable you to carry my wishes into full effect, I will 
now and in each succeeding year during my life, until the Hospital 
buildings are fully completed, and in readiness to receive patients, 
place at your disposal the sum of one hundred thousand dollars. 
In addition to the gift, already made to you, of the thirteen 
acres of land in the city of Baltimore, upon which the Hospital will 
be built, I have dedicated to its support and to the payment of the 
annual sum provided to be paid for the support of the Orphan’s 
Home, property which you may safely estimate as worth, to-day, LETTER OF JOHNS HOPKINS. 
13 
two millions of dollars, and from which your corporation will 
certainly receive a yearly revenue of one hundred and twenty 
thousand dollars; and which time and your diligent care will make 
more largely productive. 
If the Hospital and Orphan’s Home are not built at my death, 
it will be your duty to apply the income arising from the property 
so dedicated, to their completion. When they are built, the income 
from that property will suffice for their maintenance. 
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 shall be your duty to make 
such division of the sexes and patients among the several wards of 
the Hospital as will best promote the actual usefulness of the 
charity. 
You will also provide for the reception of a limited number of 
patients who are able to make compensation for the room and 
attention they may require. The money received from such 
persons will enable you to appropriate a larger sum for the relief 
of the sufferings of that class which I direct you to admit free of 
charge; and you will thus be enabled to afford to strangers, and to 
those of your own people who have no friends or relations to care 
for them in sickness, and who are not objects of charity, the 
advantages of careful and skilful treatment. 
It will be your special duty to secure for the service of the Hos- 
pital surgeons and physicians of the highest character and greatest 
skill. 14 
THE JOHNS HOPKINS HOSPITAL. 
I desire yon to establish in connection with the Hospital a train- 
ing school for female nurses. This provision will secure the services 
of women competent to care for the sick in the Hospital wards, and 
will enable you to benefit the whole community by supplying it 
with a class of trained and experienced nurses. 
I wish the large grounds surrounding the Hospital buildings to 
be properly enclosed by iron railings, and 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. 
I desire that you should in due season provide for a site and 
buildings, of such description and at such distance from the city as 
your judgment shall approve, for the reception of convalescent 
patients. You will be able in this way to hasten the recovery of 
the sick, and to have always room in the main Hospital buildings 
for other sick persons requiring immediate medical or surgical 
treatment. 
It is my especial request that the influence of religion should be 
felt in and impressed upon the whole management of the Hos- 
pital; but I desire, nevertheless, that the administration of the 
charity shall be undisturbed by sectarian influence, discipline or 
control. 
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. 
I have felt it to be my duty to bring these subjects to your par- 
ticular attention, knowing that you will conform to the wishes 
which I thus definitely express. PREPARATION OF PLANS. 
15 
In other particulars I leave your Board to the exercise of its dis- 
cretion, believing that your good judgment and experience in life 
will enable you to make this charity a substantial benefit to the 
community. 
I am, very respectfully, your friend, 
Johns Hopkins. 
After careful consideration of the various questions arising 
under the will and letter of instructions, the Trustees authorized 
their Building Committee to confer with five physicians, chosen 
from different parts of the country, who had made hospitals their 
study, and to obtain from them advice. This was done in the early 
part of 1875, the physicians selected being Hr. Horton Folsom, of 
Boston; Hr. Stephen Smith, of Hew York; Hr. Caspar Morris, of 
Philadelphia; Hr. Joseph Jones, of Hew Orleans; and Hr. John S. 
Billings, of the United States Army; to each of whom a letter was 
sent, of which the following is a copy: 
Office of the Johns Hopkins Hospital, 
Baltimore, March 6, 1875. 
Dear Sir:—The late Johns Hopkins, a rich citizen of Baltimore, 
bequeathed to trustees a munificent foundation for the building 
and support of a hospital, mainly intended for the benefit of the 
indigent sick of the city of Baltimore and its environs. 
The letter which, some time before his death, he addressed to his 
trustees will best describe the object he had in view, and a copy of 
it accompanies this communication. 16 
THE JOHNS HOPKINS HOSPITAL. 
The execution of this munificent charitable purpose has been 
entrusted to a body of trustees, none of whom, with a single excep- 
tion, belong to the medical profession, and, apart from the injunc- 
tion which the founder’s letter imposes upon them, “ to obtain the 
advice and assistance of those, at home and abroad, who have 
achieved the greatest success in the construction and management 
of hospitals,” they would have distrusted their own ability to cope 
with a subject so strictly scientific and professional, without first 
resorting to the best sources of information within their reach. 
To this end the Board of Trustees has authorized their Building 
Committee “to confer with five distinguished physicians, chosen 
from different parts of the country, who have made hospitals their 
study, and obtain from them such advice as they may need, and to 
compensate them for it.” It is in execution of the authority thus 
conferred that this communication is addressed to you, and you 
are invited to make such response to it as your fulness of informa- 
tion, stimulated by the importance to humanity of the subject, 
may prompt you to. 
Besides the information afforded by the letter, some additions 
are needful to be made, and some corrections which altered circum- 
stances require. 
You will observe that the site of the proposed building is there 
designated; and, as we assume that you are not acquainted with it, 
it is proper to add that it consists of an eligible piece of ground sit- 
uated in the eastern part of the city; that it is fourteen acres in 
extent, in the form of a parallelogram, 709x856 feet; that it is very 
elevated above the general level of the city, and commands an 
extensive view in all directions; that it is healthy, with complete 
surface drainage, whilst underground drainage may be accom- PREPARATION OF PLANS. 
17 
plishecl to tide-water; and that it is easily accessible by street rail- 
way and by paved streets, which bound the four sides of it. 
It is also proper to state that the endowment, which in the letter 
is spoken of as amounting to two millions of dollars, is now, by 
subsequent additions made to it by the founder, at least three 
millions of dollars, yielding an annual revenue of $180,000. 
Out of this income, the Hospital building proper, an establish- 
ment for convalescent patients, and a home for colored orphans are 
to be erected, after which the income will be applied to their support, 
as indicated in the letter. The means thus available we believe will 
be ample to execute the trust with as much speed as a due regard 
for doing it carefully will justify. 
You should also be told more fully than is done in the letter, 
that the founder of the Hospital, by his will, provided for the estab- 
lishment of a University, upon a site also devised by him, distant 
about a mile from the Hospital. To the uses of this institution he 
has also dedicated over three millions of dollars of his fortune, and 
he looked to the Hospital as furnishing a most desirable aid to 
medical education in the University. 
These preliminary statements are made in order that you may 
have a full view of the subject about which we now seek your 
advice. 
It will readily occur to yon that the subject most prominent at 
this day, in the professional consideration of the hospital question 
as applicable to cities, is the choice between the pavilion system, 
which admits buildings of two or more stories in height perma- 
nently constructed, of which the Herbert Hospital in England and 
several in this country may be considered good modern types; and 
the barracks system of one-story structures, destructible in whole 18 
THE JOHNS HOPKINS HOSPITAL. 
or in part, which were so successfully used in the late war, hut of 
which no extensive and prominent example is now in operation. 
In determining the claims of these systems respectively, as appli- 
cable to us, careful regard should be had to the character of patients 
intended to be the subjects of onr nursing, so as to avoid the error 
of building an institution which shall prove not to meet the require- 
ments demanded in the care and cure of women and children, and 
the generally enfeebled inhabitants of the sheltered lanes and 
alleys, however much such a structure may have been a success 
when applied to the uses of hardy men in the field. 
We presume there must be some general principles of hospital 
hygiene and of hospital treatment fixed and immutable in their 
character, the discovery and proof of which are the result of close, 
careful recorded observation and judgment. If these principles 
can be best applied through the agency of the pavilion system, we 
wish to adopt that; if by the barrack system, then we will avail 
ourselves of that form of construction; and if the true rule for our 
guidance shall be found in the selection of the good features of 
each, and the combining of them all into a harmonious middle 
course, then we desire to make that selection and combination.. 
In whatever plan may be adopted, we presume there will be no 
departure from the now very general method of a central adminis- 
tration building, with wards for the treatment of the sick as 
carefully separated therefrom and from each other as practicable. 
To the details of this building we especially invite your attention, 
the objects to be accommodated in it, the amount of room to be 
given to each, and their location with respect to each other for 
convenience and use. 
Comprehended within these details will be the consideration of PREPARATION OF PLANS. 
19 
the accommodations needed for the training school for nurses, and 
whether they should be within the hospital building or separated 
from it; and as the Hospital will be used for clinical teaching to 
the medical classes of the University, it will be needful to consider 
what accommodations that subject will require, and how and where 
they should be provided. 
As closely connected therewith, we should be glad to have your 
advice as to the most judicious location of the medical school 
buildings of the University; that is, whether they should be in 
close proximity to the Hospital or whether they can, with equal 
profit and convenience, be erected with the other buildings of the 
University, a mile distant. 
In the same general category of things to be provided would be 
included suitable appliances for promptly and efficiently caring for 
accident cases, so numerous in a large city, and a dispensary for 
out-of-door relief, both by the dispensing of medicines and the 
giving of medical advice. 
In the treatment of these subjects, it is not to be expected that 
you will present architectural drawings, but if your views can be 
illustrated by such suggestive sketches as your pen or pencil can 
throw off in aid of your thoughts, they will be gratefully received, 
and placed in the hands of our architect for more elaborate 
expression. 
Certainly not second in importance to any of the matters you 
are invited to instruct us upon, are those of ventilation and heating, 
and the kindred subjects of light and sunshine, as curative agents. 
The various methods of heating, combined with ventilation, form 
professional problems about which the most experienced and best 
informed medical minds seem to be far from being united. Whether 20 
THE JOHNS HOPKINS HOSPITAL. 
heating should be accomplished by steam or hot water pipes radiating 
their heat directly into the room, or by the same agency imparting 
heat to air in chambers, to be thence sent into the apartments to 
be warmed; or by open fires in the angles or side walls; or by 
ventilating stoves in the centre of the ward, or by a combination of 
these methods, are subjects upon which opinions widely differ;—and 
whether ventilation should be accomplished by what is called the 
natural method, through doors, windows, and unavoidable leakages, 
or through flues and ducts acted upon by the differing temperature 
of the outer and inner air, or by enforced currents set in motion by 
fans, blowers, or other mechanical contrivances, are points which 
have equally learned advocates and opponents. To solve for our- 
selves these difficult problems, we invoke the aid of your experience 
and thoughtful judgment. 
The location of the kitchen and its appurtenant offices is a 
subject of great practical importance upon which new and, so far 
as we know, hitherto untried suggestions have been made. Whether 
it should be in a separate building from those devoted to adminis- 
tration or to the nursing and care of patients, or in the basement 
of some one of them, or in the upper story of any, are points open 
to discussion and to be carefully considered. 
Upon the subject of management, with its numerous details of 
medical attendance, resident and occasional, nursing, domestic 
advice, and, indeed, with reference to the whole matter, our wish is 
to put you in our place so far as to learn from you how you would 
execute the trust we are now seeking to be instructed about, if it 
were confided to you. 
We beg you to consider what has been said as mere suggestions 
of some of the topics to be considered, and not as limitations either PREPARATION OF PLANS. 
21 
upon the subjects to be treated or upon your mode of treating them, 
and we ask your zealous co-operation in this humane subject, to 
which it is understood you have given great attention. 
It is right that you should also know that, besides the request 
now made to you, a copy of this letter has been addressed to four 
other distinguished members of your profession, whose communi- 
cations in reply, together with yours, will be printed in a volume 
for our private use, and for such useful distribution as so valuable 
a contribution to medical literature will be well entitled to. 
It only remains for us to add that, if you will kindly serve us 
and the cause of suffering humanity in the way we have indicated, 
we shall hope to receive your paper by the first of May. 
Please acknowledge the receipt of this, and oblige, 
Very respectfully yours, etc., 
Francis T. King, 
President of Board of Trustees. ADDRESS DELIVERED AT THE OPENING OF THE 
HOSPITAL, MAY 7, 1889. 
By Francis T. King, 
President of the Board of Trustees. 
It is my pleasant duty, in behalf of the Trustees of the Johns 
Hopkins Hospital, to offer you a cordial welcome, and to express 
our high appreciation of the interest in our work which is manifested 
by your presence here to-day. 
It cannot be a matter of small or temporary importance that 
brings to this opening the chief executives of our State and our 
City, so many of our distinguished men in all branches of the public 
service, so many well-known professional men from distant cities 
and countries, and so many of our own most prominent and public- 
spirited citizens; and it gives us a renewed sense of our responsi- 
bilities and duties to find that we are to give an account of what we 
have done in the past and what we hope to do in the future to such 
an audience as we see before and around us. 
It encourages us to hope and believe that the trust which has 
been confided to us is one not only of local but of national and even 
of international importance, and we have abundant evidence in the 
many letters which have come to us from beyond the sea, that the 
opening of this Hospital and the commencement of its philanthropic, 
educational and scientific work, is a matter which interests many 
men and women in Europe as well as in all parts of this country. 
Johns Hopkins did not leave a hospital; what he did leave was 
a complicated piece of machinery in the form of various investments THE JOHNS HOPKINS HOSPITAL. 
capable of evolving the power required to construct and maintain 
a hospital, for in this sense money is power. This machinery 
requires constant adjustment and looking after, and for this part 
of the work the Trustees are solely responsible. 
When I tell you that these seventeen buildings have been con- 
structed and furnished, and these fourteen and a half acres enclosed 
and beautified as you see them to-day, not only without taking a 
dollar from the principal placed in the hands of the Trustees, but 
with an actual increase of the endowment by judicious investments 
by the sum of one hundred and thirteen thousand dollars, I think it 
may be justly claimed that the Trustees have not failed in this part 
of their duty. 
The speakers who are to follow me will tell you of the plqns of 
the Hospital, of the objects which have been kept in view in the 
preparation of the methods adopted to secure the best possible 
conditions for the treatment of the sick and wounded who come to 
it, of its relations to medical education, to improvement of the 
science and art of medicine, and to the other great trust of Johns 
Hopkins with which it is so intimately connected—namely, the 
University. 
I will therefore devote my closing remarks to one or two personal 
reminiscences of the man to whom we owe the magnificent possi- 
bilities of his two great gifts. 
I need not speak of the birth, education and business career of 
Johns Hopkins, with which most of you are familiar, as he was a 
native of this State. 
What were the motives which led him to found his two great 
trusts, each with an endowment of nearly three millions and a half 
of dollars? Was it the act of a man of great wealth without ADDEESSES AT OPENING OF HOSPITAL. 
25 
children, who, near the close of life, wished to build a monument to 
his memory ? No, not at all; it was done conscientiously, with all 
the deliberation, judgment and grasp of subjects which characterized 
him through life, first as a successful merchant, then as a banker. 
I remember, many years ago, while spending an evening at 
Clifton, I heard Johns Hopkins say, in reply to a question put to 
him by an intimate friend of his own age, why he had never made 
a will, that he looked upon his wealth as a gift, for which he was 
accountable; that it grew and piled up from a small beginning, he 
hardly knew how; but he was sure it was given to him for a 
purpose, and he did not believe he would die before he was given to 
see how he should dispose of his estate. “ This wealth,” he repeated, 
“ is my stewardship.” 
Again, when his Trustees arranged to visit the hospitals of 
Philadelphia, New York and Boston, he was asked to accompany 
them; his reply was, “You surely do not want to parade me around 
the country. I would not for a moment think of going; it would 
be in very bad taste, to say the least of it. I have carefully chosen 
my Trustees, and have committed everything to them. I will 
furnish the means, and they must build the Hospital.” 
