a Al yt! - 3 s : ct > of 27) fea Soar, Pw se hod 3 is J O i" atte oF ne x 4 $a r¢ 1 ¢ Ph ‘ ’ fare . : ; ’ : : iy ¢ Ww bow : ‘ i iad ; f , > 7 ; F “y' . : ae hd ; ; , -\ Fs : *, *. oa EP HOSPITAL =e meay * nt va f 4 Return this book on or before the Latest Date stamped below. A charge is made on all overdue books. U. of I. Library 11148-S Ct, vy meant ohies MOIS LIBRARY OF THE UNIVERS!Ty OF ILLINOIS NOLAIy, &9 ydousojoyg dNOUS TVOIGAW SNIMdOH SNHOf AHL THE JOHNS HOPKINS HOSPITAL 7 _ PUBLISHED BY THE JOHNS HOPKINS HALF-CENTURY COMMITTEE BALTIMORE i925 odo 1) ; 4 , ony > / _ w~ AOKI “A | FOREWORD y N the tenth day of March, 1873, there was addressed to twelve of the leading men of Baltimore a remarkable docu- ment. It 1s not too muchto say that this communication, in its far-reaching effects on social and educational progress, was one of world-wide importance. This document was the letter of Johns Hopkins, set- ting forth to his trustees his hopes and plans for the future of the hospital which now bears his name. The new hospital, he wrote, should ‘compare favor- ably with any other institutions of like character in this country or Europe;”’ it should admit “‘the indigent poor. . without regard to sex, age or color. . and. . without y) charge;” it should be staffed by “‘surgeons and physi- cians of the highest character and greatest skill;”’ it should ‘establish a training school for nurses . . to benefit the whole community;”? and it should ‘‘ulti- FOREWORD mately form a part of the Medical School of that Uni- versity for which I have made ample provision in my will.” These conditions, together with the unusual provi- sions for grounds, buildings and endowment, marked Johns Hopkins as a man of rare foresight. Time, and the faithful carrying out of his trust, have made his name known in the most distant parts of the world, and have established the Johns Hopkins Hospital as the central unit of what many believe to be one of the leading medical centers of the world. The purpose of the following presentation is to ex- plain in a brief but comprehensive manner the signifi- cance of the Johns Hopkins Hospital as an agency for the treatment and care of persons afflicted by acute dis- eases, for the pursuit of medical research, and for advanc- ing the standards of medical education and the tech- nique of modern medical practice. Henry D. Harian Chairman of the Board of Trustees Winrorp H. Smitu, M.D. Director of the Hospital PART ONE THE JOHNS HOPKINS HOSPITAL WHAT IT IS 7 1. THE TREND TOWARD UNITY [1TH hospitals, as with newspapers, banks, railroads | and great manufactories, the trend today is toward concentration, toward the establishment of more complete and effective units. And especially is this Stee == true of organizations whose activities are nation wide. With hospitals this trend is toward the establishment of great medical centers, where there can be brought to bear upon the treatment of disease, and for the purpose of educating physicians, all the knowledge and facilities available to modern medical science. Such centers have existed for many years in Europe, in Berlin, Vienna, Paris, London and a number of other cities. Such centers are either planned or in develop- ment in Boston, New York, Chicago, Phil- adelphia, Nashville and Rochester. AN ESTABLISHED EXAMPLE Baltimore, in possessing the Johns Hop- kins Hospital and the medical branches of the Johns Hopkins University, has had such a center for many years, and, with the establishment since 1912 of the Johns Hopkins School of Hygiene and Public Health and of four new clinical institutes and the financing of a fifth, many believe that the Johns Hopkins medical center is today the most thorough and effective mobilization, in one compact group, of medical resources in the New World. NATIONAL IN SCOPE This movement for the organization of great medical centers has arisen in many instances because in certain municipalities there has been an ever increasing realiza- tion that the medical facilities which serve the immediate community should be bet- 6 THE JOHNS HOPKINS HOSPITAL ter organized. The Johns Hopkins Hospi- tal and the medical institutions with which it is affiliated, however, constitute more than a local medical center, for ap- proximately 80 per cent. of its private patients and 33 per cent. of all its patients come from homes outside of Baltimore. The Johns Hopkins Hospital has been and is a national and even an international hospital and from two viewpoints is one of the leading hospitals of the world. First, as a center for the treatment of all manner of acute diseases for rich and poor alike; and second, as a center for the training of physicians and surgeons. The combination of these two aims has proved both logical and effective. Through its methods in treating disease and in teaching students the Hospital has pro- moted a large amount of research work which has advanced medical knowledge and furthered the conquest of disease. AN IMMEDIATE OPPORTUNITY The Johns Hopkins Hospital is today one of the great hospitals of all time. In addi- tion it presents an outstanding opportu- nity for the promotion of medical progress in the future and for the establishment of an even greater institution, such as may well equal any like venture, past or pres- ent, for the welfare of humanity. u. THE INSTITUTION Johns Hopkins’ original gift to the Hospi- tal was $3,228,404.84. Because he directed that it should be the equal of any like in- stitution in the world, such an endow- ment was sufficient only to provide income for its operating expenses even at the be- ginning. For that reason it was necessary to allow the interest to accumulate for many years in order that the buildings might be erected without impairing the principal of the endowment. Thus, it was not until 1889 that the Hospital was completed and opened. GROWTH IN CAPACITY The Johns Hopkins Hospital of 1889 was equipped with 230 beds. Its founder ex- pressed the hope that it “might ultimately be able to receive four hundred patients.” Today the total number of beds is 683, of which 473 are in the wards and 190 in the Marburg Building and other divisions for private patients. With the completion of the Wilmer Institute, funds for which have already been provided, the total bed capacity of the Johns Hopkins Hospital will be 743. THE GENERAL HOSPITAL The aerial view, used as a frontispiece, in- dicates the physical proportions of the Hospital. Its grounds include fourteen and one-half acres—more than four city blocks. Its buildings, exclusive of the Med- ical School and the School of Hygiene and Public Health, with which it is associated, include twenty-one structures. These buildings not only house the va- rious and complex medical and surgical services of a great general hospital, as illustrated on the accompanying page, but also four great clinical institutes, each of which is a special hospital and research center in itself, yet all are integrated in the general hospital organization. WTI LS. GENERAL HOSPITAL Total No. of Beds WEE DIGAINCLINIG, O27 ard Beds) Met yale lie aera eel, 92 GENERAL MEDICAL METABOLIC DISEASES NERVOUS DISEASES TUBERCULOSIS GASTRO-INTESTINAL DISEASES DISEASES OF THE HEART SURGICAL CLINIC, 93 Ward Beds GENERAL SURGERY EAR, NOSE AND THROAT DISEASES OF THE EYE BRAIN SURGERY PLASTIC SURGERY ORTHOPEDIC SURGERY DENTAL CLINIC WIARBURGIDUILDING,) oo Ptivete Rooms |) Wiel ry 8. ils ke OP eri 1a PAVILION FOR PRIVATE PATIENTS IN ALL GENERAL SERVICES CLINICAL INSTITUTES Brapy UROLOGICAL INSTITUTE, 21 Ward Beds, 20 Private Rooms, 19 Cubicles , 60 GENITO-URINARY DISEASES OF MEN WomMaNn’s CLINIC, 126 Ward Beds, 10 Private Rooms, 18 Cubicles ‘ 3 ; RL ha OBSTETRICS GENITO-URINARY DISEASES OF WOMEN GYNECOLOGY CHILDREN’s Criinic (Harriet Lane) 90 Ward Beds, 10 PrivateRooms . . I00 MEDICAL DISEASES OF CHILDREN Puipps PsycHIATric CLINIC, 70 Ward Beds, 18 PrivateRooms . . . . 88 MENTAL DISEASES Preseni i oral of Beds ai. ||) . | tana: O83 WILMER INSTITUTE, 4° Ward Beds, 10 Private Rooms, 10 Cubicles . . . 