The “Big Four”

The founding faculty of Johns Hopkins School of Medicine comprised some of the most respected medical men of their era. All were innovators with rigorous standards of practice, research and training.

They set the bar high for other medical schools, and many of their graduates went on to establish or transform other programs around the country.

The Big FourWilliam Welch, who helped the university's president, Daniel Coit Gilman, assemble the team, was a pathologist;  William Osler, the internist who oversaw the department of medicine, was a Canadian considered the finest doctor practicing in the United States; William Stewart Halsted headed up surgery; and Howard Kelly, gynecology and obstetrics.

The original "Big Four" are depicted here in John Singer Sargent's "The Four Doctors," which hangs in the medical library on the Johns Hopkins campus.

At a time when individual doctors could be institutions unto themselves, Osler introduced the concept of the medical residency, and Welch a training program in advanced techniques for full-fledged doctors that resembled a modern post-doctoral course. Welch also founded the country's first school of public health. Kelly established his own cancer clinic.

Halsted taught his students to operate at a new level of skill and care, and was responsible for introducing the use of surgical gloves, which in beginning were meant merely to protect doctors' and nurses' hands.

Calvin Trillin’s rule of thumb

The writer-humorist Calvin Trillin has said that his idea of alternative medicine is a doctor who was not trained at Johns Hopkins School of Medicine in Baltimore, Md. To the extent that Johns Hopkins is considered the gold standard of medical care, the institution's excellence owes much to its beginnings.

Johns Hopkins

Johns Hopkins

Johns Hopkins, the son of prosperous Maryland Quakers (his first name was his great-grandmother's maiden name), made a fortune investing in America's first important railroad, the Baltimore and Ohio.

In 1867, he established funds for a university and hospital to bear his name, and when he died in 1873, he left $7 million for the two institutions, the largest gift ever bequeathed in America up to that point.

John Shaw Billings, a major in the U.S. army who had distinguished himself as a surgeon in the Civil War, and for his writings on, and criticism of, the care of sick and injured soldiers, created a plan for the hospital that reflected his keen interest in infrastructure, and his assiduous research into the best hospital designs in Europe.

John Shaw Billings

John Shaw Billings

For example, he had the hospital wired for electricity years before it was on the grid. Johns Hopkins was also the first hospital in the country with central heating.

The measures Billings took to prevent the spread of disease throughout the hospital ranged from the horizonal layout of the wards, to the decision not to include elevators, to the elaborate ventilation system that prevented patients from breathing each other's air.

Billings also came up with the idea of a four-year medical school and favored a tough curriculum to weed out all but the best candidates. According the John Hopkins Medicine website, history has not given this remarkable man his due.

Getting the hospital up and running took 12 years. Even though many of the revolutionary ideas the institution embodied were his, Billings decided it was time to move on. He ended his career as director of the New York Public Library.

Johns Hopkins Hospital

An early view of the hospital

Opened in 1889, Johns Hopkins Hospital had 17 buildings (three of which remain today, part of a 22-acre campus) and cost $2 million.

Johns Hopkins Hospital had no religious affiliation, which made some people nervous. In 1896, William Wallace Spence, a wealthy Baltimore businessmen, donated a large statue of Jesus Christ that still stands in the rotunda of the Billings Administration Building.