Johns Hopkins Hospital and the residency system

The Baltimore merchant Johns Hopkins died in 1873 and left $7 million to found a university and a hospital, with a medical school to join them. He planned a hospital that would care for anyone regardless of sex, age or race, and he wrote to its first trustees that it should in time form part of the university's medical school. The university opened in 1876. The hospital, built to a plan by John Shaw Billings with widely separated pavilions linked by long corridors, opened on 7 May 1889, almost 11 years after ground was broken.

The endowment was tied to poorly performing investments, so the medical school could not open with the hospital. William Osler became physician in chief, William Halsted head of surgery and Howard Kelly head of gynecology, alongside the pathologist William Welch, and for four years they trained young doctors in the hospital before any medical students arrived. These residents lived in the hospital's administration building, and their training had no fixed end; some of Osler's stayed seven or eight years. Halsted built a surgical program with several tiers that, with some changes, became the model for surgical and medical residency training in North America.

The School of Medicine opened in 1893. Entrants needed an undergraduate degree and a working knowledge of French and German. It admitted women on the same basis as men, a condition set by a committee of wealthy women, Mary Elizabeth Garrett foremost among them, who had raised the money needed to open it.

Osler's clinical clerkship put students on the wards. From the third year they took histories in the outpatient dispensary under the residents. In the fourth year each clerk was assigned five or six patients in each department, examined them, kept daily records, tested blood and urine, and followed them to discharge. Osler led ward rounds with students three days a week.

While the school's opening was delayed, Osler wrote The Principles and Practice of Medicine, published in 1892, which ran to sixteen editions. He stayed at Hopkins until 1905, when he left for Oxford.