60 (Will be opened within the coming year) DISEASES OF THE EYE Total Number of Beds Next Year. HOSPITAL LABORATORIES PATHOLOGICAL CHEMICAL BACTERIOLOGICAL SEROLOGICAL PHYSIOLOGICAL AND CARDIOGRAPHIC (For preparation (For diagnosis of the physical action of the heart of serums) and other bodily organs) TUBERCULOSIS WASSERMAN (Throughout all the services there are distributed a large number of smaller research laboratories, many of which are supported by the Medical School. In the Harriet Lane Home, for instance, there are fourteen such laboratories) SPECIAL DEPARTMENTS ExecutivE DeparrMent—Handles the administrative affairs of the Hospital and trains hospital executives. SociaL SERVICE DEPARTMENT—Handles approximately 12,000 cases a year. Nursinc DEPARTMENT AND SCHOOL FOR NursEs—Includes 250 student nurses and 72 graduates as head nurses and instructors. Has trained 1,260 nurses. PosTGRADUATE CouRSES FOR PHYSICIANS Course For DIETICIANS Mepicav Liprary PHoToGRAPHIC DEPARTMENT WorKSHOP FOR APPLIANCES FOR CRIPPLED CHILDREN 8 THE JOHNS HOPKINS HOSPITAL CHILDREN’S DISEASES The first of these clinical institutes to be established was the Harriet Lane Home for Invalid Children, which was opened in 1912. It was erected with funds pro- vided through the will of Mrs. Harriet Lane Johnston of Washington, D. C. This | =the FS institute is devoted to the study and treat- ment of children’s diseases. Last year it cared for 1,334 bed patients and approxi- mately 18,000 additional children re- ceived treatment in its dispensary. The work of its staff, the members of the Hos- pital’s Department of Pediatrics, have led to the discovery in its wards and lab- oratories of a large portion of that knowl- edge which made possible the introduction of successful methods for the treatment of rickets, tetany, acidosis and a large num- ber of the diseases of children which are due to nutritional causes. The fact that children with bowlegs and heads deformed by rickets are rapidly ceasing to bea com- mon sight is due to a great extent to the work of this department of the Hospital. UROLOGICAL CLINIC The Brady Urological Institute, in which thousands of persons suffering from dis- eases of the genito-urinary system have received treatment, was founded byJames B. Brady. The methods developed in this institute have reduced the mortality in operations for hypertrophy of the pros- tate gland from some 20 per cent. to 2 per cent. In its laboratories there has been discovered a long series of compounds for the treatment of disease. Among these are mercurochrome, an antiseptic of wide value not only in the treatment of urinary diseases but also for the purpose of com- COURT OF THE PHIPPS CLINIC bating blood poisoning and similar dis- orders, and flumerin, the introduction of which marked a new advance in intraven- ous treatment of syphilis. PSYCHIATRIC CLINIC A third clinical institute was established through the gifts of Mr. and Mrs. Henry Phipps. This is the Phipps Psychiatric Clinic for the study and treatment of men- tal diseases. Mental disease still presents some of the most trying problems which confront the physician. This clinic is one of the few places which is equipped with practically every known facility for the study of the causes which underlie insan- ity and mental illness. So little is known of these disorders that such an institution occupies a position of even international importance. WOMAN’S CLINIC Little more than a year ago a fourth clin- ical institute, the Woman’s Clinic, was established through the gift of Mrs. Lucy Wortham James. From the standpoint of WHAT ITIS 9 the number of patients treated it ap- proaches the general hospital, for 3,522 women were cared for in its rooms and wards last year. It is also the first and only modern obstetrical clinic in America to be established as a full-time depart- ment of both a hospital and a medical school. THE WILMER CLINIC Within the coming year there is to be es- tablished as part of the Johns Hopkins Hospital and the Johns Hopkins Medical School a fifth clinical institute. This will be the Wilmer Clinic for the study and treatment of diseases of the eye and in- vestigation of the causes of blindness. It will be under the direction of Dr. William Holland Wilmer of Washington, D. C. In all $3,000,000 has been contributed for this project. COORDINATE STRENGTH There are few hospitals in existence which have the counterpart of any one of these five clinical institutes. No other American hospital combines their equivalent in a single group. The Wilmer Institute, for instance, will be unique in that no like project has been attempted hitherto in this country, which for the most part has had to depend on Europe for the bulk of advanced research regarding diseases of the eye and for the training of its leading ophthalmologists. Disease does not attack one part of the body and leave the other parts function- ing normally. Diseases of the eye are often closely related to diseases of the brain; diseases of the bones to diseases of the blood; diseases of the skin to diseases of the internal organs; remote infections may result in serious and even fatal diseases of the heart. INTERRELATION OF DISEASE Throughout the whole field of human ail- ments the problems are so interrelated that one disease or one group of diseases can seldom be understood and treated to the best advantage without a thorough knowledge of other diseases or disorders which are related to the specific trouble under observation. The men who special- ize in one field find that their work is gen- erally much more effective if they can ob- tain aid from men who are specializing in other fields. That is the reason why each service of the Johns Hopkins Hospital and each of its clinical institutes gains strength through its association with the other departments of the unified group. None could be so useful and effective if it stood alone. Because of these facts the Johns Hop- kins Hospital has extended its services in an effort to compass, as nearly as possible, the entire range of medical and surgical ailments which afflict those who come to it for aid. mi. RELATION TO THE MEDICAL SCHOOL If disease were an open book, if it were mation concerning its problems. But, al- thoroughly understood, hospitals would be in no further need of additional infor- though the last fifty years have seen greater medical progress than all the pre- 10 THE JOHNS HOPKINS HOSPITAL ceding years of history, the physicians and surgeons of a hospital find that all they know now does not begin to provide them with the knowledge which they need. A TEACHING HOSPITAL Therefore it is a matter of prime impor- tance to remember that the Johns Hop- kins Hospital is a teaching hospital—a hospital where men try not only to apply what is already known, but also seek to = discover better and more effective meth- * ods for the conquest of disease, where such methods are not only applied to the relief of patients within the hospital but also serve to teach the physicians and the sur- geons of the future. It was the first hospi- tal in this country which was founded pri- marily with the idea that it should be- come a partof a medical school and should make the advancement of medical knowl- edge one of its major endeavors rather than a subsidiary activity. BENEFICIAL RESULTS The resulting benefits are twofold: first, the patients of the hospital receive the full benefit of the latest medical knowledge and the discoveries which result from re- search in the Medical School; second, the Medical School has the opportunity to study disease as a living problem rather than as a dead language or something which is dealt with merely in books and lectures. FACULTY AND STAFF ARE ONE The value of such cooperation between a hospital and a medical school is evident. The problem, however, has been to make THE HARRIET LANE HOME it effective. That an effective method was found at Johns Hopkins has been evi- denced by the fact that its system has been followed by many of the leading hos- pitals of the country, particularly those which are associated with Class A medical schools. The union between the two insti- tutions was brought about by making the staff of the Hospital and the faculty of the Medical School one body. “THE FOUR DOCTORS” The late Sir William Osler was the Physi- cian-in-Chief of the Hospital and the first Professor of Medicine in the Medical School. Dr. William S. Halsted was the first Surgeon-in-Chief of the Hospital and Professor of Surgery in the Medical School; Dr. Howard A. Kelly was the first Gynecologist-in-Chief and Professor of Gynecology, and Dr. William H. Welch, who organized the Hospital’s Department of Pathology, was also the first Professor of Pathology in the Medical School. We ESAS ITA TS, II BEST FOR THE PATIENT Ever since that time the junior members of the staff, as well as the chiefs of ser- vices, have also been members of the Med- ical Faculty. This insures to patients the best of medical attention, for these men bring to the treatment of disease the lat- est and most effective medical knowledge. As teachers, they must give the reasons for the things they do, and hence their knowledge must be of the soundest type. Under such a system fallacies are open to immediate detection. RESEARCH AND MEDICAL PROGRESS Engaged as it is with the Medical School in an educational project, the Hospital is seeking to advance medical knowledge. Thus the members of its staff are always endeavoring to discover better methods by which to combat disease. Although the Hospital has many laboratories of its own, which are in constant use for the chemical, physical and bacteriological tests neces- sary to the every-day diagnosis, the mem- bers of its staff are able to go much further in the study of the underlying causes of disease because of the laboratory facilities provided by the Medical School. COOPERATIVE EFFORT The staff of the Johns Hopkins Hospital, for instance, has played a leading role in discovering the underlying cause of rickets and dependable measures for the preven- tion and cure of this disease. This could hardly have been accomplished without the laboratories of the Johns Hopkins Medical School and the Johns Hopkins School of Hygiene and Public Health, or without the aid of men on the faculties of these schools. RELATION TO THE SCHOOL OF HYGIENE Hospital patients are always the victims of disease, but the ideal hospital should endeavor not only to cure them but to keep them well. It is therefore of particu- lar advantage that the Johns Hopkins Hospital is closely associated with the School of Hygiene and Public Health. This school is concerned primarily with the