Johns Hopkins purchased this site himself, which then consisted 
of the grounds of the Maryland Insane Asylum, two large lots and 
seventeen dwellings, in all fourteen and a half acres of ground, in 
an improved portion of the city, closing two public streets, thus at 
once determining the magnitude and character of his Hospital. 
Let Johns Hopkins again speak for himself in the words of his 
letter to his trustees, which show the wide scope of his interest in 
all conditions of mankind : 
“You shall receive into the Hospital the indigent sick of this city THE JOHNS HOPKINS HOSPITAL. 
and its environs, without regard to sex, age or color, who may 
require surgical or medical treatment, and the poor of this City and 
State, of all races, who are stricken down by any casualty. 
“You will also provide for patients who are able to make com- 
pensation for the room and attention they may require, and thus be 
enabled to afford to strangers and to those of our own people who 
have no friends or relatives to care for them in sickness, and who 
are not objects of charity, the advantages of careful and skilful 
treatment. 
“ It will be your duty hereafter to provide for the erection, upon 
other ground, of suitable buildings for the reception, maintenance 
and education of orphan colored children, for which purpose I desire 
that you shall apply the yearly sum of twenty thousand dollars, or 
so much thereof as may be necessary.” 
I wish to say, on behalf of the Trustees, a few words of recognition 
to all who have labored to bring these plans to their conclusion ; to 
the medical adviser, whose invaluable services have covered more 
than ten years; to the President of the University, who has so ably 
aided in organizing; to the architects and builders, and to those 
who have had hut occasional opportunities to serve us, but who 
have freely contributed their wisdom and experience whenever 
called upon, and especially to the physicians and surgeons, the 
managers of other hospitals, the superintendents of training schools 
for nurses, and to many others, at home and abroad, whose kind 
co-operation has been most serviceable. 
Many of these friends are within the sound of my voice, others 
far away; none are forgotten; not a few sent us letters which show 
their lively interest in this occasion. 
As Johns Hopkins was brought up by godly parents—members ADDRESSES AT OPENING OF HOSPITAL. 
27 
of the Society of Friends—I should have been glad if we might 
have heard the voice of Whittier, the Quaker poet, but in the letter 
which I hold in my hand he pleads his age and illness as an excuse 
for his silence. He expresses his pleasure in seeing that the wise 
and benevolent design of the founder has been so well carried out, 
and his hope that the example of Johns Hopkins will not be lost 
upon his country. 
To the words of his letter I will venture to add this verse, which 
he wrote for another occasion, but which is equally appropriate to 
this:— 
“Not vainly the gift of its founder was made ; 
Not prayerless the stones of its corner were laid ; 
To Him be the glory forever !—we bear 
To the Lord of the harvest our wheat with the tare ; 
What we lack in our work, may He fin'd in our will, 
And winnow in mercy our good from the ill! ” ADDRESS, DELIVERED AT THE OPENING OF THE HOS- 
PITAL, MAY 7, 1889, ON THE PLANS AND PURPOSES 
OF THE JOHNS HOPKINS HOSPITAL. 
By John S. Billings, M. D., 
Surgeon, U. S. Army. 
The third paragraph of the letter of instructions communicated 
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 institution 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 conversations 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 30 
THE JOHNS HOPKINS HOSPITAL. 
indicates, nevertheless, a conception of much more definite char- 
acter, and one which had been the subject of more discussion and 
reflection than his scheme for a University. Whether this be so or 
not, I am at all events sure that his trustees have endeavored 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 he presently explained, and the end of 
which will be, as we hope and believe, to make life happier for 
millions 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 manifold perplexities which at 
first attended their decisions and movements. Only one or two of 
them had any knowledge of hospital matters; most of them were 
business 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 equaled, but 
all other hospitals in this country or in Europe—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 ADDRESSES AT OPENING OF HOSPITAL. 
31 
be temporary or permanent; of wood, brick, or marble; in one large 
building or in many; and many other like points, before even the 
preparation 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 satisfied 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 architect of 
the Board, and the result was a set of sketch plans which he took 
abroad and upon which he obtained much counsel and criticism, 
examining at the same time the model hospitals 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 settled 
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 scheme was settled, and the rest was 
comparatively easy for the time being. 
Let us now for a few moments consider the broad general 
principles which governed the trustees in the adoption of this plan. 
The first hospitals were established to give shelter and food to the 
sick poor, especially those who gathered in cities. Gradually 32 
THE JOHNS HOPKINS HOSPITAL. 
physicians found that they could learn much in these aggregations 
of suffering, and that they afforded the means of teaching others; 
but 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 properly 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 welfare of the sick which can hardly be found in 
any private house, and also freedom from noise and many petty 
annoyances, 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 who 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 possible. A hospital may 
do harm by its foul air, by spreading 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 ventilation, isolation, and 
nursing are such as to entirely do away with this danger. There 
is another danger connected with free hospitals and dispensaries 
which is of quite a different kind, and to which I can here only ADDRESSES AT OPENING OF HOSPITAL. 
33 
allude; namely, the danger of promoting negligence, shiftlessness, 
laziness, and vice by offering free relief from their consequences— 
the danger of pauperizing people. This is a danger connected with 
organization and management 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 hospital 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 treatment. Moreover, the very act of teaching clarifies and crys- 
tallizes his own knowledge; in attempting to explain, the dark 
places become prominent and demand investigation; 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 under- 
stood 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.” 
How, 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 34 
THE JOHNS HOPKINS HOSPITAL. 
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 he taken in hand. One of these principles is the thorough 
teaching of that which is known; another 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 hos- 
pital, 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 dispensary for the treat- 
ment 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 extended, 
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 appear- 
ance 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 ADDRESSES AT OPENING OF HOSPITAL. 
35 
should be of the same character, so far as their purpose would 
admit. 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. 
Bearing in mind, then, these main principles, to provide 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 orna- 
mental and attractive, 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 venti- 
lation 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 Bal- 
timore may vary from 103° in the shade to 3° below zero F., hence 
its perfect hospital must be one which would answer for the tropics 
or for northern Bussia. 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 he exactly regulated to any tempera- 36 
THE JOHNS HOPKINS HOSPITAL. 
ture between 150° F. and the temperature of the external air by 
simply regulating the velocity of the flow of water by the valves 
attached 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 60° F., to suit the needs of different 
cases. The 80,000 gallons of water contained in this heating appa- 
ratus go round and round, carrying heat from the furnaces to the 
wards; but every building has its own independent means of ven- 
tilation, and it is not possible to go from one ward into another 
without going into the open air on the way, so that foul air, if any 
forms, cannot spread from one building to another. Nevertheless, 
the buildings are so connected 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 of obstruc- 
tion and fully exposed to the sun, the end of the ward being a large 
bay window looking 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 arrangement for easy cleansing, and to prevent possible accu- 
mulations of dust in corners and crevices. Corners are to a great ADDRESSES AT OPENING OF HOSPITAL. 
extent done away with, and easy curves given in their place; even 
at the junction 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 fashionable, and take the 
place of the old mop-hoard 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 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, apothecaries1 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 reception of accidents and emergencies of 
all kinds. It the second place, provision is made for at least thirty 
students to reside constantly in the hospital to 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 themselves 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 diplo- 38 
THE JOHNS HOPKINS HOSPITAL. 
mas. They have to get this experience on their first patients, and 
sometimes the experience is rather hard—for both doctor and patient. 
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 conveniences, 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 practical applications of the 
laws of hygiene to heating, ventilation, 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 beneath 
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 increas- 
ing 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 
heating 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 currents with those drawn downward. 
One structure is very largely devoted to and fitted for experi- 
mental research, and that is the pathological laboratory, where the 
causes, processes, and results of disease are to be studied. Upon ADDRESSES AT OPENING OF HOSPITAL. 
39 
the results obtained 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 business light, 
the value of real estate and the rate of taxation 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 preliminary steps to far greater and better knowledge of how 
to prevent or to treat them than we now have. The probable length 
of life of the new-born 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 must open fresh win- 
dows 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 experience 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 suc- 
cess 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 cannot take the place of knowledge, and this kind of knowl- 40 
THE JOHNS HOPKINS HOSPITAL. 
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 them with the attrac- 
tive and comfortable home which they deserve, and to send them 
where they are most needed, with provision 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 hand- 
some building, separated from the others, and exclusively appro- 
priated to the female nurses, where each can have her own com- 
fortable 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. ADDRESSES AT OPENING OF HOSPITAL. 
41 
The fifth object which I mentioned as having been kept in view 
in the plan and construction of these buildings 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 
prescribe for the patients, and having bath-rooms, and a small 
apothecaries’ establishment for the issue of the medicines ordered. 
This building is connected with the amphitheatre 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 somewhat 
peculiar, and merit examination. 
With regard to the architectural design and external 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’s 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 Biver 
stone, and of molded terra-cotta of the color of the brick. The 
external designs for these, as for all the other buildings, were fur- 42 
THE JOHNS HOPKINS HOSPITAL. 
nished by Messrs. Cabot and 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 intelligent supervision as it progressed. For this supervision 
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 sugges- 
tions 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 exe- 
cuted by Messrs. Bartlett, Hayward & Co., of this city. I should 
like to go on and mention the names of a number of other persons 
who have done good work here, but want of time forbids. 
Briefly and incompletely as I have sketched these salient points 
of the plans and purposes of this Hospital, I hope I have, neverthe- 
less, shown you that it is intended for other purposes besides pro- 
viding 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 abundant 
need of their existence and work also; hut 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. ADDEESSES AT OPENING OF HOSPITAL. 
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 begin- 
ning, however, it has been recognized that the buildings and 
machinery are only means to an end, 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 organiza- 
tion 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, nevertheless, 
a tolerably definite conception as to the ideas, mode of work, char- 
acter and wants of those who are to constitute this staff, and when* 
the time came for selecting, it was made by this standard. 
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 scientific men and physicians with 
regard to it. From the time of the first announcement of the Hop- 
kins bequests to the present, these men, all over the world, have 
been keenly interested in the plans and methods adopted in carry- 
ing them out. Whenever and wherever the problems 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 med- 
ical schools, and have been copied with more or less modification 
in some of our latest hospitals. 44 
THE JOHNS HOPKINS HOSPITAL. 
What is it, then, that the physicians want ? Is it more physi- 
cians, 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 over- 
burdened 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 increas- 
ing 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 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 become its stud- 
ents 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, includ- 
ing actual work in properly fitted laboratories, and that after this 
they will be brought into contact with the sick, and thus obtain 
practical experience of the duties and responsibilities of the practi- 
tioner 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 educa- 
tion should be conducted, and what should be required of the 
candidate for the degree of doctor of medicine. ADDRESSES AT OPENING OF HOSPITAL. 
45 
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 connec- 
tion 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 are secured common 
interests and mutual influence, and it is hoped, therefore, that the 
necessary details of technological instruction will be arranged in 
accordance with and subordinate to the broad principles of scientific 
culture 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 endeaver 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, 46 
.THE JOHNS HOPKINS HOSPITAL. 
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 accomplish ? 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 improved methods of prevention and treatment, 
based on the advances in knowledge of the last fifty years, have 
already extended the average duration of life in civilized countries 
nearly five years, have prolonged thousands of useful and pro- 
ductive 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 according 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 
incumbent 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. ADDRESSES AT OPENING OF HOSPITAL. 
47 
To yon, the officers of this institution, and to you, men and 
women of Baltimore, there is now given the opportunity of giving 
powerful aid in this increase and diffusion 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 Univer- 
sity 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 sympathize 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; hut we must not be impatient. There 
are difficulties 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 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 co-operation, and by persistent effort. 
A hospital is a living organism, made up of many different 
parts having different functions, but all these must be in due pro- 
portion 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 fire; the reputation 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 48 
THE JOHNS HOPKINS HOSPITAL. 
need of new means of diagnosis, of new instruments and med- 
icines ; 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 com- 
munity in which it is placed. When the mediaeval priest estab- 
lished 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 stim- 
ulus to help their fellow-men; and doubtless the cause of humanity 
and religion was advanced more by the effect on the givers than on 
the receivers. It is the old lesson so often expounded, apparently 
so simple and yet so hard to learn, that true 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 outlook than the 
men of a thousand years ago. This Hospital 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 interest of suffering humanity, intimately connected with a 
great University, amply provided 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 improvement 
in its organization and methods, and enlargement of its activity 
and influence. ADDRESSES AT OPENING OF HOSPITAL. 
49 
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, with 
any other institution of like character in existence. STATISTICS OF CONSTEUCTION. 
The following summary of materials employed and work done 
is taken from the report of the Superintendent of Construction, Mr. 
Leeke, for the year 1887, and will serve to give some idea of the 
magnitude of the work :— 
Amount of excavation, 201,180 cubic yards. Amount of concrete 
foundations, 31,000 cubic feet. Amount of drain and terra-cotta 
pipe laid, 30,000 feet. Amount of concrete pavement laid, 107,272 
square feet. Amount of granolithic pavement laid, 42,457 square 
feet. Asphalt floors laid, 19,443 square feet. Number of bricks 
used, 20,100,000. Cement used, 22,000 barrels. Lumber, 2,522,000 
feet. Sash weights, 38 tons. Sash cord and chain, 32,763 feet—equal 
to six miles. Number of sash pulleys, 6000. Glass, 8200 lights. 
Nails, 1200 kegs. Iron, cast and wrought, 2557 tons. Copper, 304 
tons. Slate and metal roofing, 220,500 square feet. Length of pipe 
for hot water, steam, gas and water, from 4 inch to 26 inches in 
diameter, 233,600 feet—equal to 444 miles. Tile arches and parti- 
tions 203,377 square feet. Nailing, wrought iron, 2725 feet. Gas 
pipe railing, 1860 feet. Number of trees, shrubs and plants set out, 
3067. Amount of top soil brought on the ground for gardens, etc., 
9333 cart-loads. THE HOSPITAL GROUNDS THE HOSPITAL GEOUNDS. 
The grounds upon which the Hospital is built are located in East 
Baltimore, between Broadway and Wolfe Streets on the west and 
east, and between Monument and Jefferson Streets on the north 
and south; and include an area of about fourteen acres; measuring 
about 856 feet from east to west, and 708 feet from north to south. 
The streets which would have crossed this area have been perma- 
nently closed by Act of the Legislature of the State of Maryland. 
The grounds are on the side of a hill, near its summit, sloping 
towards the southwest, the lowest point being at the southwest 
corner—87 feet inches above mean tide—and the highest at the 
northeast corner—115 feet 6 inches above mean tide. This hill is 
part of a ridge formed by the great fault, or line of displacement 
of the earth’s crust, which runs along the Atlantic coast from below 
Savannah to the Hudson Biver, being a part of the original shore 
which has been several times sunk beneath the surface of the sea 
and again raised. While it was above the sea level, the clay of 
which it was formed was cut through by numerous streams; when 
it again sunk, the gullies thus formed were filled with sand and 
gravel. 
At one time, while it was submerged, a thin layer of bog iron 
was formed. The result of this alternate rising and sinking, of the 
formation of gullies and hollows in the clay, and the filling these 
with deposits of different material, has been to make the ground 
an irregular series of alternate layers of sand and stiff clays, much 
folded and contorted; and, in some places, small underground 54 
THE JOHNS HOPKINS HOSPITAL. 
basins filled with sand and water have formed in the clay. Two 
springs, and several wet and marshy places, existed on the ground, 
being outlets of water which fell upon that portion of the hill above 
the lot, and which came to these wet points through underlying sand- 
layers and veins. From a series of trial-borings, it was found that 
these sand-veins lay so deep on the eastern part of the ground that 
it was impossible to reach them there and thus cut off the supply. 