discovery of methods for the preven- tion of disease. It is regarded as one of the leading centers for this new medical sci- ence, and its students, mostly trained medical men, come to it from every con- tinent. This school has been housed at a considerable distance from the Hospital, but its new building is being erected as part of the main medical group. AIDED BY THE UNIVERSITY The problems of combating disease, to a great extent, concern the application to the functions of the living body of the basic knowledge of such sciences as Chem- istry, Physics, Biology and Psychology. The departments of the Johns Hopkins University naturally are able to make a more extensive study of these sciences than are the Medical School and the School of Hygiene. Hence, the scientific faculties of the University are able to pro- vide the staff of the Hospital with special aid and counsel which is often of the ut- most importance. For example, the test which is now used in the Hospital to de- termine whether or not a patient’s kid- neys are in condition to withstand the 12 THE JOHNS HOPKINS HOSPITAL shock of an operation—a test which has saved many lives—is made with a sub- stance discovered in the University’s De- partment of Chemistry. THE SUM The general medical and surgical services of the Johns Hopkins Hospital, plus its five clinical institutes, plus the Johns Hopkins Medical School, plus the Johns Hopkins School of Hygiene and Public Health, plus the scientific departments of the Johns Hopkins University, sum up the scope of a medical group which offers in- deed a mighty bulwark against disease. It also represents a foundation established by thirty-six years of outstanding fruitful endeavor and a physical plant which to- day would cost many millions of dollars to duplicate. On the basis of what already exists at Johns Hopkins this country now has the opportunity to develop for itself, within a relatively short time, a medical center such as may well equal if not surpass any- thing which existed in Europe even prior to the war or is likely to exist there for many years to come. PART. TWO THE JOHNS HOPKINS HOSPITAL WHAT IT DOES 7 = =, LD THOUGH patients come to the Johns Hopkins | | in promoting the conquest of disease goes far be- Hospital from all parts of the country, its influence yond the range of the persons who receive direct =) benefit from treatment within the institution itself. The Hospital, as a center of medical education, is able not only to give its own patients much better care than would otherwise be possible, but is also able to benefit thousands of persons who will never see the Hospital itself. 1.§ ADVANCING MEDICAL KNOWLEDGE There are now 1,936 Doctors of Medi- cine, graduates of the Johns Hopkins Medical School, who were trained in the Johns Hopkins Hospital. They are caring for the sick, preventing disease, and car- rying on medical research in every state and territory of the United States and in fifteen foreign countries. The graduates and former members of the Johns Hopkins medical staff, more- over, include 121 men who now hold full professorships in forty-two American and nine foreign medical schools. As the Johns Hopkins method of coordinating the work of medical education with that of hospital treatment has been adopted generally throughout the country, the majority of these men are also members of the staffs of important hospitals where teaching is coordinated with care of the sick. RESEARCH LEADERS AND CLINICIANS On the staff of the Rockefeller Institute for Medical Research Johns Hopkins men outnumber those from any other medical institution. The directors of both the in- stitute and its hospital are former mem- bers of the staff of the Johns Hopkins Hospital. Johns Hopkins men also occupy such positions as Surgeon-in-Chief, Physi- cian-in-Chief, Obstetrician-in-Chief and Physician-in-Charge of the Neuropsychi- 14 THE JOHNS HOPKINS HOSPITAL atric Division, at the new Henry Ford Hospital in Detroit. TRAINING HOSPITAL EXECUTIVES Many of the directors of well-known hos- pitals also received their early training at Johns Hopkins. These include the direc- tors of the hospitals of the Universities of Chicago, Maryland and Georgia; the Cornell Clinic, New York City; the Barnes Hospital, St. Louis; the Charles T. Miller Hospital, St. Paul, and the Hartford Hospital, Hartford, Conn. One of Great Britain’s foremost institutions for the treatment of mental diseases, the Royal Mental Hospital of Glasgow, is also under the direction of a former mem- ber of the Johns Hopkins staff. POSTGRADUATE INSTRUCTION During several months of the year the Hospital also offers postgraduate instruc- tion to practising physicians and surgeons, who come to attend clinics or serve for a period on the staff of some department. In recent years medical progress has been so rapid that many men in general practice are eager to avail themselves of such op- portunities. Their patients, though they may never receive care at the Johns Hop- kins Hospital, benefit through this work. TRAINING OF DIETICIANS Food is an important factor in the treat- ment of disease in the cases of under- nourishment among children and in many other conditions where diet is all impor- tant. In view of this fact, a department was established in the Hospital to make a special study of nutritional problems in- A CUBICLE IN THE WOMAN’S CLINIC volved in the care of various patients, and at the present time asix-months’ course in hospital dietetics is provided. An average of ten graduate dieticians, chiefly from other hospitals or universities are study- ing this work at Johns Hopkins through- out the year. TRAINING OF NURSES The School for Nurses is the principal ed- ucational branch of the Hospital as dis- tinct from the University. This school was founded with the opening of the Hospital in 1889 and in its own field of medical ed- ucation has been a leader in establishing higher standards. It was the first: 1 To put instruction ahead of routine work in the training of nurses. 2 To abolish pay for nurses in training, thus putting them on a student rather than an employe basis. 3 To establish an eight-hour day, thus provid- ing student nurses more ample time for study. 4 To establish laboratory courses for nurses. 5 To establish a three-year nursing course. 6 To employ regular paid instructors to conduct the courses for nurses. WHAT IT DOES 15 Its alumni number 1,260 and among them are a large number of women who hold or have held the most important po- sitions in the field of nursing throughout the world. They include: Director of the Department of Nursing and Health, Teachers College, Columbia Univer- sity. Professor of Nursing, University of Michigan. Director, Department of Nursing, American Red Cross. Chief, Department of Nursing, League of Red Cross Societies, Switzerland. President, American Nurses Association. President, National League of Nursing Educa- tion. Superintendent of Nurses, Union Medical Col- lege and Hospital, Peking, China. The School for Nurses and the Depart- ment of Nursing of the Hospital are uni- fied under the same control. The School, therefore, not only trains nurses for ser- vice in other hospitals, in homes, in pub- lic health work and in industrial services, but also insures that the Hospital itself is provided with a corps of nurses who are competent to care for its patients. WIDE INFLUENCE OF HOSPITAL TRAINING Thus, through the men whose medical education was received in the Johns Hop- kins Medical School and the Hospital, through the men who have received train- ing in the Hospital as members of the staff or as postgraduates, and through the work of nurses and dieticians trained in the Hospital, the benefits derived from this institution are carried throughout the country and to distant parts of the world. u. THE STAFF No matter how extensive the buildings, how complete the organization and the departmental services of a hospital, these things in themselves cannot establish an institution of the first rank. After all they are details—means to an end. The end is accomplished through them, but the ac- complishment itself lies in the work of men—the men and women who make up the staff and personnel of the Hospital. At the present time the personnel of the Johns Hopkins Hospital, including the Dispensary, is as follows: Resident Physicians... a. 220-24: ais Visiting: Pysicians:\.. 22. rece 189 Officers and Head Nurses......... op? Stident Nurses oh. s2 t vee aes 250 Bayi timploveseces: ss 23 dakeaee 752 1338 In keeping with the original direction of the founder, the staff of the Johns Hop- kins has been always fortunate in having “surgeons and physicians of the highest character and greatest skill.” MORALE Its reputation has not been established alone by the outstanding men who head the various departments. These men have been assisted by a large body of younger men of marked ability, and the efforts of the entire staff have always been marked by a spirit, a morale, which has fused theaccom- plishments of individuals into the greater and common record of the Hospital. The members of the Johns Hopkins staff are willing to put pride in the ac- complishments of the Hospital as a whole 16 THE JOHNS HOPKINS HOSPITAL before pride in individual accomplishment. The result is found in the widespread faith of the public in the Hospital as a whole; in the fact that hundreds of pa- tients come to Johns Hopkins every year, firm in the belief that they will receive the best of treatment, and yet without the remotest idea as to the identity of the in- dividual physicians and surgeons who will attend them. ul. THE PATIENTS There is no arbitrary standard by which the ability of a hospital staff can be judged but one of the best tests is whether its pa- tients come not only from the immediate community but also from distant points. WHERE THEY COME FROM From January Ist to December 31st, in- clusive, 1924, there were 3,310 bed pa- tients who came to the Johns Hopkins Hospital from homes outside of Balti- more. This was 33 per cent. of the total number for the year. Their residential distribution was as follows: Maryland putes Peer koe 997 West Virginia. . 381 Peéennsylvania.2)..14.4 Pas eee 273 ViTgini anti hi we eae 246 North Carolina: s\n uniee eacasiols 240 DROW LODK coy Syl er AeA ern te 185 District of Columbiavin nanan 128 SoutniCarolina 9. i) \e waits ee IOI NCHNESSER 2 ob sa. earcie on eeee Sn 99 Flondan sii i.e io cee See 94 EOP Se rae ol ak 73 New Jersey! icici k eae ee 65 US WN eg EOE PL SN 44 Gebietes grica te: sateen se 43 Delaware? 253)... 4 i ee 35 Kenpeckviies ok... 5.0): ae eee 34 Alabatigiaetes. cece cn wake 22 Connegtienty...(.. . ASS aan eae 23 Thins mies Fe...!s 1 UA 2 ae 21 Okla@ere eis... 4 tele een ski 21 Other States East of Mississippi... 64 Other States West of Mississippi... 67 Residents of Foreign Countries.... 44 These patients included residents of forty-three states, the District of Colum- bia, the Panama Canal Zone, and ten foreign countries. REPRESENTATIVE OF ALL CONDITIONS The diseases from which these persons suffered were as diverse as their geographic distribution and the patients themselves ran the gamut of race, color, creed and condition. As an illustration, among those cared for at Johns Hopkins during the last few months were: A former member of the Cabinet whose home was in California. A negro who came to the Hospital by “riding the rods” of a freight train from North Caro- lina. Wealthy residents of New York, Detroit, Chicago, Denver and San Francisco. The blind children of a West Virginia moun- taineer, whose entire savings for two years were barely sufficient to pay their fare to Baltimore. THE WIDEST DISTRIBUTION Although the majority of the patients at the Johns Hopkins Hospital are unable to pay the full cost of their treatment and care, it is among those who can do so and find the cost of travel no impediment, that the widest geographic distribution is found. A survey, representative of an average day in the Hospital, showed that 81.5 per cent. of the private patients came WT ATER ESD OF S from homes outside Baltimore. Their resi- dential distribution was as follows: UNIS iia le ONE a Ra a ut LESTE AN Sec Me Res Ue Ne II reste Vitis? Pre Mon ees cos, el, AONE 0 A er 9 7 6 5 4 4 I 3 TE at he ll BR OF 3 PepeEeTROuaATONN A 9. Madhu hk asin . EES Sole Ra BU oa oy SE 2 2 2 2 2 2 2 I I I I I I ROMA ATG AH alk: s http ites! Li ib OME Tan 8 SE TE ey BO oem NOR CIN GAI nares let oe rie, Cte see MIE WRPEESCY 6 iota es ee ta sb Bra niia me one eka oboe LF 015g Va Pate OSU Mag Ta aa ee meagan eee bee ce, woe eke "Hesse aN ott A ik A, OSCE ey Bo 2a nae PVLEIECO Maye. Sta Se Fo honcien 3 ate 1924 A RECORD YEAR In 1923 the Hospital cared for 8,549 pa- tients. This total was greater than that for any previous year in its history. But in 1924, that is, the year ending January 31, 1925, it exceeded this record by 1,622. The total number of bed patients cared YEARLY INCREASE IN NUMBER OF PATIENTS 1890-1925 17 DISTRIBUTION OF PATIENTS Year Ending Fanuary 31, 1925 Days Treatment 26,917 14,528 11,492 24,563 77,590 GENERAL HospPITaL Private Ward Rate Less than Ward Rate... . Free Patients Patients 1,370 875 719 1,330 4,294 EAC EL 3 7G) 1,602 6,638 19,808 Less than Ward Rate... . Free Patients 29,418 Puipps PsycutaTric CLINIC Private Ward: Ratesn seer Less than Ward Rate... . Free Patients........... 9,248 8,336 5,099 3,831 26,514 Brapy Uro.ocicat INSTITUTE Private Ward Rate Less than Ward Rate... . Free Patients 11,969 2,652 670 1,497 16,788 Woman’s Ciinic Private 1,084 621 g,012 12,956 235933 47,606 Ward Rate Less than Ward Rate... . Pree: Patientsosias. eee Totals 10,171 197,826 for during the year that has just come to a close was 10,171. The daily average of bed patients for the year was 542. The average weekday total of Dispensary patients was 579. This means that on every regular week- day throughout 1924 the Johns Hopkins Hospital treated an average of 1,127 sick persons. More patients are constantly seeking aid than can be cared for, but the 18 THE JOHNS HOPKINS HOSPITAL Hospital is constantly striving to give lished when a total of 1,558 bed and dis- treatment to all who come to it. On Feb- ruary 24th, 1925, a new record was estab- pensary patients received treatment on — that day alone. Iv. FREE CARE There has somehow arisen a widespread impression that a very large proportion of the patients who come to the Johns Hop- kins Hospital are persons of wealth. This is not true. The facts are that for every bed patient who comes to Johns Hopkins and is able to pay the full cost of his treatment, four are cared for who are unable to do so; that for every patient who pays the full cost there are two patients who are unable to pay anything. The following is the total of bed pa- tients cared for in the Johns Hopkins Hospital from February 1, 1924, to Jan- uary 31, 1925: Number Total Days Patients Treatment Private Patients... 20... 2,120 50,588 Semi-Private Patients. . . 51 621 Ward Rate Patients.... . 1,714 36,130 Less than Ward Rate.... 2,054 36,855 rec Patients yee sone pease se 73,032 LP otalscne sabia 10,171) 197,826 FORTY-SIX PER CENT. PAY NOTHING Of these patients only 21.3 per cent. paid the full cost of their treatment. In all 78.7 per cent. were cared for at less than cost and 41.6 per cent. of the total were cared for absolutely without charge. The fact that 5 per cent. more who intend to pay prove to be unable to do so, brings the total of wholly free patients to 46.6 per cent. of the total. 78.7% AT LESS THAN COST Although 78.7 per cent. of the patients at Johns Hopkins are cared for at less than cost, they are not, in general, habitually dependent. They are rather to be regarded in the light of persons who are the victims of catastrophe such as a fire, an earth- quake, or a war. WHEN DISEASE STRIKES Many an industrious workman, who is well able to provide for himself and his family under ordinary conditions, is un- able to bear any of the cost of hospital treatment when he becomes acutely ill. Even though he has been thrifty and has accumulated savings, these are often only WHAT IT DOES 19 enough to guard his family against priva- tion while he is unable to work. COST EXCEEDS $500,000 A YEAR At any rate such a patient is admitted to the wards regardless of his ability to pay. The ward rate is $2.50 a day, approxi- mately half the cost per capita to the Hospital for each patient, which is $5.08. Only approximately one-fourth of the ward patients, who constitute four-fifths of all the bed patients in the Hospital, are able to pay the full ward rate. Less than one-fourth are able to pay some amount less than the ward rate. More than one- half of the ward patients pay nothing at all. In all the Hospital spent more than half a million dollars on free care last year. ALL PATIENTS TREATED ALIKE These patients who pay nothing or less than cost nevertheless receive the same expert treatment and care that wealthy persons seek to obtain by paying the reg- ular private rate of seven to thirteen dol- lars a day, plus fees for treatment, and often the cost and time involved in com- ing to Johns Hopkins from a great dis- tance. In the main it may be said that the ward patients receive exactly the same treatment as the private patients with the exception of not having a private room to themselves. Many members of the staff attend both private and the free patients; the same laboratories and facilities for diagnosis and treatment are available for both. All patients are admitted to the Hospital on the basis of but one considera- tion: the degree of their need for medical and surgical attention. Ability to pay is not a determining factor either in receiving or caring for patients in the wards. CARE OF COLORED PATIENTS In this connection it is important to note that 2063 of the Hospital’s bed patients last year, approximately one-fifth of the total, were colored people. In many dis- tricts throughout the South there are no local facilities whereby colored people can obtain the best of medical and surgical attention, and from there many indigent patients turn to Johns Hopkins for aid. v. THE DISPENSARY The patients who are so acutely ill that they must be cared for in the wards of a hospital are but a small proportion of those who need medical aid. Each day, for every patient who receives bed care in the Johns Hopkins Hospital, there is another who is treated in the Hospital’s Dispensary. In all, approximately 3,127,- 711 visits have been made to this depart- ment. In the year ending January 31, 1925, alone, the number of dispensary visits was 176,631. FREE CARE Many of these patients would have be- come bed patients had it not been for the treatment received while they were able to be up and about. The suffering and the economic waste prevented by this service cannot be estimated. Most of those who 20 THE JOHNS HOPKINS HOSPITAL SSE anaepaed sey B AFM FESSTEE 4h ME ot OEE Dray erceg ta a wee sat Aig PPR OS pagar oc gay fr CSTOURBE el OE 2 THE NEW DISPENSARY (To be opened in 1926) avail themselves of it would suffer intense- ly if sickness destroyed their earning capacity even for a short while. This is shown by the fact that the average return in fees to the Hospital for each visit of a Dispensary patient is but nine cents. The cost of operating the Dispensary is a large item in the total of the $500,000 a year whieh the Hospital expends on free care. SCOPE OF THE WORK To a large extent the same staff which at- tends the private patients cares for the Dispensary patients. Every facility at the command of the Hospital for diagnosis and treatment is used for their benefit. The wide scope of this service is illustrated by the following table of medical and sur- gical classifications of the Dispensary pa- tients treated during one year. DISTRIBUTION OF DISPENSARY PATIENTS YEAR 1924 Medicine: /vis- iene ae eee 10,982 Gastro-Intestinal............. 