Hence it was necessary to use a somewhat elaborate system of 
drainage for the whole grounds in order to insure the dryness so 
requisite for a healthful site, and to obtain firm foundations for the 
buildings. Upon the northeast corner of the lot was situated the 
building of the old Maryland Asylum for the Insane, with which 
was connected a series of drain pipes and privy wells, the location 
of most of which had long been forgotten, and which were only 
discovered in the process of draining the grounds. Upon the west 
part of the grounds were three old cemeteries, the principal one 
being almost on the site occupied by the Administration Building. 
These were excavated, and not only were the skeletons and remains 
removed, but also all the contaminated earth around and beneath 
them for a considerable distance. The system of drainage adopted 
is shown on Plate No. 2. 
The nearest and most convenient point for discharging drainage 
into a public channel was the Harford Run, on Jefferson Street. 
By permission of the city authorities, a sixteen-inch tile pipe was laid 
from this point to the southwest corner of the Hospital lot, being a 
total distance of 1594 feet, with a fall of 53 feet. Subsequently, 
this was turned into the new Harford Run sewer at Eden Street. 
Where this drain crossed streets, iron pipe was used. At the south- 
west corner of the grounds, being at their lowest point, this sixteen- THE HOSPITAL GROUNDS. 
55 
inch main drain enters a large silt trap, a horizontal section of which 
has the shape of a quarter of a circle. The bottom of this silt trap 
is at the level of 75 feet 9 inches above mean tide, and the sixteen- 
inch pipe above referred to enters it 3 feet 9 inches above this level. 
To this silt trap is brought a large part of the drainage of the 
Hospital grounds ; it being distinctly understood that it has no 
connection in any way with sewerage, but is exclusively devoted 
to the removal of surface water, subsoil drainage, and of the dis- 
charges of water from the roofs. The location and direction of the 
drains connected with this silt trap are shown on the plan. 
One of the springs above referred to was situated near the south- 
east corner of the lot, just north of the laundry; the swamp referred 
to was located on the site of the male pay ward, between that and 
* 
the administration building. Another spring was situated near 
the northeast corner of the kitchen building. In order to avoid 
the expense of digging a trench about 850 feet long and 12 feet 
deep to drain this spring, it was determined to make use of a 
system of perpendicular drainage for this portion of the lot. Two 
wells of five feet diameter, indicated on the plans as drainage wells, 
between the amphitheatre and the kitchen, were sunk to water, 
where a bed of coarse gravel was struck at a depth of 77 feet. 
Into these wells the water from the spring, and some other small 
veins of water opened in excavating, were turned, and the result 
has been satisfactory. 
This system of soil drainage has continued to give excellent 
results, and has not only insured suitable dryness of the Hospital 
grounds, but also of the cellars on the opposite side of Broadway 
below the Hospital. The main drains connected with the silt trap, 
as shown on the plan, one on the south and the other on the west 56 
THE JOHNS HOPKINS HOSPITAL. 
side of the lot, are each ten inches in diameter at their point of dis- 
charge. By the side of each main drain pipe lies a four-inch tile drain 
for the removal of local moisture. These two large drains receive 
the discharge from four longitudinal pipe drains crossing the lot 
from east to west, into which tile pipe drains arranged as laterals 
open in the usual way, and also the tile drains laid around the 
foundations of each building. The total amount of tile drains laid 
is between five and six miles. 
The slope of the lot required a very considerable amount of 
grading in order to make it suitable for the plans of building 
adopted, the soil being removed from the north and east to form 
the terraces on the south and west. Not a single foot of the 
surface of the lot is now at its original level. 
* 
The air in this soil contains a high proportion of carbonic acid 
gas, three analyses made by Dr. Abbott of the air taken at a depth 
of five feet beneath the surface showing an average of 120 parts 
per 10,000, and this fact has to be constantly borne in mind in 
determining the amount of carbonic acid gas due to exhalation 
from the lungs and skins of inmates in the wards. In the course 
of digging the well situated south of the Nurses1 Home, it hap- 
pened several times that carbonic acid gas accumulated in the 
excavation to such an extent that the workmen could not remain 
in it until the gas had been removed by mechanical means. GENERAL ARRANGEMENT OF BUILDINGS 
ON THE GROUNDS GENERAL ARRANGEMENT OF BUILDINGS ON THE 
GROUNDS. 
The arrangement of the buildings upon the grounds is shown in 
the block plan, Plate 2. The main front of the Hospital, and the 
principal entrance, is on Broadway, facing to the west, and having 
an excellent view of the city across the valley of Jones’s Falls. The 
buildings upon this main front, and especially the administration 
building, with the two pay wards, may be said to embody the 
architectural features of the Hospital, all the other buildings having 
comparatively plain exteriors. The general effect of the main, or 
west, front is shown in Plate 1. 
The buildings having special relations to the educational feat- 
ures of the institution—namely, the Amphitheatre, Dispensary, and 
Pathological Laboratory—are located on the northeast, in proximity 
to grounds owned by the Johns Hopkins University on the north- 
east corner of Monument and Wolfe Streets, upon which grounds 
the buildings of the Medical Department of the University are to be 
erected. The block plan shows the Hospital buildings thus far 
erected. In addition to these, the original complete plan provides 
for a row of five wards on the south side, opposite to, and corres- 
ponding with the octagon, three common, and isolating wards 
now constructed on the north, thus partially enclosing the large 
central lawn or garden, which, as before stated, is an essential 
feature of the plan. The original plan also provides for the erec- 
tion of a large greenhouse on the south front, midway between the 
laundry and the nurses’ home. The open space on the east, front- 60 
THE JOHNS HOPKINS HOSPITAL. 
ing on Wolfe Street, is reserved for tents, or temporary wooden 
buildings, in case of the outbreak of an epidemic. It should be 
remembered that the buildings intended for administrative purposes 
are of a size suited to the original complete plan, and will be ample 
when all the wards are erected. 
All the buildings except the gate lodge, the pathological labo- 
ratory, the laundry, and the stable, are connected by a covered 
corridor, as shown in the block plan. The floor of this corridor is 
at the uniform level of 114 feet above mean tide, being the level of 
the main floors of the administration and apothecaries’ building, 
the kitchen, nurses’ home, and bath house. The top of this 
corridor is nearly flat, forming an open terrace walk at the uniform 
level of 124 feet above mean tide, being, the level of the ward floors. 
This arrangement permits a perfectly free circulation of air between 
and around the buildings above the level of the ward floors, and 
secures the best influence of the prevailing southerly winds. As 
will be seen in the description of the ward buildings, it is not pos- 
sible to pass to or from the octagon or either of the common wards 
without going into the free external air, so that there can be no 
communication between the air of different wards. Beneath the 
corridor is a passage-way containing the pipes for heating, lighting, 
water supply, sewage, etc., which is called the pipe tunnel, 
although it is above the level of the ground for more than half its 
height, and is, therefore, a half basement passage, rather than a 
tunnel. It will be described more in detail in connection with the 
system of heating and ventilation. An interior view of the west 
corridor is given in Plate 4, and a corresponding view of the pipe 
tunnel in Plate 6. GENERAL CONSTRUCTION OF BUILDINGS GENERAL CONSTRUCTION OF BUILDINGS. 
The buildings are constructed of brick, with trimmings of Cheat 
River stone and of moulded terra-cotta. The Cheat River stone 
is a very fine-grained, compact sandstone of a bluish-gray color, 
which harmonizes excellently with the red brick. It is obtained 
from West Virginia, and is one of the most durable of our building 
stones, especially when laid on its natural bed, i. e., in the same 
relative position which it had in the quarry—and care has been 
taken that it should always be so laid in these structures. The 
buildings on the main, or west, front are constructed of the best 
quality of pressed brick ; the other buildings of what is known in 
this vicinity as sand brick, being intermediate in quality between 
pressed brick and the ordinary hard brick of commerce. The foun- 
dations of the principal buildings consist of a solid concrete base; 
for the other buildings they are broad flags of Port Deposit granite. 
All foundation and interior walls are of hard brick, laid in Cum- 
berland cement below the ground level, at which point they are 
covered by a layer of heavy slate. Lines of drain tile are laid around 
the foundations, and for all the buildings having cellars or half 
basements, the outer surface of the walls beneath the ground is 
sheathed with overlapping slates. Above the horizontal layers of 
slate at grade, the walls are hollow, with a two-inch air space nine 
inches from the inner surface. This air space is closed in for two 
or three courses of brick at the top. 
All pitched roofs are covered with carefully selected Peach 
Bottom slate laid on English asphalt felt, and secured with copper THE JOHNS HOPKINS HOSPITAL. 
nails. The comparatively flat portions of the roofs of the pay 
wards are covered with copper, which is also used for all gutters, 
flashings and down spouts on the administration building, the 
nurses’ home, kitchen, apothecaries’ building, and all the ward 
buildings. The floors of the principal buildings, and of the corridor, 
are formed of moulded hollow blocks of hydraulic lime of Teil laid 
between iron beams of suitable size, and covered with wood, con- 
crete or asphalt. Such floors are fire-proof, and are much lighter 
than those constructed with solid brick arches. The floors of the 
basements are of artificial stone laid in large blocks, and under- 
neath all heat coils is placed a heavy coat of asphalt to prevent the 
passage of ground air up through the coil. 
The floors of the pipe tunnel and of the kitchen are of concrete. 
The floor of the corridor and of the bath house is what is known 
as granolithic, being composed of cement and ground granite, laid 
in blocks of suitable size, and forming a very hard, smooth and 
durable covering which is easily cleaned. The floors of bath 
rooms, water closets and lavatories are of asphalt. The floors of 
the main kitchen and of all tea kitchens are of concrete. The 
floors of all wards and rooms for the sick are of edge grain Georgia 
pine 1£ inches thick, which was soaked in water for six months and 
then preserved dry for several years before it was dressed for use, 
in order to secure the removal of all soluble matters and thorough 
seasoning. 
All walls are plastered in three coats, and, for the most part, 
finished with a hard trowelled sand finish, preparatory to being 
painted in oil. All walls were allowed to stand for at least two 
seasons before being plastered, in order to permit of thorough 
settling and to minimize the risk of cracking of the plastering as GENERAL CONSTRUCTION OF BUILDINGS. 
65 
much as possible. The walls being hollow, the plastering is laid 
directly on the inner surface of the brick. In the pathological 
laboratory, the bath house, and the female pay ward, a finish 
composed of finely-ground soapstone with plaster of Paris was 
used with very satisfactory results. It is more elastic and less 
brittle than the ordinary hard finish, and therefore less liable to 
crack, becomes sufficiently hard after about a year’s exposure to 
permit of cleansing by rubbing with soap and water, and has an 
agreeable French gray color. In all rooms in which wooden beams 
were used for the ceilings, including the wards, wire netting was 
used in the ceiling in place of wooden lath, in order to prevent 
cracking of the plastering, and to secure a fairly fire-proof con- 
struction. The stairways in the wards are of iron, with a layer of 
asphalt in the treads. In all wards and rooms occupied by the 
sick, woodwork is very sparingly used. Window sills are of slate. 
The woodwork is of ash, and is free from quirks, grooves and 
broken surfaces, having plain bevelled or rounded mouldings, 
which do not afford catch-places for dust, and are easily cleaned 
by rubbing with a damp cloth. The windows are finished with 
plain half-round heads and mouldings. The doors of the wards 
are self-closing by means of double-acting springs sunk in the 
threshold, being the Archibald Smith & Stevens patent. 
The wards are supplied with outside shutters, so constructed 
that they can be opened above and below in the ordinary manner, 
or the lower half of the shutters can be tilted outwards to form a 
sort of awning, permitting free admission of air, while largely 
excluding light. The roofs are high-pitched, giving an ample 
space above the ceilings, which space is ventilated, and thus the 
heat of the sun upon the slate roofs during the hot summer months 
does not affect the wards. 66 
THE JOHNS HOPKINS HOSPITAL. 
The walls of the wards are painted in oil, of a French gray color, 
somewhat darker below for a height of six feet. All hard wood is 
finished in hard oil. In the upper stories of the administration 
building and nurses’ home the woodwork is painted white. In 
the kitchen and the upper stories of the apothecaries’ building the 
woodwork is painted light gray. 
The glass in the windows of the administration building and the 
pay wards is French plate—in all other buildings it is first quality 
French double-thick. 
Heating and Ventilation. 
All the wards, the administration building, the nurses’ home, 
the apothecaries’ building, and the kitchen, are heated mainly by a 
system of circulation, through iron pipes, of hot water of compara- 
tively low temperature and pressure, the heat being furnished by 
boilers at the kitchen and nurses’ home. In many of the rooms in 
these buildings, including all the private, or isolating, rooms for 
patients, and all living rooms in the administration building, open 
fire-places are also provided, but these will probably be rarely used. 
The amphitheatre, dispensary, and bath house are heated by steam 
furnished from boilers at the kitchen building. The pathological 
laboratory and the laundry are heated by steam, each having its 
own boiler. The general distribution of the hot water and steam 
systems is shown in Plate 4. 
The hot water boilers for heating are six in number, four being 
in the vaults at the kitchen building and two in the cellar of the 
nurses’ home, all being on precisely the same level—viz.: 85 feet 
above mean tide. Each of these boilers is five feet in diameter and 
sixteen feet long, and contains 106 three-and-a-half-inch tubes or HEATING AND VENTILATION. 
67 
fines. From the boilers the heated water passes into the great out- 
flow main, which is a cast-iron pipe 26 inches in inside diameter, 
hung on rollers from the ceiling of the pipe tunnel, as shown in 
Plate 6, and provided with expansion joints just outside the kitchen 
building. A view of one of these expansion joints is given in Plate 
7, and the plans are shown in Figs. 2 and 3, Plate 31. From this 
main flow pipe, pipes are given off at each building, and from these 
smaller mains the pipes in the heating coils are supplied. From 
these heating coils the cooled water returns by a similar system of 
pipes and mains to the boilers. This circuit is practically a closed 
one; none of the water being drawn off, or used, at any point, so 
that there is very little loss. The force which produces this circula- 
tion is a small one, being the difference in weight of a column of 
heated water from that of a similar column of water of from 8 to 
15 degrees F. lower temperature, each column being about 29 feet 
high, which is the difference between the level of the water in the 
boilers and that of the top of the heating coils. By means of valves 
on all the mains, and on the supply and the discharge pipe to each 
coil, the rapidity of the circulation can be controlled for each 
building and for each coil, thus giving a corresponding control 
over the temperature of the coils themselves, since this is depen- 
dent on the amount of water of a given temperature which passes 
through the coil in a given time. The entire system of hot-water- 
heating contains about 175,000 gallons of water, and practical trial 
has shown that it produces an equable, agreeable temperature in 
all the buildings to which it is applied, in all conditions of cold 
weather, and with the fullest ventilation desired. To prevent loss 
and waste of heat from the mains in the pipe tunnel, and in the 
basements of the several buildings, these pipes are covered with 68 
THE JOHNS HOPKINS HOSPITAL. 
felt, enveloped in asbestos paper, and the whole is enclosed with 
stout canvas thoroughly painted. The effect of this protection is 
marked and satisfactory—very little heat is lost, as is shown by 
the temperatures in the pipe tunnel, and a great saving of fuel is 
thus effected. The heating coil most distant from the kitchen 
boilers is that in the southeast end of the isolating ward, being 
763 feet away, as measured along the tunnel and basement of the 
ward. 