9,932 Metabolism.) Jos aine ee 2,196 Tuberculosis, :<:\.40). 5.2 a ee Nenrology{ sac) ie eee 3,692 SUPRELY sa pic wide sae eles ae 26,302 Genito-Urinary...4 4; 003 II,915 Orthopedicssai) gare cae noe 13,531 Ear, Nose and Throat........ 11,095 Diseases of the Eye.......... 7,980 Skin. re; 22 Suen, sae 4,847 Gynecology :):. Gatien eo 95323 Obstetrics...) \Su near, ce 7.038 Dentistry. i cts ee ee 2,030 Syphilis: |: eee pee. 19,031 XRay lon Soap te ts fog 11,185 Children’s Diseases........... 18,232 Psychiatry senna © ke Are 2,522 TOtalguerraw can sea cree 176,631 WOH AER ED OES 21 Such brief classifications, however, do not always speak so eloquently as the fact than more than half of the crippled chil- dren of Baltimore alone have, at one time or another, received aid from the ortho- pedic service of the Dispensary. Most Dispensary patients have very little money but many of them contrive to come to the Dispensary from a distance. One family spent the accumulated sav- ings of two years in paying the carfare of two children whose sight was restored through free treatment. THE CARNEGIE GIFT Remarkable as the record of the Dispen- sary has been, its work nevertheless has been hampered and curtailed by lack of money and space, both in the treatment of patients and in the teaching of students. The Carnegie Corporation, however, con- sidering that the curtailment of this work would be a great misfortune, has given $1,000,000 for the erection of a new dis- pensary building and $1,000,000 for the endowment of the work. vi. SOCIAL SERVICE Attention has been called to the fact that the Johns Hopkins Hospital attempts not only to enable people to regain their health but also endeavors to teach and aid them to retain it when once regained. To this end it established its Social Ser- vice Department, one of the first hospital agencies of this kind. The workers in this department not only assist the medical staff in furnishing patients with such in- struction as is needed best to insure con- tinued health, but also strive to combat those influences which, though not pri- marily medical and surgical problems, have a most important bearing on the recovery and subsequent health of the patient. THE PROBLEM Before this work was begun patients not infrequently came to the Hospital for treatment, were discharged as cured and then returned within a short time suffering with the same ailment. Sometimes this would occur repeatedly within a few months. The results were disappointing— waste in the health of patients, waste of the time of the physicians, and in the cost of treatment. THE SOLUTION By giving special attention to aiding pa- tients in establishing habits of life which are conducive to health, obtaining em- ployment such as is not detrimental to them as individuals, and in improving the hygienic surroundings of daily life, the Social Service Department has done much to overcome the cases of recurring ail- ments. A large part of its work, however, has to do with the patient while he or she is still in the Hospital. Recovery often can be materially hastened by the removal of worries which interfere with a patient’s normal recuperation. Sometimes a mother is worrying because she fears her children are being neglected in her absence, or a father does not get well because he is afraid he will lose his job while he is in the Hospital. When such fears are put to rest, the effect on the re- ed THE JOHNS HOPKINS HOSPITAL covery of the patient is often remarkable. This department also endeavors, when- ever possible, to bring all members of a family to the Hospital for examination, when one of their number is found to be suffering from a communicable disease. In this manner the contact of a single person with the Hospital often results in an en- tire home being freed from disease. vu. IDEALS Money, building, equipment, able ad- ministrators and able staff are not alone sufficient to make a hospital all that it should be. A hospital is a human institu- tion, not a machine. For that reason it must have certain aims and ideals by which to guide its course. The first object of the Johns Hopkins Hospital is, as far as possible, to give the patient the most effective treatment and care. Its activi- ties as a center of medical education exist primarily in the interest of the patient. Thus, the attitude of the Hospital toward the patient is the criterion of its policy. This attitude is summarized in the follow- ing code: THE CODE (All patients are admitted without regard to creed, color, race, social condition, or ability to pay. @All patients are admitted solely on the basis of their need for medical and sur- gical attention. @ All patients are to receive equal considera- tion and care. (All patients are to receive the full benefit of scientific investigation seeking better methods to combat disease. @All patients are to be regarded as indi- vidual problems rather than general “cases.” All patients are to receive not only skillful medical and surgical attention, but con- siderate treatment as human beings as well, @LAll patients are to receive any aid the Hospital can give, in addition to hos- pital care, which will promote their recovery. @All patients are to be given any instruc- tion or information which will help them to stay well after they have left the Hospital. @ All patients are to be treated fairly in re- gard to fees, no matter whether they are able to pay much, little or nothing at all. vil. THE FRUITS OF RESEARCH In surveying the scope of the work that goes on within the Johns Hopkins Hospi- tal there is danger of thinking of its use- fulness only to the persons primarily in- volved, the patients in the beds and the pa- tients who come to the Dispensary for treatment. It must always be remembered however, that the research and _ skill brought to bear in the constant effort to provide better means and methods for the treatment of these immediate patients have resulted in great advances which have been of benefit to patients in all parts of this country and in foreign lands as well. TE SIRURURE 23 To recount even a general summary of representative Johns Hopkins contribu- tions to the advance of medical knowledge requires a pamphlet by itself, such as was recently published by the Half-Century Committee under the title: “The Spirit of Inquiry in Medical Education.” It would not be fitting, however, to pass by this subject without some word concern- ing the part which present and former members of the staff of the Johns Hop- kins Hospital have played in the estab- lishment of modern methods in Medicine and Surgery. IN SURGERY In Surgery the substitution of skillful dis- section for blunt tearing; the practice of the gentle handling of tissue to avoid trauma and of leaving no dead tissue be- hind; the present operative methods in cases of intestinal diseases, hernia, cancer of the breast, goitre, gall-bladder surgery, blood vessel surgery, brain surgery and gynecological surgery, all are standards and methods which, as now followed in ' this country, owe much to the past and present members of the Johns Hopkins staff. IN MEDICINE In Medicine the same is true. The fact that the underlying causes of disease can be discovered and finally overcome by exhaustive research involving a deep knowledge of the chemical and physical reactions of the body and of the activities of bacteria, has been demonstrated re- peatedly by the work at Johns Hopkins. Here it was shown that the laboratory provided a most practical means for ap- plying the knowledge of the exact sci- ences to the specific problems of the in- dividual in the hospital bed. The diagnosis of typhoid fever by blood culture, the isolation of the paratyphoid bacillus, the first important studies in this country of amoebic dysentery, the dis- covery of the cause of tetany, the discov- ery of the Welch Bacillus, the gas-produc- ing organism which was a common cause of “gas gangrene” in the wounds of sol- diers, are typical products of the work in the departments of Medicine and Pathol- ogy in the Johns Hopkins Hospital. HOSPITAL PUBLICATIONS Every laboratory research and every ob- servation of disease at Johns Hopkins Hospital, wherein something is discovered which will be of benefit to others in pro- tecting against or combating disease, is published. The Hospital and University maintain two periodicals for this purpose. They are the Bulletin of the Fohns Hopkins Hospital and the Fohns Hopkins Hospital Reports. The scientific medical papers printed in this manner give to the entire world the benefits of discoveries made in the Johns Hopkins Hospital. PART THREE THE JOHNS HOPKINS HOSPITAL ITS FUTURE ml | 7 MAN institutions, no matter how distinctive their | past record, do not maintain the same level of | achievement. They either retrogress or go forward. | It is the intention of the Johns Hopkins Hospital | to go forward. When an army moves forward it con- solidates the gains already made, as well as marking out new objec- tives. These two characteristics pervade the plans which the Hos- pital is laying for the future. In the early part of this presentation it was pointed out that one of the chief dis- tinctions of the Johns Hopkins Hospital was the fact that it now has, in addition to the general medical and surgical ser- vices, five great clinical institutes, each one of which is a special hospital and research center in itself. These, with the general medical and surgical services of the Hospital represent the units established in an encircling movement now under way at Johns Hopkins to completely invest and lay siege to the entire province of disease. 1. DISEASES OF CHILDREN At the present time one of these units is threatened financially. This is the Harriet Lane Home for Children, the institute which is devoted to the study and treat- ment of the acute diseases of infancy and childhood. One-third of the income now used to support its work is derived, under temporary permission, from $1,000,000 of a fund contributed by the General Edu- cation Board for the general development program of both the Medical School and the Hospital. This money must soon be expended according to the terms of thegift. A TRAGIC CRISIS Unless the Hospital obtains $1,000,000 to replace this sum, it will be faced by the tragic alternative of closing one-third of Pee LR 25 the beds now devoted to the medical care of children or of abandoning free care in this department. The adequate financing of this work is the most immediate need of the Hospital program. u. MEDICINE AND SURGERY The next step in rounding out the group of clinics is the enlargement of the facil- ities for general medicine and surgery. Present facilities are entirely inadequate, but opportunity for equal progress in all other branches of Medicine and Surgery can be provided for at Johns Hopkins by the reconstruction, enlargement and en- dowment of its present medical and sur- gical clinics. The Medical School, for in- stance, is seeking $500,000 each for de- velopment in the following fields: ortho- pedic surgery, diseases of the ear, nose and throat, and diseases of the skin. At present the Hospital has very few beds for the treatment of diseases in these fields, but the reconstruction of the med- ical and the surgical wards would over- come this deficiency. THE TRUNK OF THE TREE The special clinics and institutes of the Hospital contribute greatly to its general strength and effectiveness but the very foundation of the Hospital’s work is its general medical and surgical wards. Of the 683 beds of the Johns Hopkins Hos- pital only approximately one-fourth are devoted to general Medicine and Surgery. The Hospital is now like a tree which has branched out fruitfully without a corre- sponding growth of the trunk. This is due to the fact that it has not received money for the reconstruction and enlargement of its general wards. There are ninety-two beds in the medi- cal clinic and ninety-three beds in the sur- gical clinic. Both are confined to cramped quarters in the identical structures which they occupied when the Hospital was opened in 1889. The lack of better oppor- tunities to study general Medicine and Surgery is also hampering the progress of the Medical School. THE SUPREME REASON But the one supreme and compelling rea- son which calls for the reconstruction and expansion of the medical and surgical clinics is the fact that hundreds of patients in excess of the number that can be ac- commodated, particularly from the East and South, are applying to the Hospital each year for treatment. There are, for instance, only ten beds for the surgical care of children and only ten beds for contagious diseases of adults. The arrangement of the old wards is not such as to provide for the most ef- fective and economical grouping of pa- tients according to their diseases and, with the progress of medical science, this will become an increasing handicap un- less remedied. As they stand now, the old wards can be reconstructed so that each new clinic can accommodate from 150 to 200 pa- tients. The cost in each instance will not be more than $650,000, which is consider- ably less than would be required for erect- 26 THE JOHNS HOPKINS HOSPITAL BLOCK PLAN JOHNS HOPKINS HOSPITALS MEDICAL SCHOOL Hospitat Buitpincs 1 Administration Building 2 Administration Annex 3 Students Rest Room 4 Marburg Private Wards 5 Staff Dining Room 6 Service Bldg., Kitchen, etc. 7 Brady Urological Clinic 8 Public Wards, D & E 9 Public Ward F; D,E,F, Future Surg. Clin. 10 Public Ward G 11 Public Wards M & O; G,M,O, Future Med. Clin. 12 Woman’s Clinic 13 Institute of Pathology 14 Dispensary Bldg., incl. 15 Research Labs. & Operat- ing Dept. 16 Present Nurses Home Annex, Future Eye Clinic 16aFuture Eye Clinic 17 Nurses Home 18 Harriet Lane Home for Invalid Children 19 Henry Phipps Psychiatric Clinic 20 Laundry 21 Proposed Nurses Home Mepicat ScHOOL 22 Anatomy Building 23 Hunterian Laboratory 24 Old Hunterian Laboratory 25 Physiology Bldg., incl. Physiological Chemistry & Pharmacology 26 Scuoot oF HYGIENE 27 Central Power & Heating lant MON UM EN T ing wholly new buildings. The accom- panying drawing illustrates how two old wards, similar to those which now house the Medical Clinic, were recon- structed in the building of the Woman’s Clinic, which adjoins them. Mme ELDERR YY J USSF OF ESR SOON —CWOO Le) One Story Corridors ENDOWMENT OF FREE BEDS These clinics are devoted chiefly to the care of free patients or patients who pay but a fraction of the cost of their care and treatment. Their enlargement will call for additional endowment for the free care of RUS BU TURE 27 le SENT ME The New Medical Clinic will be built by remodeling the two old wards [Gand M-O]} connecting them, and by constructing additional stories on the old foundations, as was done in ae the D,Eond F Woman's Clunic. The new Burgical Clinic will be handled in a sumiar manner, using the old wards additional patients therein. Each of these clinics must have $1,500,000 in endow- ment for their operation when recon- structed. The Hospital hopes, however, to build up a considerable portion of these funds by the endowment of memorial beds. The cost of endowing such a bed so that it may be devoted to free care in per- petuity is $20,000. 1. NERVOUS DISEASES Finally, in order to completely round out the group of clinical institutes at Johns Hopkins, a Neurological Clinic should be established. At the present time America has no great institutes for the research, study and treatment in the field of nerv- ous diseases such as exist in Europe and particularly in England. As the Johns Hopkins Hospital already has the Phipps Psychiatric Clinic for mental diseases, it is most logical that there should be es- tablished here a neurological clinic. The nervous and the mental diseases are so closely related that the existing and the proposed clinic would each supplement in a most effective manner the work of the other. TO MEET A NATIONAL NEED The proposed Neurological Clinic would be devoted to the study and treatment of such diseases as neuritis, hydrocephalus (water on the brain), traumatism (injury to the nervous system), tumors of the brain, paralysis, and like afflictions. Its establishment would be an advantage not only to the patients who come to Johns Hopkins from all parts of the country but would also be a contribution to hospitals and medical schools in all parts of this country through providing facilities such as now do not exist in America for the training of the neurolo- gists of hospital staffs and of medical school faculties. 