The great advantages of this system of heating for rooms con- 
stantly occupied by the sick, in the climate of Baltimore, are its 
uniformity of action, the comparatively low temperature of the 
heating surfaces over which the air is passed, the ease with which 
different temperatures may be secured in different rooms, or even 
for different beds in the same room, and, above all, that it ensures 
the delivery of a large supply of air heated to the temperature 
required for comfort without the risk of overheating or of sudden 
changes. 
This will appear more fully when we come to speak of the 
ventilation, and especially of the ventilation in the sick wards. 
The heating of the amphitheatre and dispensary is effected by 
low-pressure steam furnished by boilers at the kitchen building 
and conveyed through pipes carried direct from the boiler vaults 
to the amphitheatre, through an underground tunnel eight feet 
high specially constructed for that purpose. Steam-heating was 
selected for these buildings, partly because they are not constantly 
occupied, and it is desirable to have the means of raising the tem- 
perature in them more rapidly than can be done by the circulation 
of hot water, and partly because it was desired to have the means 
of careful comparison of the two systems of heating for experi- HEATING AND VENTILATION. 
69 
mental and teaching purposes. For purposes of experiment and 
observation, thermometers are fixed at various points in the flow 
and return pipes of the hot-water-system in order to determine the 
temperature of the water at various distances from the source of 
heat, and before and after it has passed through the heating coils 
and given off some of its caloric to the air passing up between the 
heating surfaces. 
Two pieces of apparatus have been inserted for the purpose of 
determining the velocity of the current of hot water in the pipes 
under various circumstances of external temperature, and thus 
obtaining data as to the amount of water producing a given 
heating effect in a given time. One of these is placed in the base- 
ment of the octagon ward, the other near the point most distant 
from the boiler in the isolating ward. The plan of this apparatus 
is shown in Fig. 5, Plate 5. 
It consists essentially of a by-pass connected with one of the 
smaller supply pipes in such a way that all the water coming 
through this pipe can be sent through a glass tube having the 
same diameter as the pipe, in which glass tube the velocity of the 
stream can be measured by injecting a small quantity of colored 
fluid, such as a solution of carmine, and noting the time required 
for it to pass a measured distance in the glass tube. 
With a temperature of 92.6° F. in the flow pipe and 85.4° F. in 
the return, the rate of flow as determined by this apparatus is 13.5 
feet per minute. With a temperature of 134.8° F. in the flow pipe 
and 129.7° F. in the return, the velocity was found to be 16 feet per 
minute. The following tables indicate the radiating surface for 
the different buildings and for some of the more important rooms: 70 
THE JOHNS HOPKINS HOSPITAL. 
Table Shoiving the Radiating Surface in the Steam Coils for Buildings and 
Rooms Heated by this System. 
Building or Room. 
CUBIC FEET OF 
SPACE HEATED. 
SQUARE FEET OF 
RADIATING SURFACE. 
Amphitheatre—Main Room 
55,614 
1,216 
Dispensary—Main Room 
56,911 
4,824 
Pathological Building—Amphitheatre 
26,019 
492 
Laundry Building—Total 
59,544 
1,071 
Ironing Room 
15,194 
160 
Drying Room for Patients’ Clothing 
1,664 
340 
Table Showing the Number of Square Feet of Radiating Surface in the Hot 
Water Coils for the more Important Buildings and Rooms Supplied by this 
System. 
Building or Room. 
CUBIC FEET OF 
SPACE HEATED. 
SQUARE FEET OF 
RADIATING SURFACE. 
Administration Building—Total 
429,441 
17,881 
Superintendent’s Office . . . 
14,973 
630 
Pay Ward—Total 
147,554 
7,947 
Single Room for Patients 
2,606 
162 
Nurses’ Home—Total 
229,104 
9,394^ 
Each Room 
1,760 
85 
Octagon Ward—Ward 
44,192 
2,400 
Bay Window in Ward 
2,400 
60 
Nurses’ Closet and Bath Room 
3,184 ' 
150 
Dining Room 
4,323 
200 
Common Ward—Total 
78,880 
5,307 
Main Ward 
39,766 
3,150 
Private Ward 
3,570 
2623 
Dining Room 
3,570 
2623 
Water Closet and Lavatory 
2,924 
162 
Foot-plate in Sun Room 
1,886 
131 
Isolating Ward—Total 
59,295 
4,6453 
Single Room 
2,145 
162 
Apothecaries’ Building—Total 
79,463 
3,410 HEATING AND VENTILATION. 
71 
The following table gives'the dimensions and capacity of the 
hot water boilers in the different buildings. The water in these 
boilers is heated by steam. 
Table Showing Dimensions of Batli or Hot Water Boilers—Wrought Iron. 
Building. 
NUMBER. 
DIMENSIONS. 
CAPACITY. 
Isolating Ward 
1 
2/6// diam. 
X 
5/6// long. 
200 Gallons. 
Common “ 
1 
2'6" 
CC 
X 
6/0// 
u 
220 
CC 
Octagon “ 
1 
Z'O" 
cc 
X 
VO" 
“ 
370 
cc 
Amphitheatre Building 
1 
2'0" 
a 
X 
WO" 
cc 
183 
cc 
Dispensary “ 
1 
2/0// 
CC 
X 
VO" 
cc 
165 
c c 
Kitchen “ 
1 
Z'O" 
cc 
X 
8'0" 
cc 
423 
cc 
Male Pay Ward 
1 
3/0// 
cc 
X 
7'0" 
cc 
370 
cc 
Administration Building 
1 
3/0// 
cc 
X 
VO" 
cc 
370 
cc 
Apothecaries’ “ 
1 
Z'O" 
n 
X 
7'0" 
cc 
370 
cc 
Nurses’ Home “ 
1 
Z'O" 
u 
X 
7'0" 
cc 
370 
cc 
Bath House “ 
2 
2'6" 
(( 
X 
6'0" 
cc 
440 
cc 
Laundry “ 
• 1 
2'6" 
(( 
x 13/0// 
cc 
477 
cc 
The following gives the dimensions of the steam boilers: 
Steam Boilers—Horizontal Tubular. 
Kitchen Building, 3 0" Boilers with 58 tubes each. 
Laundry “ 2 42"Xll'0" “ “ 38 3" “ 
Pathological “ 1 3G"X 9' 0" “ “ 28 3" “ 
Accelerating coils of one-inch pipe, heated from the high-pressnre 
steam boiler at the kitchen building, are placed in all the principal 
aspirating shafts, as indicated in the description of the several 
buildings. The following table shows the number of square feet of 
radiating surface of steam pipe in each accelerating coil, the area 
of the shaft in which it is placed, and the height of the shaft above 
the coil: 72 
THE JOHNS HOPKINS HOSPITAL. 
Coils in Aspirating Shafts. 
SQUARE FEET 
AREA OF 
HEIGHT OF 
OF RADIATING 
SHAFT ABOVE 
SURFACE. 
COIL. 
Administration Building, W. C. Shaft 
50 
28" X 36" 
15 feet. 
it 
a 
Bath Room Shaft 
40 
24" X 30" 
15 “ 
Apothecary 
a 
W. C. Shaft 
30 
3/5"X 14" 
12 “ 
H 
a 
Vent, 2 cylinders 36" inside 
25 
Coil in S. E. 
only 20 feet. 
Nurses’ Home 
a 
W. C. Shaft 
30 
24" X 32" 
25 feet. 
a a 
a 
a a 
30 
24"X 32" 
25 “ 
a a 
a 
Vent “ 
150 
6/X 3"X6/3" 
25 “ 
Male Pay Ward “ 
it t( 
72 
2' X 2'6" 
20 “ 
a a 
it 
W. C. “ 
40 
30" X 24" 
20 “ 
a it 
a 
Slop Sink Shaft 
30 
30" X 24" 
20 “ 
Female “ 
a 
Vent “ 
72 
V X 2/6" 
20 “ 
a a 
a 
W. C. “ 
40 
30" X 24" 
20 “ 
a a 
a 
Slop Sink “ 
30 
30" X 24" 
20 “ 
Bath House 
a 
W. C. and Vent Shaft . . 
50 
30"X 18" 
12 “ 
Kitchen 
a 
W. C. Shaft 
60 
36" X 24" 
12 “ 
Common Wards, each Ward “ 
70 
5'2"X 6/2" 
30 “ 
a it 
Service “ 
56 
4' X 4' 
12 “ 
a a 
W. C. 
a 
60 
24" X 36" 
30 “ 
Octagon Ward, Ward 
a 
130 
8' X 8' 
30 “ 
a a 
Service 
a 
64 
4' X 4' 
12 “ 
a a 
W. C. 
a 
50 
3' X 3' 
30 “ 
Isolating “ 
Commode Closets, each Shaft .... 
40 
2/6"X 18" 
40 “ 
it it 
W. C. Shaft 
40 
36" X 2' 
10 “ 
Amphitheatre Building, Vent Shaft 
160 
6' X 6' 
25 “ 
“ 
a 
W. C. “ West 
20 
V X 4" 
2 “ 
a 
a 
“ “ East 
20 
V X 2" 
2 “ 
Dispensary 
a 
Vent “ 
160 
6' X 6' 
25 “ 
it 
a 
W. C “ 
20 
8"X 12" 
2 “ 
U 
11 
a a 
20 
8"X 12" 
2 “ 
Autopsy 
a 
North Vent Shaft 
54 
y X 3'6" 
30 “ 
it 
a 
South “ “ 
54 
y x y 
30 “ 
Laundry 
a 
Main “ “ 5'0//X5'0// 
Boiler Smoke, 24" diam. 
a 
a 
Drying Room “ 5'0//X5/0// 
Ironing Stove, 12" “ 
a 
a 
W. C. “ 14"X 13" 
Steam Pipe, 4" 7 sq. ft. rad. sur. HEATING AND VENTILATION. 
73 
Closely connected with the heating apparatus are many of the 
arrangements for ventilation. The external temperatures at the 
Hospital have a range of from 102° F. in summer, to six degrees 
below zero F. in winter, these extremes occurring about once in ten 
years. To provide for these requires buildings and apparatus 
which would be satisfactory in either Calcutta or St. Petersburg. 
Let us first consider the arrangements for ventilation in cold 
weather. In the wards, and rooms occupied by the sick, the sizes 
of flues and registers, and the amount of heating surface, have 
been arranged for a supply of one cubic foot of fresh air per second 
for each person in the ward, with the possibility of doubling this 
supply for a short time in flushing out the ward, as will be pres- 
ently explained. In the pay wards, where each patient has a sepa- 
rate room, making it more difficult to secure thorough distribution, 
the supply of air is to be one and a half cubic feet per second per 
head. In the isolating ward, designed for cases giving rise to 
offensive odors or in which a large amount of organic matter is 
thrown off, or in which, for other reasons, a large amount of air is 
desirable, the air supply is fixed at two cubic feet per second per 
head. Finally, three rooms in the isolating ward are arranged 
with perforated floors (see Figs. 1 and 2, Plate 26) for an air supply 
of four cubic feet per second per head, with capacity for doubling 
this if desired. For all the wards the air is warmed in cold weather 
before it is admitted to the room, forming the so-called method of 
heating by indirect radiation or by air convection. All registers 
and flues for fresh air are of such sizes as to permit the passage of 
the requisite amount of air with a velocity not exceeding one and a 
half feet per second under ordinary circumstances. Air currents 
of this velocity having a temperature of from 70° to 75° F. are 74 
THE JOHNS HOPKINS HOSPITAL. 
barely perceptible by the hand, and create little or no discomfort. 
The fresh air registers are as a rule placed in the piers in the outer 
walls, at a height of nine inches from the floor, one register being 
allowed to each pair of beds. Besides these there are registers 
beneath the windows in the wards, which are only used in very cold 
weather, to check the down draughts produced by the chilling of 
the air through the glass of the window. The chief register, being 
that in the pier between each pair of beds, is so arranged that the 
nurse, by turning an iron arm upon its face, can reduce the temper- 
ature of the incoming air nearly to that of the external air, or can 
increase it to the maximum which the heating coil affords, but 
without changing the quantity of the air admitted. Ordinarily, as 
is well known, when a room heated by indirect radiation becomes 
too warm, the only way to shut off the heat supply is to close the 
register and thus shut off the air supply also, but in these wards 
the temperature can be regulated at the different registers, in 
different parts of the room, to suit the needs of different patients, 
without interfering with the air supply. 
The mechanism by which this is effected is shown in Fig. 2, 
Plate 22. 
The following 'memoranda are furnished by Dr. A. C. Abbott as 
the results of observations made of the workings of this apparatus 
in one of the common wards during the month of December, 1889, 
the average number of patients in .the ward being twenty-four. 
In the main ventilating shaft of the ward, the accelerating coil 
being heated, the velocity of the ascending current was 3.8 feet per 
second, giving a total flow of 95 cubic feet of air per second, being 
nearly 4 cubic feet per second per head. When the accelerating 
coil was not heated, the velocity was 2.8 feet per second. In the HEATING AND VENTILATION. 
75 
water closet shaft of the common ward, measuring 24 x 36 inches, 
the velocity of the ascending current was 188 feet per minute. The 
velocity of the air currents entering through the registers varied 
from 1.6 to 3.3 per second, depending upon of the 
valve for admitting the outer air freely to the coils. 
The following table shows the average temperatures, the mean 
relative humidity, and the mean dew point of the outside air as 
compared with the corresponding figures for the air in the wards : 
Month. 
TEMPERATURE OF 
OUTSIDE AIR. 
TEMPERATURE OF 
AIR IN WARD. 
MEAN REL. 
HUMIDITY. 
MEAN DEW 
POINT. 
MEAN TEMP. 
IN COILS. 
VELOCITY 
OF INCOM- 
ING AIR. 
Max. 
Min. 
Mean. 
Max. 
Min. 
Mean 
Outs’e. 
Inside. 
Outs’e. 
Inside. 
Flow. 
Ret’rn. 
Average. 
November . 
67° 
27° 
44.2° 
75.5° 
62.4° 
70.4° 
70.7% 
33.2% 
34.7° 
38.5° 
119.7° 
110° 
3 feet. 
December . 
50.1° 
33.3 
43.6° 
74.5° 
67.3° 
70.5° 
73% 
34.2% 
34.8° 
39.8° 
134.8° 
129.7° 
3.3 feet* 
*i. e. 1.6 feet per bed per second, 
The carbonic acid determinations made by Dr. Abbott to deter- 
mine the distribution of the fresh air within the ward are not yet 
sufficient in number to give positive results, chiefly owing to the 
fact that very great variations are found in the proportion of the 
carbonic acid in the external air due to the direction of the wind 
and to other circumstances. In general, however, it may be said 
that the proportion of carbonic impurity due to the respiration of 
patients in the ward is about 2 parts in 10,000, and the above 
table, showing the comparison of dew points and relative humidity 
of the outer air and the air in the ward, indicates that the vapor 
and other impurities added to the air by the respiration of the 
patients in the ward is removed almost as rapidly as it is formed. 