28 THE JOHNS HOPKINS HOSPITAL tv. CONVALESCENT BRANCH There is one way in which the service as a whole can be increased materially with- out the addition of a single bed to the Hospital proper. This can be accom- plished by the establishment of a con- valescent branch in the country for pa- tients who are on the road to recovery but yet not well enough to return to their homes. This would shorten the average stay of patients in the Hospital proper and enable it to care for a larger number of critical cases. The recovery of patients can also be hastened materially if they are removed from the city and from strict- ly hospital surroundings as soon as they become convalescent. It will cost $200,000 to build and $600,000 to endow an ade- quate convalescent branch of the Johns Hopkins Hospital such as would be ade- quate to meet its needs. v. NURSES HOME In the private pavilion, in the wards, in operating rooms, and clinics, physicians and surgeons come and go. They spend only an hour or two with a patient at any one time and frequently but a few min- utes. Yet every minute of the night and day each patient is under the constant care of a nurse. A nurse is at the bedside or within sight and call all the time. On whether she does or does not carry out her mission faithfully hang the lives of pa- tients and the reputations of hospitals. The morale of the nursing corps therefore is of the utmost importance. It has been demonstrated that this morale flourishes best whenstudent nurses, resident nurses and head nurses not only work together but also live together as one family group. At the present time many of the student nurses are quartered in old buildings outside the Hospital, the nurses’ quarters in the Hospital are not unified, and a part of them must soon be taken over for other purposes. For this reason the Johns Hopkins Hospital about to let the contract for a new Nurses Home which will cost upward of $650,000 or $700,000. This is one of the most press- ing needs of the present program and will have to be met immediately. vi. SCHOOL FOR NURSES The Hospital also is seeking $500,000 for the endowment of the School for Nurses. As an educational institution this school is at present dependent on the general funds of the Hospital and has no fixed in- come of its own on which it can rely for support. The best of our schools, colleges, and universities are endowed institutions or receive their income directly from the State and not as an indefinite part of some other appropriation. The foremost authorities on nursing education are of the opinion that this profession, in which women have proved their superior fitness almost to the total exclusion of men, will never be adequately provided for from the standpoint of education until its schools have independent endowment. 29 <- oe > N12) AR om Sy > Bee Cee ac T ESAT TINTS ERT es BE wait en coun oe Beem Pare Af RENPVE NG EPOR TITLE I ital BAAD a Ut . 7 Tess: oe. tbe J 2, soe ea saa ah ares TP ar" a AB IFS Trt ae ‘7 ‘ pees ey SS Re mien < eee) re 3 pon that some of them are fully as vital to the Medical books—for the most part the TTS eT OVE, FR THE FUTURE HOME FOR NURSES (To be opened in 1926) To safeguard the system of education of to physicians,and to the whole public he public, health program. . nurses is most important to t vu. MEDICAL LIBRARY The needs of the Hospital are so closely related to those of the Medical School and schools as to the Hospital. the School of Hygiene and Public Health, 30 same books—are needed by the staff of the Hospital and the faculty and students of the schools. From the standpoint of numbers and the material they contain, the books at Johns Hopkins constitute one of the best medical libraries in this country. But these books as a whole are not easily available to all the men and women who are connected with the schools and the Hospital. The Hospital has its library. Each of the schools has its own. THE JOHNS HOPKINS HOSPITAL All these libraries are so limited in space that a large number of the books are scat- tered through various departments. The need for a central medical library build- ing therefore is great. It will cost in the neighborhood of $450,000 to build and $800,000 will be needed for its mainte- nance and the yearly acquisition of such new medical writings as are necessary to the study and treatment of disease and the pursuit of research. vil. HEATING AND POWER PLANT The Central Heating and Power Plant is also a joint enterprise which will serve the Medical School and the School of Hy- giene as well as the Hospital. Together they form a medical center which re- quires the power and light of a small city. Thus the plant, which is now being erected, will cost approximately $700,000, which, together with about $300,000 to be ex- pended in replacing antiquated heating and lighting systems in the older build- ings, will raise the entire cost of this proj- ect to the neighborhood of $1,000,000 by the time it is complete. x. SERVICE BUILDING Beside the power plant, the general pro- gram will necessitate the erection of a new service building at a cost of $200,000, for the needs of provisioning the Hospital, preparing food for the staff and patients and providing additional storage room. The present service building already has been outgrown. x. CARE FOR PERSONS OF MODERATE MEANS One of the most common criticisms leveled against American hospitals in general is that, although they provide the best med- ical and surgical attention at their com- mand for the wealthy, who can pay for it, and provide free, or at a nominal charge, similarly good care for persons who have little or no money, they fail to provide equally well for persons of moderate means at a fee in keeping with their abil- ity to pay. The average clergyman, the average news- paper man, the average man or woman whose income return to the government does not include a surtax, is often in a grave dilemma when faced by the need of hospital care, particularly when the ailment is complex and acute. He hesi- tates to consult a number of specialists, as would a wealthy man. He also hesi- tates to go to the dispensary or wards of a hospital, knowing that the fees in EE SRP ORE. a Tr *GENERAL ENDOWMENT *MeEpIcAL CLinic SurcicaL Ciinic *CHILDREN’S DISEASES . Nervous DISEASES *Nurses HoMeE AND SCHOOL CoNnvVALESCENT BRANCH *MeEpICAL LIBRARY . : *HEATING AND Power PLanr . SERVICE BUILDING . a herb 3 Diacnostic Ciinic FoR PERSONS OF Moperate MEans Norte: The items indicated with a star are those included in the immediate program which both the Hospital and the Medical School of the Uni- versity hope to finance before February 22, 1926. In this immediate program, $1,000,000 each in general endowment is being sought for both the Hospital and the Medical School. In addition, the Medical School is seeking $800,000 for the THE TEN YEAR PROGRAM FOR THE HOSPITAL CONSTRUCTION ENDOWMENT $2,000,000 1,500,000 1,500,000 1,000,000 1,000,000 500,000 TOTAL $2,000,000 2,150,000 2,150,000 1,000,000 1,750,000 1,150,000 800,000 450,000 1,000,000 200,000 200,000 450,000 1,000,000 500,000 $4,550,000 $8,600,000 $13,150,000 endowment of the Central Library. All the items of the immediate program total $8,550,000. Toward this amount $3,500,000 has been re- ceived from the General Education Board and $85,000 from graduates of the School for Nurses. Thus the net total which is necessary to carry out the immediate program for medical needs at Johns Hopkins is $4,965,000. these services are set for the accommoda- tion of those who have little or no money. In consequence, the person of moderate means often endeavors to shift as best he can without going to a hospital and, as a result, often suffers irretrievably. THE SOLUTION To meet this situation the Johns Hopkins Hospital will establish, in its new and more ample Dispensary Building, a diag- nostic clinic for persons of moderate means where such a patient may come with his family physician and receive, for a moderate fee, all the benefits of diag- nosis by specialists in the various medical sciences which have a bearing on his in- dividual condition. Not infrequently, how- ever, the patient will need care in a hos- pital bed, and will be able to pay more than the ward rate but less than the rate for private patients. The Hospital can- not admit many of them as private pa- tients unless it has at its disposal a sufh- cient fund from which the difference be- tween what the patient can pay and the cost of private care can be made up. UNIVERSITY OF ILLINO!S LIBRARY-CHEMIS y 22 THE JOHNS HOPKINS HOSPITAL THE COST It is estimated that an endowment of $500,000 will be adequate to provide suf- ficient income both for this purpose and for making up the deficiency between the fees of such patients and the cost of oper- ating a diagnostic clinic for persons of moderate means. x1. GENERAL ENDOWMENT There yet remains one more thing to in- Clinical Chemistry Laboratory... . . $100,000 sure the success and stability of the Hos- pital’s future program. This is the need for $2,000,000 in general endowment. Half of this sum is needed within the next few months to provide for the proper op- eration of services which are now without adequate funds. To be of the greatest benefit this fund should be unrestricted, yet the same result could be gained by endowment for various services now being supported from the general income. These include: Clinical Bacteriological Laboratory 100,000 Clinical Serological Laboratory. . 100,000 (Preparation of Serums and Vaccines) Physiological and Cardiographic Laboratoriesi:.¢2-. A ee $200,000 (Diagnosis of physical action of the heart and other bodily organs) (All the above laboratories are used mainly for the active work in diagnosing the disease and aiding in the treat- ment of patients.) Social Service.c Gy, (a) ee Gee $5 Dietetic Department and School... 200,000 Appliances for Crippled Children... 50,000 Dental Care n22 025s Se 50,000 Cate of Sick Nurses. 5. eee 50,000 Hospital Publications. . 25,000 Endowed Beds and Rooms for Free Caré.c3t. 5 oa) ey eee 15,000 to 35,000 xu. FINANCES The last item of the program, general en- dowment, calls for an explanation of the present financial status of the Hospital. This institution receives no governmental support, Federal, State or Municipal. It is primarily an endowed institution. Its growth has been made possible by gifts from individuals and foundations which have sought in this manner to invest for the welfare of humanity. The bulk of these funds, however, has been given for spe- cial purposes rather than for the support of the Hospital as a whole. Despite the fact that it is now caring fora yearly total of approximately five times as many patients as the average during the first few years of its operation, and despite the fact that costs in general are more than twice that of thirty-six years ago, INCOME ENDOWMENT AND SPECIAL FUNDS $341,715.69 PRIVATE PATIENTS $414,310.12 the total productive endowment of the Hospital has not begun to keep pace with ETS eC RAE these increases. The present total for the support of this 683-bed hospital is $6,134,- 714.00. This is less than twice the sizeof the productive endowment which was at the disposal of the Hospital in 1889 for the operation of 230 beds. INCOME FROM GENERAL ENDOWMENT HAS FAILED TO KEEP PACE WITH OPERATING COSTS—1905 THROUGH 1924 05 06 0708 09 10 Ii 12: IS i4 1S 16 [7 18 9 20 2) 22 23 24 GENERAL ENDOWMENT Even now $1,974,088.53 of the productive endowment is restricted for special pur- poses. This means that the total general endowment, on which the Hospital must depend in the main for support, in addi- tion to fees and other charges, is but $4,160,623.82. This sum includes Johns Hopkins original gift of $3,228,404.84 and means that $932,218.98 is the sum of all additional general endowment that the Hospital has received since 1889. DOES NOT PAY FREE CARE COST The income from all endowment is $341,- 713.69 a year. This amounts to approxi- mately only 70 per cent. of the annual amount the Hospital is spending on free care. The question naturally arises: How has the Johns Hopkins Hospital, in the face of rising costs and increasing numbers of patients and despite the fact that it limits the fees of even the 20 per cent. of its pa- tients who can pay all or more than the cost of their treatment, how has it, in 33 spite of these facts, kept free from debt and continued to increase its usefulness? EFFICIENT OPERATION The Medical School bears a large portion of the salaries paid to the staff but the chief answer to the question lies in the fact that the Hospital, which has been a model of adminstration, has been able to maintain its high standard of treatment and care at an average daily cost per pa- tient of $5.08. The report of the General Hospital Fund has shown this to be much less than the average operating expense of metropolitan hospitals throughout the East. MAXIMUM RETURN ON INVESTMENTS Although the funds of the Hospital are conservatively invested it receives an average return of 5.46 per cent. This is conceded to be as much as can be hoped for in consideration of the factors of safety which must be maintained in the invest- ments of such an institution. Both from investments and from administration the authorities of the Hospital are convinced that they are obtaining the maximum re- turn from their money, but there is no margin to fortify the institution against any general financial depression and there is grave need of additional endowment to ballast the general development program which is now being undertaken. PROGRESS OR RETROGRESSION? The cost of operating the Hospital during 1924 resulted in a deficit of $41,000. This means that unless additional general en- dowment is obtained the Hospital must stint its services for the present year and retrogress instead of going forward. MEMORIALS 5/5 the Johns Hopkins Hospital serves the entire na- tion it is appealing to the nation as a whole for the support of its program, and particularly to the people of Baltimore ,New York andthe other large cities of the East and South from which a great number of its patients come. Its authorities are convinced that its major needs constitute a series of outstanding opportunities for those who wish to establish memorials that will be monuments of lasting benefit to mankind. MEMORIAL GIFTS may serve as the basis for establishing In addition to the major projects of the memorials. A number of these are classi- program there are a number of special fied in the following list under the amounts funds, included in the totals, which well needed for each. $100,000 CLINICAL CHEMISTRY LABORATORY CLINICAL BACTERIOLOGICAL LABORATORY CLINICAL SEROLOGICAL LABORATORY $50,000 ENDOWMENT FOR THE PURCHASE OF APPLIANCES FOR CRIPPLED CHILDREN ENDOWMENT FOR THE CARE OF SICK NURSES MEMORIAL INSTRUCTORSHIP IN THE SCHOOL FOR NURSES $35,000 ENDOWED PRIVATE ROOMS $30,000 ENDOWED BEDS IN THE PHIPPS PSYCHIATRIC CLINIC $25,000 ENDOWMENT FOR THE HOSPITAL PUBLICATIONS ENDOWED CUBICLES $20,000 ENDOWED BEDS IN GENERAL SERVICE MEMORIALS aK $15,000 ENDOWED BEDS IN THE HARRIET LANE HOME $1,000 MEMORIAL ENDOWMENT FUNDS TO PAY FOR THE FREE CARE OF ONE PATIENT FOR TEN DAYS EACH YEAR AT THE RATE OF $5.00 A DAY It is likely that a considerable portion of the endowment needed for the support of free care in the enlarged medical and surgical wards, or in meeting the emer- gency situation in the care of children, will be made up of single memorial beds. The laboratories included in this list are now dependent for support on the re- stricted present endowment, yet on them depend in large part the diagnosis of dis- ease in the Hospital and the preparation of the antitoxins and serums which are among the most effective weapons for the conquest of many diseases. In the last analysis, however, any gift, no matter how large or how small and no matter whether or not it is designated as a memorial, is in reality a memorial—a lasting memorial which will live on, gen- eration after generation, in the lives of those who benefit by the work of the Johns Hopkins Hospital. (It has been possible, herein, to give but a limited outline of both the work and the needs of the Fohns Hopkins Hospital. Further information concern- ing these subjects can be obtained from the office of the Fohns Hopkins Half- Century Committee, 603 Keyser Building, Baltimore). THE JOHNS HOPKINS HOSPITAL y POINTS OF DISTINCTION AND INTERESTING FACTS | Pehoe American hospital to integrate its work with the activities of a medical school in such a manner that patients might obtain the full benefit of the foremost advances in medical knowledge. @ First hospital to be associated with a school of Hygiene and Public Health which seeks knowledge to prevent disease before there is need for a cure. @ Includes in its medical group a number of clinical institutes, which are special hospitals in themselves. These include the Woman’s Clinic, the Harriet Lane Home (Children’s Diseases), the Phipps Clinic (Mental Dis- eases) and the Brady Urological Institute (Genito-Urinary Diseases), and will soon in- clude the Wilmer Institute for diseases of the eye. @ Research seeking better and more effective methods to combat disease is carried on in every department. @ Educational activities include the training of medical students, hospital executives, re- search workers, nurses and dieticians and the postgraduate training of physicians. @ Patients and students come to it from all parts of the United States and from many foreign countries. @ Its publications give the benefit of medical discoveries to the world in general. @ Strives to teach patients how to stay well after they are cured. @Social Service Department combats fac- tors other than medical which impede the recovery of patients. @Seventy-nine per cent. of its patients are treated at less than cost and more than half of these are free patients. @ Patients are admitted solely with regard to the seriousness of their illness and without re- gard to race, creed, color, social condition, or ability to pay. @ Approximately one-fourth of its patients are colored people. @ Half the crippled children of Baltimore alone have received treatment through the Orthopedic service. @_Bed patients cared for since 1889 total 190,347. @Total days of treatment given patients since 1889, approximately 3,303,400. @ Total visits to the Dispensary in the same period, approximately 3,127,000. @ Although the yearly number of bed pa- tients increased from 1,890 in 1890 to 10,171 in 1924, the Hospital’s general endowment in- creased but one-third in that period. @ During the war it equipped and staffed throughout a 500-bed military hospital, the first to sail overseas with a contingent of American troops. THE JOHNS HOPKINS HALF-CENTURY COMMITTEE 603 KEYSER BUILDING BALTIMORE DanieL WILLARD, General Chairman SEWARD Prosser, Treasurer JosEpH S. AMES Epwin G. BAETJER Newton D. Baker, LeweELtys F. Barker, M.D. Tuomas R. Brown, M.D. Frep G. Boyce, Jr. Davin J. CARVER H. A. B. Dunnino Cuar_es K. Epmunps Ricuarp H. Foutuis, M.D. FRANK A. Furst F. H. German Joun M. GLENN Frank J. Goopnow B. HowE i Griswo.p, Jr. Henry D. Haran Wivuram H. Howe. R. Brent KEYSER Rosert G. Merrick SipneEy R. Mitier, M.D. Joun R. Ottver, M.D. ALEXANDER RANDALL BLANCHARD RANDALL Rosert H. RILey Juxian D. Sears Winrorp H. Situ, M.D. Gen. GEorGE O. SQuiIER Henry L. Straus W. Stuart SyMIncTON, JR. Lewis H. WEEp, M.D. WivuiraM H. We cu, M.D. . oar ai neuinie Nel) 5) UOOPRESE ORT ty MOinaant he Pat, Ha es ONORMANUT, Al MUNDER 61CO. jm) la ame al ran BALTIMORE = ie mah at Ph A A ; tag ; er i '. A UNIVEPSITY OF ILLINT 3 -——~ *