As regards temperature, it is certain that the wards can be kept at 76 
THE JOHNS HOPKINS HOSPITAL. 
a temperature of 70° F. in the coldest weather, while at the same 
time such ventilation is being secured in the ward that a person 
with a normal sense of smell coming from the fresh external air 
shall at no time perceive any trace of musty or animal odor. A 
systematic series of observations of temperature, dew point and 
relative humidity of the external air in the central garden and in 
the wards are now being carried on, the observations being made 
at 8 A. M. and 8 P. M., and from these, taken in connection with the 
corresponding series of carbonic acid determinations in the wards 
and in the external air to be made by Dr. Abbott throughout the 
coming year, all of which will be duly published, the operation of 
the heating and ventilation apparatus can be determined with 
scientific precision. At present it is sufficient to say that it amply 
fulfils the purposes for which it is designed, and furnishes and 
properly distributes within the wards an amount of fresh air 
heated to an agreeable temperature, which is, if anything, in excess 
of the requirements laid down by the best authorities on hygiene. 
Water Supply. 
The water supply of the hospital is taken from the general 
supply of the city of Baltimore, mainly through a 6-inch pipe 
which enters the centre of the street front of the boiler vaults at the 
kitchen building. In these vaults it passes through two large filters 
of the Loomis patent. These are iron cylinders six feet high and 
two feet in diameter, nearly filled with clean sand. At intervals of 
about twenty-four hours the direction of the current through these 
filters is reversed, and the accumulated impurities are washed 
out into the street. The straining effect of these filters is shown 
by the bacteriological examinations of the water which have been SEWAGE DISPOSAL AND HOUSE DRAINAGE. 
77 
made in the hospital. Before filtration the water contains an 
average of 39 micro-organisms per cubic centimeter; after filtra- 
tion the average number found is 6 per cubic centimeter. The 
arrangement of these filters is shown in Fig. 4, Plate 32. 
As these filters greatly obstruct the free supply of water which 
would be requisite in case of a fire, although they permit the 
passage of an ample supply for ordinary use, a by-pass around 
them is arranged so that in case of necessity the steam pump can 
draw directly from the street main. This steam pump is connected 
to force water into large tanks placed in the attic of the annex 
to the administration building. These tanks or reservoirs have a 
capacity of 31,843 gallons, and are intended both to contain a 
reserve supply for use in case of temporary interruption of the 
supply from the street main owing to breakage, etc., and to give 
additional head or force when the pressure in the street mains is 
too small to produce the desired effect. 
Sewage Disposal and House Drainage. 
Baltimore has no system of sewerage. From the majority of 
the houses the soiled water from kitchen sinks, laundries, baths, 
etc., is allowed to run into the open gutters, while excreta are 
discharged into privy pits, wells, cesspools or boxes. Some of these 
are comparatively water-tight, and are cleaned out at stated 
intervals or when they become full and offensive; many of them 
allow of more or less leakage of their contents into the surrounding 
soil, while some are in the form of deep wells extending to the under- 
lying gravel, and are seldom or never cleaned out. This last was 
the arrangement for the old Maryland Asylum for the Insane 
when it was upon the hospital grounds, and several such wells 78 
THE JOHNS HOPKINS HOSPITAL. 
were found in the process of grading and laying soil drains. In 
arranging for the disposal of the fouled water from the various 
buildings, the water closet and ward sink sewerage was kept distinct 
from that coming from the kitchen sinks, wash basins, etc. The 
discharges from ward water closets and sinks, and from all water 
closets and housemaid’s sinks in the administration building, the 
apothecaries’ building, the kitchen, and the nurses’ home, are con- 
veyed by a separate system of iron pipes from each building to 
an iron pipe which runs in the pipe tunnel from the isolating 
ward on the east to the point where the corridor to the female 
pay ward is given off. Here this pipe leaves the tunnel, enters 
the ground, and passes to a well west of the nurses’ home. 
(See Block Plan, Plate 2.) This well is seven feet in diameter and 
seventy-one feet deep. At the bottom it enters a stratum of coarse 
gravel and pebbles through which water is constantly, though 
slowly, flowing towards the southwest. At right angles to the 
direction of this subterranean stream, drifts or tunnels were exca- 
vated, running fifteen feet on each side of the well, and being two 
feet wide and five feet high. The bottom of this tunnel was 
formed by the water bearing stratum of gravel above described; 
its sides and crown were lined with brick laid without mortar or 
cement. This well is ventilated by a pipe which is carried in the 
ventilating shaft of the nurses’ home to the top of the building. 
The well for the pathological building is five feet in diameter and 
eighty-one feet deep. That for the laundry is six feet in diameter 
and seventy-five feet deep. That for the amphitheatre and dis- 
pensary is six feet in diameter and seventy-seven feet deep. 
While this is by no means an ideal method of sewage disposal, 
it was adopted as a temporary measure until the city shall be SEWAGE DISPOSAL AND HOUSE DEAINAGE. 
provided with a proper system of sewers, which it is believed 
cannot be long delayed, and there is no reason to doubt that, so far 
as the hospital itself is concerned, it will dispose of its sewage for 
many years without danger to the health of its inmates or the 
production of nuisance. All pipe lines are laid with reference to 
connections with the city sewers when they are built. 
The sewage from the pathological building, from the amphi- 
theatre and dispensary, and from the laundry, is discharged into 
similar wells, the location of which is shown on the block plan. 
The water from wash basins, kitchen sinks, etc., is conveyed by a 
separate system of pipes to the street gutters or to the sixteen-inch 
pipe drain about ten feet beyond the silt trap in the southwest 
corner of the grounds. All soil pipe was delivered on the grounds 
as it came from the foundry, without being tarred or painted. It 
was then tested by passing through each length or section a swab 
dipped in a mixture of linseed oil and red lead. The slightest 
defect in the casting was indicated by the appearance of an oily 
stain on the external surface of the pipe. After passing this test 
the pipes were painted with red lead. All pipes are so placed as to 
be readily accessible and freely exposed to view. 
The arrangement of soil pipes and plumbing within the building 
is in accordance with the plumbing regulations of the city of Bal- 
timore, being the same, substantially, as that prescribed in New 
York and Washington. All fixtures have separate traps placed as 
close to the fixture as possible; all traps have back ventilation, and 
all perpendicular soil pipes extend upwards through the roof, full 
size, and open freely to the outer air. The soil pipes from the 
laundry, the pathological building, the amphitheatre, and the 
dispensary, are each trapped near the wells into which they 
empty, and have a fresh-air inlet inside the trap. 80 
THE JOHNS HOPKINS HOSPITAL. 
The water closets are washout closets, being what is known as 
the Brighton closet. 
The bath tubs are of iron, are not enclosed with woodwork, 
stand upon iron legs clear of the floor, and are movable from place 
to place, being unconnected with the plumbing. The sinks are of 
porcelain; those for the use of the ward nurses and housemaids 
having an all-round flushing rim, as well as a central flush by 
means of a large draw cock. All the pipes and traps are either 
fully exposed to view or are readily accessible by opening a door. 
For all the wards the perpendicular soil and trap-vent pipes are 
placed in a sort of small closet or large ventilating shaft which 
extends above the roof and has in it an accelerating steam coil to 
secure a constant upward current. Into this shaft pass ventilating 
tubes from the water closets and urinals. The working of this 
system has proved in practical use to be very satisfactory. 
Lighting. 
All the buildings are at present lighted with gas, but all the 
wards and the administration building have been wired for light- 
ing with incandescent electric lamps, whenever it shall be deemed 
best to adopt this mode of lighting. The gas fixtures are of special 
designs, and in all rooms occupied by the sick these designs are in 
simple rounded forms, so as to be easily cleaned and to retain as 
little dust as possible. (See interior views of octagon and of com- 
mon wards, Plates 19 and 24.) These ward fixtures carry arrange- 
ments for incandescent lamps as well as for the ordinary gas 
burners. The number of burners in each building is as follows: 
administration, 466; apothecaries’, 116; kitchen, 181; pay wards, 
184 each; nurses’ home, 349; common wards, T9 each; octagon THE ADMINISTRATION BUILDING. 
81 
ward, 127; isolating ward, 90; amphitheatre, 70; dispensary, 90; 
bath house, 28; pathological building, 56; laundry, 50; corridor and 
tunnel, 40; gateway and gate house, 11;—total, 2285. 
Clocks. 
Pneumatic clocks are placed in all the wards, in the corridors, 
kitchen, administration building, and nurses’ home. These clocks 
are all driven by pulses or puffs of air sent through small iron 
pipes from the central apparatus in the administration building, 
thus ensuring uniform timekeeping throughout the buildings. 
Telephones. 
All the buildings are connected by telephone with the clerk’s 
office in the administration building, which also communicates 
with the general telephone service of the city. By means of a 
switchboard in the clerk’s office.any building of the hospital can 
be put in direct telephonic communication with any other building 
of the institution. 
Provision has been made for a system of registration by electri- 
cal dials, or the so-called telemeter system, of the amount of air 
passing out of a common ward, and of temperatures at one or two 
points in the ward. 
The Administration Building. 
This building, the largest and, from the architectural point of 
view, the most important building of the hospital, is on the centre 
of the main front, and its external appearance as seen from Broad- 
way is shown in Plate 1. It contains three floors besides a cellar 
and a finished attic story, is crowned with a dome and a spire in 82 
THE JOHNS HOPKINS HOSPITAL. 
the centre, and has an annex in the rear containing water closets 
and bath rooms. The height to the top of the dome is 150 feet, to the 
top of the spire 185 feet, to the top of the vane about 200 feet. The 
height from the main floor to the top of the inner dome is 79' 9". 
The brickwork rests on a battering base of four courses of rubbed 
Cheat River stone, rising to a height of 108 feet above mean tide. 
The cellar or half-basement is 14 feet high in the clear, is floored 
with concrete, and contains the hot-water coils for heating the 
building. The main or first floor contains the offices, library, recep- 
tion, examination, and board rooms; the second floor is devoted to 
the living rooms of the Superintendent and resident physicians; 
and the third floor is intended for bed rooms for the resident 
students. The arrangement of rooms is shown in the plans of the 
first and second floors (Plates 8 and 9), and transverse sections of 
the building through the centre from north to south and east and 
west are shown in Plates 10 and 11. Entering the building by the 
porch on the west front, and passing through the vestibule, the 
visitor comes into the large central octagonal hall beneath the 
dome, which central hall has a large double staircase on the east, 
and opens into the main hall running north and south. At each 
end of this main hall is a vestibule entrance. The total length of 
the building, excluding the vestibules at the ends, is 184 feet; the 
length of the main hall from one inner vestibule door to the other 
is 170 feet 10 inches; the diameter of the central octagon beneath 
the dome from one pier to its opposite is 34 feet. This central hall 
is lighted through a central inner dome of ribbed glass, as shown in 
the section Plate 10. The floor of this hall is of marble tiles. The 
rooms on this floor, as well as the halls, are wainscoted and finished 
throughout in quartered oak. The staircase is also of oak. The 
plan of the rooms is shown in Plate 8. THE ADMINISTRATION BUILDING. 
83 
The office on the right of the main entrance is devoted to the 
general records and business of the hospital, and contains a large 
fire-proof safe or vault, extending from floor to ceiling and divided 
into two stories. This office also contains the central telephone 
switch, by means of which communication can be had between any 
two buildings of the hospital; and the annunciator for the electric 
bells of the rooms in the upper stories of this building. The room 
marked Officer of the Day is for the use of the physician on duty. 
The room marked Board Room is for the use of the Board of 
Trustees, and contains the private library of Johns Hopkins, con- 
sisting of non-professional books. An interior view of this room is 
given in Plate 13. The library contains the medical library of the 
hospital, with the exception of the current periodicals, which are 
placed in the reading room. This main floor is on the level of the 
corridor floor in the rear—i. e., 114 feet above mean tide. The height 
of the rooms in the main building and annex is as follows: 
Main Administration. 
1st story, 17' 4" clear, 
2d “ 13' 
3d “ 12' 9" “ 
4th “ 12' 6" “ 
Annex. 
9' 0" clear. 
14' 10" “ 
13' 0" “ 
9' 6" “ 
The arrangement of the rooms on the second floor is shown in 
Plate 9; the third floor is substantially the same. This building is 
heated throughout by the hot-water system, mainly by indirect 
coils in the cellar, each room having a separate flue for fresh warm 
air supply. The ventilation is effected by this fresh-air flue in 
connection with the open fireplace and chimney flue connected 
with each living room. No water pipes are brought into the main 84 
THE JOHNS HOPKINS HOSPITAL. 
building except in the superintendent’s rooms in the southeast 
corner of the second floor, and there are no fixed washstands. 
With the exception above noted, all water and soil pipes are con- 
fined to the rear annex building. On the upper floor of the annex 
are three boiler-iron water tanks capable of holding 31,843 gallons 
of water. (See Plate 11.) These tanks are filled by a steam pump 
in the kitchen boiler vaults, and are intended to secure a reserve 
supply of water at a higher pressure than that afforded by the city 
mains. The large vane on the top of the spire is arranged for 
electrical connections which, when made, will indicate the direction 
of the wind on a dial placed in the main central hall. 
The Pay Wards. 
The two buildings which are especially intended for the recep- 
tion of private, or pay, patients, are situated on the west or 
Broadway front of the grounds, on either side and in front of the 
administration building, as shown on the Block Plan, Plate 2. 
Pay patients are also placed in the rooms connected with the 
common and octagon wards, and in the isolating ward, as cir- 
cumstances may require, hut these two buildings, being devoted 
exclusively to such patients, are known as the pay wards. Each 
of them is one hundred and thirty feet long, forty-nine and a half 
feet wide, and two stories high, with a cellar, and a rear projection 
in the centre containing the bath rooms, water closets, stairs, etc. 
The general arrangement of each floor is shown in Fig. 1, Plate 14. 
It will be seen that it contains a series of rooms opening from each 
side of a central corridor which runs north and south, and which 
opens at either end upon a veranda which has a roof, but is open 
at the sides and ends. At the point of junction of this corridor THE PAY WARDS. 
85 
with the east and west corridor of the rear, or administrative 
portion, is an octagonal hall, lighted from above. 
The rooms for patients are each 15' 5" long, and vary in width 
from 12' to 13'. Each of them has an open fireplace in the corner 
next the corridor. The fresh air is brought in through a register 
near the door in the external wall, as shown in the plan; the 
arrangements for heating this air, and for regulating its tempera- 
ture, being substantially the same as those for the common wards 
described hereafter, except that the air is taken from the interior, 
as shown in Fig. 3, Plate 15. Besides the open fireplace and 
chimney due, each room has an exit due, 9" x 16", in the inner or 
corridor wall next the dreplace, as indicated by the exit arrows in 
the plan. These dues pass upwards to the attic, where they are 
gathered into a single galvanized iron due which passes to the 
centre of the building, where it enters a perpendicular shaft in 
which is an accelerating steam coil. This arrangement is indi- 
cated in the sections Figs. 1 and 2, Plate 15. 
The south pay ward is devoted exclusively to females, and the 
north one to males. In the female pay ward the large central 
room on the west front of the second story is dtted up as an 
operating room, with tiled door, sinks, wash basins, etc. 
An exterior view of the male pay ward, taken from the north- 
east, is given in Plate 1. 
These buildings are dnished in ash, have an electric bell for 
each room, and are handsomely furnished. Each bed has over it 
an iron crane or swinging bracket, from which is suspended a 
strong leather strap, by means of which the patient can assist 
himself to turn or rise in bed. (See Fig. 1, Page 86.) An interior view 86 
THE JOHNS HOPKINS HOSPITAL. 
of one of these private rooms, showing style of furniture and one 
of the cranes above referred to, is shown in Plate 16. 
Fig. 1. 
The Common Wards. 
The three common wards are almost precisely alike, so that a 
description of one will serve for all, the chief difference being that 
the basement of the one nearest the octagon ward is connected by 
a covered corridor with the amphitheatre, as shown on the block 
plan, Plate 2. The plan of the main, or ward, floor of a common 
ward is shown in Fig. 1, Plate 21. 
The main ward is a room 99 feet 6 inches long, 27 feet 6 inches 
wide, 15 feet high at the side walls, and 16 feet high in the clear in 
the centre, and is intended to contain twenty-four beds, as shown THE COMMON WARDS. 
87 
on the plan, giving to each bed 7' 6" of wall space, 106.9 square 
feet of floor area, and 1768.9 cubic feet of air space. 
At the south end of the ward is a large bay window, the sash of 
which comes nearly to the floor, forming a sort of sun room, and 
in the floor near the walls and windows of this bay are laid iron 
plates, covering an iron box, in which run hot-water pipes, thus 
giving a warm floor, to prevent the downflow of air chilled by the 
window surface, and thus to ensure warm feet and comfort to the 
convalescents sitting in this space in cold weather. Right angles 
in the ward are avoided as far as possible, all corners are rounded, 
the junction of the ceiling with the walls forms a quarter circle, 
and the same occurs at the junction of the walls and floor, this last 
being effected, as shown in Fig. 6, Plate 23, by the use of a curved 
strip of hard wood instead of the ordinary washboard. 
The most important feature of the ward is the method of heating 
and ventilation, which is arranged as follows:—The heating is 
effected by hot water coming from the mains in the pipe tunnel and 
passing through coils of 3-inch cast-iron pipe arranged in stacks in 
the basement against the outer walls, as shown in Fig. 1, Plate 
22. Under ordinary circumstances, in cold weather, the average 
temperature in these coils is 150° F., but, as explained in the general 
description of heating and ventilation, the temperature in any coil, 
or set of coils, can be lowered to any degree above that of the exter- 
nal air by lessening the velocity of the current of hot water passing 
through it, which is readily effected by valves placed on the flow 
and return pipe of each coil. 
The fresh air supply is admitted through openings in the exterior 
walls of the basement of the ward, coming from over the green 
lawn which surrounds the wards. This opening in the wall is pro- 88 
THE JOHNS HOPKINS HOSPITAL. 
tected by wire netting and communicates with a galvanized-iron 
flue which passes downward to open in the chamber beneath the 
heating coil, and also upward directly to the fresh air register in 
the ward. In this flue, opposite the external opening, is a cast-iron 
valve or damper operated from the ward above, by means of which 
the incoming fresh air can be either directed wholly downward, so 
that it must all pass through the heating coil, or wholly upward, so 
that it passes directly to the ward without being heated, or partly 
upward and partly downward, so as to produce a mixture of any 
desired temperature. This arrangement is indicated in the cross 
section of the ward, Fig. 3, Plate 21, and is also shown in detail in 
Fig. 2, Plate 23. 
The lower end of the galvanized-iron fresh air flue which opens 
beneath the flue has a valve which can be closed to regulate the 
amount of incoming air, when this is necessary in cold and windy 
weather. 
The heating coils are enclosed in brick chambers, which have at 
the top, in front of the coils, a large plate composed of two sheets of 
galvanized iron with felt between. These plates or doors fit tightly, 
but can be readily removed, thus giving the freest access to the 
pipes for the purposes of cleansing or of repair. 
Two systems of exit flues are provided to remove fouled air from 
the ward. The first consists of a series of circular openings in the 
floor of the ward, one beneath the foot of each bed. These openings 
are 12 inches in diameter and are each covered with a nearly hemis- 
pherical dome of wire netting to prevent the dropping of small 
objects into the flues beneath. Each of these openings communi- 
cates with a galvanized-iron tube, 12 inches in diameter, which 
passes obliquely on the ceiling of the basement to enter the lower THE COMMON WARDS. 
89 
foul air duct, which runs longitudinally beneath the ward floor to 
enter the ventilating chimney. These lower ducts are indicated in 
dotted outline in Fig. 1, Plate 21, and in Fig. 1, Plate 23. They also 
appear in the cross section Fig. 3, Plate 21. 
The main longitudinal foul air duct is constructed of wood lined 
with galvanized-iron. At the end most remote from the chimney 
it measures internally V 10" x 1' 3", and from this point it gradu- 
ally enlarges, to provide for the additional flues entering it, until at 
the point where it enters the ventilating chimney it measures inter- 
nally 4' 4" x 2' 10". The ventilating chimney is 4' 2" in diameter 
and 75 feet high. 
The upper system for the escape of foul air consists of six open- 
ings in the centre of the ceiling of the ward, each measuring 2' x 2' 
and placed 13 feet apart. These open into the upper foul air duct, 
which runs longitudinally in the attic above the ceiling of the ward 
and enters the ventilating chimney, corresponding to the lower duct 
just described. This upper foul air duct is shown in Fig. 2, Plate 22, 
being marked YW, and in the section Fig. 1, Plate 23. The ceiling 
of the ward is one foot higher in the centre than at the sides. The 
openings in the ceiling into the upper foul air duct are controlled 
by shutters, which are raised or lowered at pleasure by the move- 
ment of an iron lever in the ventilating chimney. In this main 
ventilating chimney or aspirating shaft, there is placed, just above 
the entrance of the upper longitudinal foul air duct, a coil of pipe, 
heated by high-pressure steam, which serves to increase the velocity 
of the upward current of air in the chimney, and is therefore called 
the accelerating coil. 
Under ordinary circumstances, in cold weather, only the down- 
ward ventilation is used, as this tends to save heat; but whenever 90 
THE JOHNS HOPKINS HOSPITAL. 
the ward becomes overheated, or it is desired for any reason to pass 
a large quantity of air through it, the ceiling registers are also 
opened. In moderate and warm weather, both sets of registers 
are open. The velocity of the upward current in the ventilating 
chimney, and therefore its aspirating power, may be increased as 
above stated by means of the aspirating coil. It may also be regu- 
lated by a pair of valves near the top of the chimney, which can 
be closed or opened by an iron lever in the chimney, accessible 
through a small door just opposite the door of the ward. The plan 
and section of these valves is shown in Fig. 3, Plate 23. 
In addition to these means for producing and regulating air 
currents, the common ward nearest the octagon is provided with a 
propelling fan, situated in the basement, at the south end. From 
this fan, which is run by steam power, and is four feet in diameter, 
a duct is led from which a branch is given off, which enters each 
coil chamber at the floor and turns upward for a short distance. 
This arrangement of fan and ducts is indicated on Fig. 1, Plate 22. 
The diameter of the air duct as it leaves the fan case is four feet. 
It divides into two main branches each two feet square, and from 
these are given off the branch ducts to each coil, each being ten 
inches in diameter. By running this fan for a few moments n 
very large amount of air can be forced into the ward, securing a 
thorough aerial flushing, and the prompt removal of unpleasant 
odors. In hot, still weather the currents of air produced by the 
fan in the ward are very grateful to the sick. The other wards are 
fitted to receive similar fans and ducts, but are not yet supplied 
with them. 
The whole system of ventilation, sizes of ducts, flues and 
registers, and provision of power to ensure movement of air, is THE COMMON WARDS. 
91 
intended to secure one cubic foot of fresh air per second for each 
of the twenty-four beds in the room, and to provide a reserve 
capacity of doubling this supply if it be desired to do so. The 
capacity of the apparatus is in excess of this, as will be seen by the 
figures given in the general remarks on heating and ventilation, 
page GO, supra. In this connection it should be borne in mind 
that these wards are not intended for cases of contagious disease, 
nor for cases such as uterine cancer, etc., which give rise to very 
offensive odors. 
Special care has been taken to keep the system of ventilation of 
the ward distinct from the air supply of all other rooms. The large 
doors at the north end of the ward are self-closing, and should 
never be blocked open, except in very warm weather when all the 
windows are up and the patients are as nearly out-of-doors as 
possible. 
The methods of construction of the walls, floors, shutters, etc., 
of the ward are described in the general introduction, and need no 
special comment here. The mode of finish of the doors and win- 
dows is shown in Figs. 4 and 5, Plate 23. 
Next to the ward at the north end are the nurses’ closet, the 
bath-room, lavatory, and water-closets, while on the other side of 
the corridor are the tea kitchen, dining-room, two wards for one or 
two beds each, and clothing and linen closets. The nurse has no 
sleeping or sitting room in this building. The tea kitchen has a 
small gas stove, and a steam table. The clothing closet is for the 
clothing of the patients, each having a separate compartment with 
hooks, a place for shoes, etc. This room has a separate air supply 
and exit flue. In the nurses’ closet is a drying closet heated by 
steam. The bath tub is movable, and can be raised on a truck and 
carried to any bedside, if desired. 92 
THE JOHNS HOPKINS HOSPITAL. 
The Octagon Ward. 
The octagon ward is situated, as shown in the block plan, south- 
east of the kitchen, being the first ward reached in passing from 
the administration building. This form of ward was proposed by 
Mr. Niernsee as a modification of the nearly square ward with the 
central chimney, used in two pavilions of the Massachusetts Gen- 
eral Hospital, and it was selected for this position mainly because 
in carrying out the corresponding row of buildings on the south 
side of the lot the ordinary rectangular ward would have come too 
close to the nurses’ home. It differs from the other wards in having 
two stories, besides the usual basement for heating apparatus, etc. 
The diameter of this ward, measured from opposite faces, is 57 
feet 8 inches; the length of each face on the inner surface is 23 
feet 10 inches. The height at the centre against the central 
chimney is 16 feet, the height at the walls is 15 feet, the average 
wall area per bed is 120 square feet, the number of square feet of 
flooring area per bed is 114.9 square feet, and the number of cubic 
feet per bed is 1760.8. The cubic capacity of the whole ward, in- 
cluding the bay window, is 42,160.8 cubic feet. 
In these wards the sun room at the south end is more nearly 
separated from the ward than it is in the common ward, forming 
a bay window with sash on five sides. The floor plans of this 
building are shown in Figures 1 and 2, Plate 17. The heating of 
the ward is arranged substantially as in the common ward, hereto- 
fore described, but the system of ventilation is altogether different. 
Rising through the centre of the ward is an octagonal brick 
chimney, 8 feet in diameter internally, and with walls two feet six 
inches thick, making a total external diameter of 13 feet. Upon 
each face of this chimney are two openings from the ward, one THE OCTAGON WAKD. 
93 
near the floor, the other near the ceiling, each measuring 20" by 26". 
Those in the lower ward open directly into the central shaft. 
Within this brick chimney is set a boiler-iron tube, 5 feet 9 inches 
in diameter, resting on a projecting cast-iron base built into the 
walls, which tube extends from the floor of the lower ward to above 
the ceiling of the upper one. Into the space between this boiler-iron 
flue and the outer chimney the openings from the upper ward enter. 
Just above the top of the boiler-iron flue is placed a ring of steam 
pipe to act as an accelerating coil. Through the centre of the 
chimney rises a cast-iron pipe 12 inches in diameter, which is 
intended to serve as a smoke flue for the open fireplaces to he 
placed in the wards against the central chimney, if these are found 
to he desirable. 
This smoke flue extends to the basement floor, where a large 
opening into it is provided to permit of the removal of soot swept 
down. Above, the smoke flue extends through and projects a little 
above the fixed cowl which caps the top of the chimney. 
In these wards the general direction of the air currents is from 
the circumference towards the central shaft. In cold weather the 
air passes either entirely or in part through the heating coils, the 
temperature being regulated by a valve as described for the com- 
mon wards, and is allowed to escape during the greater part of the 
time through the openings near the floor in the central shaft, in 
order to secure uniform diffusion of the fresh air and to prevent 
undue loss of heat. During warm weather, or when it is desired to 
rapidly change the air of the ward, the upper registers in the cen- 
tral shaft near the ceiling are opened, in addition to the lower ones. 
The general arrangement of the central shaft is shown in the longi- 
tudinal section of the ward, Fig. 1, Plate 18, which also indicates 94 
THE JOHNS HOPKINS HOSPITAL. 
by dotted lines the position and course of the hot air flues in the 
piers between the windows in the external walls. The area of clear 
opening at the top of the central shaft can be diminished by valves, 
a section and plan of which are given in Figs. 3 and 4, Plate 18. 
The service rooms, private wards, etc., on each floor of this build- 
ing are substantially the same as in the common wards, and are 
shown on the plan, the exit ventilating flues being indicated on the 
section. 
An interior view of one of the octagon wards is shown in Plate 
19, the view being taken from the north, or corridor, end of the 
ward. An exterior view of the building from the southeast is 
shown in Plate 20. 
The Isolating Ward. 
This ward is situated at the extreme east end of the north cor- 
ridor, as shown on the block plan. It is a one-story building with 
a basement, the arrangement of the rooms in which is shown in 
Fig. 1, Plate 26. 
The essential feature of this ward is that the central corridor is 
freely open to the external air at either end, and rises through the 
building in a clere-story at the top, the sides of the clere-story being 
fitted with movable glass louvres. 
The walls of this corridor are practically double, and it is neces- 
sary to pass through two doors to get from the corridor into one of 
the patients’ rooms. Each room for a patient measures 11' by 13' 1". 
It has an open fireplace with a separate chimney flue placed in the 
centre of the inner wall of the room. At one side of this chimney 
and fireplace is the entrance to the room from the corridor, con- 
sisting of a small vestibule with doors on each side, as above THE ISOLATING WARD. 
95 
described; on the other side of the chimney is a small closet, in 
which is a commode containing a chamber utensil, which can be 
removed through an opening in the wall, without the necessity of 
entering the patient’s room for that purpose. This closet is lined 
with galvanized iron, and has a separate exit flue, in which is an 
accelerating steam coil. The door of this closet does not come quite 
to the floor, and the exit of foul air takes place mainly through this 
closet and up its special flue, which is of iron. The whole of this 
closet, with its exit flue, can readily be cleansed with flame. The 
object of this arrangement is that each patient taken to this ward 
shall not only be isolated from the rest of the Hospital, but also, as 
far as possible, from all other patients in the ward. There is no 
common water-closet or bath-room, and no risk that the air from 
one room may pass into another by means of the common corridor, 
since this last is practically an open air passage. 
The peculiar arrangement of these ventilating closets, with their 
flues and accelerating steam coils, is shown in Figs. 1, 5 and 6 of 
Plate 27. 
The iron pipe from the closet passes obliquely from a point just 
above the accelerating steam coil into the chimney flue leading 
from the open fireplace, and extends through this flue to the top of 
the chimney, as shown in Fig. 9, Plate 27. Fresh air enters these 
rooms through registers in the corner, in the outer wall; the 
arrangements for heating and regulating the temperature of the 
incoming air being substantially the same as those described for 
the common wards, but the amount of heating surface is greater, 
being calculated for a constant supply of air amounting to two 
cubic feet per second for each room. 
The chamber utensils containing excreta, when removed from 96 
THE JOHNS HOPKINS HOSPITAL. 
the commodes, are taken to a special sink marked K on the plan, 
Fig. 1, Plate 26. This sink is enclosed by glass doors, has special 
ventilation and air supply, and the excreta can be thoroughly 
disinfected before being thrown into the sink. Three of the rooms 
marked I on the plan, Fig. 1, Plate 26, are larger than the others, 
measuring 13' 1" by 13' 10" each, and in these rooms the fresh 
incoming air, instead of entering through a register in the side 
wall, enters through the floor, which, for a distance of 7 feet from 
the outer wall, is perforated with 1-inch holes, giving over 94 square 
feet of floor, having 50 holes to the square foot. These holes are 
slightly funnel-shaped, and 20 are estimated as equal to one square 
inch of clear inlet. There are 5000 such holes in each room. 
The arrangement for heating purposes in these rooms is shown 
in Figs. 2, 3 and 4 of Plate 27. The object is to supply a large 
amount of air, about 4 cubic feet per second, to each inmate, and to 
have this air pass constantly upwards, so that no portion of this 
air shall be rebreathed or come a second time in contact with the 
patient, thus placing him in the condition of being out-of-doors in 
a very gentle current of air. The amount of heating surface in the 
coils for these rooms is, of course, much larger than for the other 
rooms, as will be seen by the table given in the general description 
of the heating and ventilation of the Hospital. 
In order to secure as little communication as possible, between 
this ward and the rest of the Hospital, arrangements are provided 
that the nurses on duty in this building shall remain there for 
several days at a time, and, accordingly, two bedrooms are provided 
for nurses, each room containing two beds. The bath-room in this 
building is mounted on a truck, and can be readily wheeled into 
any room where it is desired. The basement of this building THE KITCHEN BUILDING. 
97 
is entirely unoccupied, except by the heating and ventilating 
apparatus. 
An exterior view of the isolating ward, as seen from the north- 
east, is given in Plate 28. 
The Kitchen Building. 
This is a square building measuring 75 feet on each side, and 
three stories in height, with a cellar, situated on Monument Street, 
in the rear of the male pay ward, and at the north end of the 
corridor which extends between it and the nurses’ home, as shown 
on the block plan, Plate 2. 
The main floor of this building is shown in Fig. 1, Plate 29. It 
is on a level with the floor of the corridor into which it opens on 
the south. The two cold rooms (see Fig. 2, Plate 30), or refriger- 
ators, on this floor are built with hollow walls formed by placing 
thick paper on the brick walls, then battens covered by a 
£-inch lining of poplar boards. Over this is another layer of paper, 
another layer of battens, and another layer of $ poplar sheathing, 
thus giving two spaces inches in width, to prevent the conduction 
of heat. In the smaller of these cold rooms a lining of galvanized 
iron is laid over the inner poplar sheathing. 
The kitchen fixtures in the kitchen itself are indicated on the 
plan. The range is a double table range, to which there is free 
access on all sides, and has over it a large hood to lead the fumes 
or vapors into the central chimney. The kitchen fixtures are those 
ordinarily used in large and well-appointed hotel kitchens, and were 
supplied by Bramhall, Deane & Co., of 1ST. Y. The food is delivered 
from the kitchen through openings into the central hall to attend- 
ants, who place the vessels containing it on small trucks, by which 98 
THE JOHNS HOPKINS HOSPITAL. 
it is conveyed through the corridor to the several buildings. All 
the ordinary ward diets are furnished from this kitchen, as well as 
the food for all the officers and servants of the Hospital. The 
arrangement of the truck and the plan of the food cases for con- 
veying food from the kitchen to the wards are shown in Figs. 2, 3, 
Fig. 4. 
Fig. 3. 
4. The food cases themselves are double boxes, the outside being 
of galvanized iron, and the inside of tin. They measure 24 x 16 
inches and are 12 inches deep. The space between the galvanized- 
iron and tin is about one inch, and is filled with hair felt. Hot THE KITCHEN BUILDING. 
99 
water is poured in the bottom of the cases, and the dishes contain- 
ing the food rest on cleats or ledges above the hot water, as shown 
in Fig. 4. The truck for conveying these cases is six feet long and 
two feet three inches wide, and has one platform 9 inches from 
the floor and an upper platform, as shown in Fig. 2. By the use of 
these cases the food is readily conveyed to considerable distances 
without losing heat. 
The second floor plan of the kitchen is shown in Fig. 2, Plate 29. 
It contains rooms for the housekeeper and cooks, and dining rooms 
for the servants and employes of the hospital. 
The plan of the basement floor of this building is shown in Plate 
30. It contains the bakery, the bread store-room, the pastry cook’s 
kitchen store-rooms, and a cold room similar in arrangement to 
that described on the preceding floor. 
The boiler vaults are shown in Plate 34. 
Sections of the building, from north to south and from east to 
west, are given in Plates 31 and 32. 
The description of the arrangements of pipes, expansion joints, 
water filter, etc., shown in Plate 32 will be found under the general 
headings heating and ventilation, and water supply. 
It will be observed that the large central chimney into which the 
smoke flues from the boilers below enter, as shown in Fig. 1, Plate 
31, does not receive the smoke and ventilating flues from the 
bakery, kitchen, etc., until these have passed above the attic floor. 
The arrangement of these flues outside the central flues is shown 
in Fig. 4, Plate 31. 
The object of this arrangement is to prevent any irregularities 
of draft in the fires of the kitchen and bakery, by reason of varia- 
tions of temperature in the large central chimney flue, according 
to whether all the boilers or only a portion of them are being fired. 100 
THE JOHNS HOPKINS HOSPITAL. 
The plan of the cellar floor is shown in Plate 34. On the north 
this cellar connects by the central passage wflth the boiler and coal 
vaults, which extend between the building and Monument Street, 
a part of the coal vaults being beneath the sidewalks, with openings 
above in the pavement, indicated by small dotted squares on the 
plan. Through these openings the coal can be dropped from the 
carts directly into the vaults below. These vaults have a storage 
capacity for about 500 tons of coal. 
The boilers are situated entirely outside the wall of the kitchen 
building itself, and their smoke flues pass on the floor of the cellar, 
as indicated by the dotted lines, to the large chimney which rises 
through the centre of the building. These boilers, with their con- 
nections, have been described in the preliminary section headed 
heating and ventilation, see page 66. 
Over the smoke flues of both the steam and hot-water boilers is 
built a platform raised 5 steps or 3' 10" above the level of the cellar 
floor, and the general return main for hot water passes beneath 
this platform on its way back to the boilers lying directly under 
the flow main which is indicated on the plan. 
The rooms marked on the plan E. L. P. are for the electric light 
plant, including engines, dynamos, etc., when it is thought best to 
provide these. 
The entire building is surrounded by an area the bottom of 
which is on the level of the floor of the boiler vaults—viz.: 86 feet 
above mean tide. On the west side this area forms a covered pas- 
sage leading to the fuel lift, situated on the north side of the branch 
corridor leading to the male pay ward, and shown on the block 
plan. By this passage and lift all the fuel used in the open fire- 
places in the wards, administration and apothecary’s buildings is THE NURSES’ HOME. 
101 
conveyed. On the south side of the kitchen building this covered 
area opens into the pipe tunnel. 
The top of the boiler vaults is on a level with the pavement of 
the sidewalk on Monument Street. The space between the boilers 
and coal vaults has a glass roof and an arrangement of openings 
to permit free circulation of air, as shown in section Fig. 1, Plate 
34. All drainage from the boiler vaults and areas surrounding the 
kitchen passes to the two draining wells shown on the block plan 
between the kitchen and amphitheatre. 
The Nurses’ Home. 
The nurses’ home is situated at the south end of the north and 
south corridor, southeast of the female pay ward, as shown on 
the block plan, and is a square building measuring 90 feet on each 
side, four stories in height above the cellar, with a central clere- 
story. In the centre of the building is a ventilating chimney, 
within which is the brick smokestack of the boilers in the cellar. 
This chimney is square, measuring 6 feet 3 inches on each side 
internally, and having walls 2 feet thick. The thickness of the 
walls of the internal circular brick stack is 9 inches. The inside 
diameter of the circular smokestack is 4 feet, the outside diameter 
5 feet 6 inches, thus giving 15.3 square feet of clear area for venti- 
lating purposes between the chimney and the stack. 
The cellar of this building contains hot-water boilers, fuel 
vaults and store rooms. The coal vaults extend beneath the side- 
walk on Jefferson Street, the arrangement being substantially the 
same as that described for the coal vaults at the kitchen building, 
and the level of the hot-water boilers is precisely the same as that 
of those in the boiler vaults connected with the kitchen. The coal 102 
THE JOHNS HOPKINS HOSPITAL. 
vaults will hold about 150 tons of coal. The plan of the basement 
floor is shown in Plate 36. It contains the nurses1 dining room, the 
training kitchen, a large pantry, a lecture room, sewring rooms 
and store rooms. 
The arrangement of the main floor plan is shown in Plate 37. 
This is on the level of the corridor floor, and contains a large main 
hall, the nurses1 parlor and library, apartments for the superinten- 
dent of nurses, rooms for head nurses, etc. The two upper floors 
are the same in plan, as shown in Figure 1, Plate 38, and contain 
rooms for nurses. 
It will be seen from the plans and sections of this building that 
its general arrangement is that of a square central tower sur- 
rounded by corridors on all sides, with an external shell of living 
rooms. The central tower contains the large ventilating chimney, 
the stairway, and the water closets and bath rooms. In the outer 
shell on the upper floor each nurse has a room to herself. All 
water pipes and soil pipes are in the central tower, there being no 
fixed basins in the living rooms. Two large shafts for air and light 
are carried up through the central tower, as shown in the plans. 
These shafts communicate freely with the outer air both above and 
below, so that they have little tendency to act as aspirating shafts, 
and from them is taken the air supply for the adjacent closets. 
The building is heated by hot water, the radiating coils being in the 
cellar for all living rooms. The outlet air flows from the rooms on 
the basement floor from openings on the inner walls into flues 
which run downwards and then horizontally, being suspended 
from the ceiling of the cellar, and enters the space in the central 
ventilating chimney between its inner surface and the outer sur- 
face of the central smokestack. THE NURSES’ HOME. 
103 
The ventilating flues from the living rooms on the upper floors 
pass upwards in the inner walls of those rooms to the attic, where 
they unite in large galvanized-iron flues, which enter the central 
chimney, as shown in the section Plate 40. On each of the upper 
floors are four rooms provided with fireplaces and electric call hells, 
as shown in the plan in Plate 38. These are intended especially 
for the use of nurses who may he sick. The ventilation from the 
water closets passes directly into the central shaft, as shown in the 
section Plate 39. The main floor of the nurses’ home is separated 
from the covered corridor which unites the wards by an interval of 
24 feet 3 inches, which forms a “fresh air cut-off” in summer, so 
that the corridor air cannot enter the home. In winter this is an 
enclosed passage. On the cellar and basement floors there is com- 
munication with the pipe tunnel, through which pass the hot 
water flow and return pipes, as shown in the section Plate 39. By 
means of a lift at the south end of the corridor, as shown on the 
basement and main floor plans, food can be brought to this building 
from the main kitchen without being exposed to the outer air. 
With these exceptions the nurses’ home is an entirely independent 
building, having the general character of a well-finished hotel of 
medium size, in which each occupant has a front room well lighted 
and separately ventilated. The external view~ of the nurses’ home, 
as seen from the northeast, is given in Plate 41. The interior view 
of the main hall in this building on the main floor, as seen 
from the terrace over the pipe tunnel, is given in Plate 42. The 
interior view of the parlor of the nurses’ home, as seen from the 
south end looking towards the north, is given in Plate 43. 104 
THE JOHNS HOPKINS HOSPITAL. 
Amphitheatre and Dispensary. 
These buildings, joined by a connecting corridor through which 
is a narrow open air passage, forming a fresh air cut-off, are situ- 
ated on the north side of the grounds, opposite the three common 
wards, as shown on the block plan, Plate 2. 
The amphitheatre is a one-story building with a cellar, measuring 
91 x75 feet, and is connected with the basement of the administra- 
tive portion of the first common ward by an enclosed corridor, as 
shown on the block plan. The arrangement of the rooms in this 
building is shown on the plan Fig. 1, Plate 48. It contains the 
large amphitheatre, measuring 52 x 47 feet, with seating capacity for 
about 280 persons, a special operating room measuring 18 x 26 feet 
6 inches, well lighted from the south and by a large bay window 
on the east, an etherizing room, recovering room, a surgeon’s room, 
a small special ward for three beds, and the accident reception room, 
containing two beds. There is an entrance to the amphitheatre 
from Monument Street, for the use of students. 
The heating of the amphitheatre is effected by steam coils placed 
in the space below the seats, the fresh warm air entering through 
the risers. The foul air is drawn off into the ventilating chimney 
6 feet square, which is in the centre of the south side of the building. 
The air may be taken into this chimney either below near the floor, 
or above near the ceiling. The arrangement for this is shown in 
section Fig. 2, Plate 48. 
The seats and backs of seats in the amphitheatre are made of 
three thin layers of birch wood, glued together and perforated with 
numerous holes, resting upon iron brackets, the fronts and caps 
being of cherry. 
This amphitheatre is lighted by a large skylight, and also by a AMPHITHEATRE AND DISPENSARY. 
105 
large window on the north side. Each set of seats rises a little 
higher than the one just below it, so that a line drawn on the top 
of the backs of the seats from above downwards forms a curve, 
the concavity being upwards, which arrangement is deemed best 
in order to secure a good view for the occupants of each tier of 
seats. 
Opening from the amphitheatre by the side of the ventilating 
chimney is a dark room, marked D on the plan Fig. 1, Plate 48. 
This room is intended for use in developing negatives which may 
be taken by photography in the amphitheatre itself. 
The special ward is intended for those cases which it is not con- 
sidered desirable to take back into the wards for several days after 
an operation. An interior view of the amphitheatre is given in 
Plate 49. 
The dispensary, situated east of the amphitheatre and con- 
nected with it by a covered corridor, as above described, is a brick 
building of one story with a cellar, measuring 91'x75'. 
The arrangement of the rooms is shown in Fig. 1, Plate 46. It 
contains a large central waiting room 52 feet square, on the east 
and west sides of which are the rooms for the physicians, surgeons 
and specialists who have charge of this service. 
It is heated by steam coils in the cellar, the fresh warm air 
being delivered through the risers and backs of the benches, as 
shown in sections Figs. 3 and 4, Plate 46. The temperature of this air 
can be regulated without diminishing the quantity by the use of 
the valves, as shown in Fig. 4, Plate 46. The extraction of the foul 
air from the dispensary is effected by a large ventilating shaft on 
the south of the general waiting room, this shaft being six feet 
square internally. The air may enter this shaft either through a 106 
THE JOHNS HOPKINS HOSPITAL. 
large opening near the floor level, or through a large duct which 
communicates with the skylight, and its flow is made constant by 
means of an accelerating steam coil placed just above the upper 
opening. 
The general waiting room is lighted by a large central skylight, 
the other rooms by side windows. 
Medicines are dispensed from the pharmacy, which is on the 
south side of the waiting room. The general waiting room has a 
seating capacity for 400 patients. An interior view of the waiting 
room and dispensary is given in Plate 47, the view being from the 
north door, looking towards the pharmacy on the south. An exte- 
rior view of the amphitheatre and dispensary, as seen from the 
north, is given in Plate 50. 
The Pathological Building. 
The pathological building is situated on the northeast corner of 
the Hospital grounds, as shown on the block Plate 2, and is not 
connected by corridors with any other building. It contains a 
morgue or room for the dead, a waiting room for friends of the 
dead, an autopsy theatre, and a number of rooms intended for the 
use of the professional staff of the Hospital in pathological and bac- 
teriological studies. For the present the building is also used as 
the pathological laboratory of the University. 
It is a two-story building, with attic and cellar, measuring 
58 x 78 feet. The general arrangement of the rooms is shown in 
Figs. 1 and 2, Plate 51. On the lower or ground floor is the 
morgue, the waiting room, the autopsy theatre, a room for those 
engaged in private research, and rooms for bacteriological work. 
On the second floor is the director’s laboratory, a laboratory for THE PATHOLOGICAL BUILDING. 
107 
pathological histology, one for experimental pathology, a patholog- 
ical museum, and photograph rooms. 
The morgue measures 17' by 29' 8". It is not heated, and is 
ventilated so that no communication exists between the air of this 
and of other rooms in the building. The floor is asphalt. The 
room is provided with running water, a sink, a refrigerator, and 
with zinc-covered tables and undertaker’s ice caskets for the recep- 
tion of dead bodies. 
The autopsy theatre measures 29' 8" by 88' 2", and extends 
through both stories of the building. This room is lighted by a sky- 
light and by east windows. The theatre is arranged so that the 
observers stand upon elevated tiers arranged semi-circularly around 
the autopsy table. The first row of standing places is 3' 6" above 
the floor, the second is 1' 5" above the first, and in passing upward 
the elevation of each tier from the next lower one progressively 
increases by from 1 to 3 inches. The width of each tier is 1' 10". 
In front of each tier is a railing 3' 3" high. The arrangement is 
such that the observers are brought as close to the autopsy table 
as possible, and can look down readily over the heads and shoulders 
of those below. There is accommodation for from 60 to 70 ob- 
servers on these tiers. Against the wall, back of the autopsy table, 
is a large table the top of which consists of a heavy piece of slate 
7' 8" long by 2' 6" broad. Beneath this are cupboards for specimen- 
trays. By means of a movable crane 9' 6" from the floor and pro- 
jecting forward from the wall 9' 10", running water is brought 
over the autopsy table. The room contains a large sink with three 
stop-cocks for running water and a drainage tray. There are 
drawers and cupboards for instruments, specimens, etc. The floor 
is of asphalt. The room is ventilated by one of the two ventilating 108 
THE JOHNS HOPKINS HOSPITAL. 
shafts, 3' by 3' 6", which are shown on the plan. There is an 
arrangement by which the autopsy table can be ventilated down- 
ward through a tube opening in its centre. 
The bacteriological rooms occupy the northern side of the 
building. An interior view of one of these rooms is shown in Plate 
53. A table attached to the wall and supported by brackets runs 
along the entire northern side of the room in front of the windows. 
The top of this table is 2 feet 10£ inches from the floor, and is 2 feet 
6 inches broad. Stools with stuffed leather seats, which can be 
raised or lowered by a revolving screw, are used by those working 
at this table. Cases 3 feet 3 inches high and 1 foot deep, with open 
fronts, and containing shelves for culture tubes, re-agents, speci- 
mens, etc., are attached to the wall in front of this working table 
between the windows. At the side of each working place is a 
drawer beneath the top of the table, these drawers being absent 
from the part of the table which comes in front of a window. 
Along the middle of the room are two stationary tables 8 feet long, 
4 feet broad, and 2 feet 6 inches high. At one end of each table is 
a tap for hot and for cold running water, and in the centre of the 
table are four gas-jets. There is a single horizontal row of six 
drawers beneath the top on each of the long sides of the table, and 
beneath these drawers the rest of the space on each side is occu- 
pied by three cupboards with a shelf running along the sides and 
back of each cupboard, leaving the central space free to receive 
high objects. Each cupboard is provided with double doors, which 
can be secured by a Yale lock. 
Against the side of the room, opposite the windows, is placed a 
hood, where three steam sterilizers can be accommodated. Next 
to this is a cremation furnace enclosed in an iron hood. This fur- THE PATHOLOGICAL BUILDING. 
109 
nace, in which small animals and rubbish can be consumed, is 
constructed on the principle adopted for some of the furnaces em- 
ployed to consume garbage. The enclosing hood prevents much 
heat from escaping into the room from the furnace when in use. 
Against the eastern wall of the room (not shown in the pho- 
tograph) are two hot-air sterilizers protected by asbestos. In this 
part of the room is also a large sink with drainage tray. The 
room contains, in addition, tables and cases with shelves, drawers 
and cupboards. A small room opening into the main room at its 
northeastern corner contains the thermostats. 
The smaller bacteriological room at the northwestern part of 
the building, a part of which is shown in the photograph, opens 
into the larger room, and is furnished in a similar manner. The 
floor of both rooms is of asphalt, and can be flushed with water. 
The two rooms on the north side of the second story (17 feet 2 
inches by 37 feet, and 17 feet 2 inches by 17 feet) are devoted to 
pathological histology. A table similar to that in the bacterio- 
logical rooms is attached to the sides in which there are windows. 
Over this table, attached to the wall, are cases 4 feet long, 2 feet 10 
inches high, and inches deep. These are divided into four 
compartments or cupboards, two above and two below, each with 
a glass door provided with a Yale lock. A shelf, 4£ inches broad, 
runs around the sides and back of each cupboard. In these cup- 
boards can be placed and locked up the microscopes, microscopical 
specimens, re-agents and instruments of those working at the table. 
Other fittings of these histological rooms are a hood, cases with 
shelves, drawers and cupboards, sinks and drainage boards, black- 
board, tables, cases for microscopical specimens, etc. A small room 
or closet opening into the main histological room is lined with 110 
THE JOHNS HOPKINS HOSPITAL. 
shelves, where are kept hardened specimens for microscopical 
study. 
Eoom E P, of Fig. 2, Plate 51, in the southeast corner of the 
building, is used for experimental pathology. This is fitted with 
a hood, sink, tables, cases with shelves, drawers, cupboards, tables 
for operating on animals, etc. Here are also an injecting apparatus, 
a Ludwig’s kymographion, electrical apparatus, manometers, and 
other instruments for experimental investigations. Dawson’s rabbit 
and dog-holders are customarily used in preference to Czermak’s, 
Bernard’s, or other forms. 
The photographic room is fitted with shutters, so that it can serve 
as a dark camera, or it can also receive light from a window. On 
the southern front of this room is a balcony, to which there is 
access from the experimental room. From this balcony a heliostat 
can be arranged upon a shelf attached to one of the shutters, and 
through a hole in the shutter the sunlight can be reflected to the 
object to be photographed. A dark closet is connected with this 
room. 
The museum is provided with cases with shelves around the sides 
and also projecting from the western wall into the interior. 
The basement or cellar is divided into a number of rooms 
lighted by windows. In one of these is placed the furnace, the 
building being heated by the outside air passing over steam coils. 
The northwest room in the cellar contains the thermostats kept at 
the proper temperature for gelatine cultures. Partitioned off from 
this room is a small room or closet 10' long by 5' 6" broad-, the walls 
of which are composed largely of glass. These walls have been 
constructed with care, so that dust cannot enter from without, and 
here, when deemed necessary, cultures can be prepared and other THE PATHOLOGICAL BUILDING. 
manipulations performed where accidental infection from the air 
is feared. Experience, however, has shown that such precautions 
as were contemplated in the construction of this roopi are unnec- 
essary. 
The southwest room in the basement is fitted with a carpenter’s 
bench and tools. 
The southeast room in the basement is at present used for 
keeping animals. For this purpose especial provisions have been 
made for the lighting, heating and ventilation of this room, so 
that the animals may be under favorable hygienic surroundings. 
The ventilation is so arranged that air from the animal room 
cannot gain access to other rooms in the building. The general 
arrangement of this room is shown in Fig. 5 (page 112). 
All of the cages for keeping animals are constructed of galvan- 
ized-iron, the sides and tops being of galvanized-iron netting. The 
larger ones can all be taken apart and sterilized; the smaller ones 
are of a size which admits placing the whole cage in a large steam 
sterilizer. The accompanying drawings illustrate the construction 
of the cages used for inoculated rabbits and guinea pigs. The 
rabbit cages, Fig. 6 (page 113), are 13 inches long, 9 inches high, and 
11 inches deep. The top and bottom of the cage can be lifted back 
on hinges. In front is a rack to receive a card containing the data 
concerning the inoculation. On the top is a handle permitting the 
ready transportation of the cage. The cages intended for inocu- 
lated guinea pigs, Fig. 7 (page 113), measure 10£ inches long, 61 
inches high, and 71 inches deep, and are made as shown in the 
drawing. 112 
THE JOHNS HOPKINS HOSPITAL. 
East. 
North. 
South. 
West. 
Fig. 5. 
PLAN OF ANIMAL ROOM IN PATHOLOGICAL BUILDING. 
A Flue in S. E. corner, 3' 8"X3' 3". 
B “ “ S. W. “ 3'8"X2'6". 
C Shelf 1 foot wide. For small hand cages. 
D Dog kennels. Frontage of each cage 2' 4", depth 4', height 3'. 
Dotted lines represent gutters draining into drain-well opposite door. 
R Rabbit cages represented in Fig. 8. 
X Sink for frogs. 
Y Hot and cold water sink. 
Room measures : 
East and west, 30' 2". 
North and south, 17' 51". 
Height, 9' 9". 
Air space of room, 4847. G cu. ft. 
Floor falls 6 inches east to west and 3 inches from either side to central 
gutter. THE PATHOLOGICAL BUILDING 
113 
Fig. 6. 
Fig. 7. 
Fig. 8 (page 114) shows a drawing of a cage intended for rabbits 
or a small dog. It is 2 feet high, 2 feet deep, and \\ feet broad. 
The door measures 11 x 14 inches. The floor slants, and is provided 
with gutters, so that the fluid discharges run through an opening 
in front into a cup. This cage can be taken apart and sterilized by 
steam. 
The cage represented in Fig. 9 (page 114) is intended for the 
confinement of dogs. It forms one of a series of twelve which are 
arranged along the north side of the room as shown in the ground 
plan drawing (Fig. 5). In size it is 4' deep, 3' high, with a frontage 
varying from 2' 4" to 3', with a door one foot wide extending the 
entire height of the front elevation. On the front of each cage, as 
in the case of the smaller ones, is a metallic rack for cards contain- 
ing records of the experiment. These twelve cages are joined 
together by a stationary framework of iron which is fastened into 
the walls at its ends and at intervals, corresponding to the lateral 
boundary of each apartment, is supported by a double iron upright. 
This form of upright support serves also as a guide into which to 
slip the movable partitions between the apartments. The partition 
is represented in the solid sides of Fig. 9. 114 
THE JOHNS HOPKINS HOSPITAL 
Fig. 8. 
Fig. 9. 
The object of the movable partition is to admit of the enlarge- 
ment of an apartment if it is found necessary. By this arrange- 
ment the whole series may be converted into one large cage. These 
cages rest directly upon the asphalt pavement of the room, there 
being no separate bottom for them. As the pavement slopes 
toward the centre from the sides, the whole may easily be washed 
out with the hose. The cages are constructed of stout galvanized 
1" iron meshing. The joints are held together by bolts and nuts, in 
order that there may be no difficulty in taking them apart for 
sterilization. 
The Laundry. 
The laundry is situated on the southeast corner of the Hospital 
grounds, at a point most remote from the buildings now erected, as 
shown on the block plan, Plate 2. It is a brick building, measuring 
externally 115 by 56 feet, and is one story high, with a basement 
cellar. The general arrangement of the rooms on the basement THE LAUNDRY. 
115 
and main floor plans is shown in Figs. 1 and 2, Plate 54. The base- 
ment contains steam boilers, storage for coal, the engine, and the 
disinfecting chambers. These last consist of two rooms so arranged 
that the clothing or other articles to be disinfected, when taken 
into one of these rooms, pass thence into the disinfecting oven or 
boiler, from which they are removed on the other side, in another 
entirely separate room, so that the articles which have been 
cleansed and disinfected are not again exposed to infection while 
in the building. 
The disinfecting chamber, of which a perspective view is given 
in Fig. 3, Plate 55, is made of boiler iron and has a double shell, into 
the space between which steam may be forced. It is also arranged 
for the admission of live steam into the interior of the chamber. It 
is of an elliptical section, the longer diameter being perpendicular, 
and is 7' 2" long, 7' 5" high, and 5' 4" wide. It is lined with wood, 
and has wooden forms on which the mattresses, clothing, etc., to be 
disinfected, may be hung or placed. There is also placed in the wall 
between the chamber which receives infected articles and that in 
which cleansed articles are delivered, a large iron kettle or caldron 
3' 3" in diameter, with a capacity of 90 gallons. This is a double- 
jacketed boiler, heated by steam, and has two hemi-spherical covers, 
one opening into the outer, and one into the inner room. In this 
articles of clothing or bedding of small quantity can be steamed or 
boiled, thus avoiding the necessity of heating up the large disin- 
fecting chamber when but few articles are to be treated. 
The main floor of the laundry contains rooms for the washing 
and drying of the bedding and clothing from the patients which 
are distinct from those used for the officers and employees. The 
washing machines used are the Hamilton E. Smith’s No. 3 Metallic 116 
THE JOHNS HOPKINS HOSPITAL. 
Washers. Two 26-inch centrifugal wringers and one 30-inch 
French mangle, are employed. The vapor from the washing ma- 
chines is carried off through copper pipes, 4 inches in diameter, 
into a ventilating shaft. The tubs for hand washing are of porce- 
lain. The top of the laundry has a flat roof, and is provided with lines 
for exposing the clothes to the fresh air and sunshine whenever 
the weather will permit, a steam lift being at hand for conveying 
the wash to and from the roof. The building has a separate water 
supply, with a filter. The cellar affords storage for 100 tons of coal. 
The Bath House. 
The bath house is situated in the southwest angle of the inter- 
section of the main north and south corridor and the corridor 
leading to the male pay ward, as shown on the block plan, Plate 2. 
It is a one-story building with a basement, and measures 64' 9" by 
31' 3", the long axis running north and south. 
The arrangement of the rooms on the main floor is shown in 
Fig. 1, Plate 56. It contains rooms for hot air and for steam baths, 
with dressing rooms, and rooms for mercurial and sulphur baths. 
The entrance to this floor is from the corridor, the floor of which is 
on the same level. 
The plan of the basement floor is shown in Fig. 2, Plate 56, and 
sections of the building are given in Figs. 3 and 4 of the same plate. 
This building is heated by steam and ventilated by a central 
chimney four feet square, in which is placed an accelerating steam 
coil, as shown in the sections Figs. 3 and 4, Plate 56. The floors of 
this building are of granolithic pavement, and the walls have a 
soap-stone finish. Description of the Johns Hopkins Hospital. 
Billings. 
1890. 
National Library of Medicine 
Bethesda, MD 
Condition on Receipt: The quarter cloth and decorated paper case 
binding was in good condition. The sewing was intact but a few of the 
pages were loose. Most of the pages were in relatively sound condition 
even though some had a few small tears and some losses. 
Treatment Report: The pH was recorded before and after treatment; 
before 5.0, after 8.0. The volume was collated and disbound. The inks 
were tested for solubility. The head, tail, and pages were dry cleaned 
and nonaqueously buffered (deacidified) with a suspension of 
magnesium oxide particles in a perfluoro compound. The pages were 
encapsulated in polyester film. The volume was post bound in two full 
cloth bindings. A leather label was stamped in gold foil. The book 
plates were removed from the original binding and were adhered to the 
front pastedowns of the new bindings. 
Northeast Document Conservation Center 
January 1997 
DW/DG