The setting was not Johns Hopkins historic Hurd Hall where Grand Rounds in every discipline have been presented for a half century, but an immaculate, high-tech auditorium overlooking the entry plaza to The Charlotte R. Bloomberg Children’s Center that opened May 1. Cars pulled up to drop patients off, two parents with toddler in hand walked through the pedestrian Pediatric ED entrance. Past them, a large red ostrich could be seen dangling in the children’s hospital’s four-story atrium. One would have thought that the inaugural Grand Rounds would be about such features of the new Bloomberg Children’s Center, but instead Director George Dover chose first to go back in time: “In looking ahead, I think it’s constructive to look back at the very origins of the institution.”
Surprisingly, he noted, pediatrics at Johns Hopkins got its start in a bath house. Long baths were considered therapeutic in those days, Dover said, so in 1896 a bath house was renovated for children, making it the very first building assigned for children by the Johns Hopkins School of Medicine. At the time, Dover added, there were no full-time pediatric faculty, training or research programs at Hopkins. But in 1903, Harriet Lane Johnston willed funds for a hospital for invalid children in Baltimore, which resulted in the Harriet Lane Home opening in 1912 and the beginning of the first fulltime academic department in pediatrics in this country.
“The melding of pediatric research and training with patient care followed,” said Dover, pointing to pioneering pediatric treatments, including the “Blue Baby” operation involving pediatric cardiologist Helen Taussig and studies of autistic children by child psychiatrist Leo Kanner. But by the late 1950s, Dover said, the Harriet Lane Home became outmoded and drawings were drafted for the Children’s Medical & Surgical Center (CMSC), “with its two wings wrapped like arms around Hopkins’ historic dome.”
Pediatric academic medicine at Hopkins thrived over the next half century, with groundbreaking research, like Mary Ellen Avery’s work in neonatal lung disorders and Jerry Odell’s in hyperbilirubinemia. Teachers like William Zinkham and Henry Seidel made CMSC known nationwide as the model for pediatric education. But like its predecessor, the CMSC eventually outlived its space and time.
“Parent focus groups cited a lack of amenities and privacy, high decibel levels and poor room conditions,” Dover said. “Research space was inadequate for the growing amount of research.”
So in 1998 plans ensued for a new Children’s Center. “Our work was cut out for us but some of our work was already done,” noted Dover, citing renovations in CMSC 4 featuring private rooms and dispersed nursing. “We began to test-drive 21st century pediatric medicine for our new hospital. We also looked at dynamics in the healthcare marketplace—discharges and patient volumes—to determine the size and shape of our clinical services and how many beds we would need. But we decided that the major changes in this hospital would not be made for market share but for the care, comfort and safety of our patients.”
In that regard, Dover said, “a big challenge loomed over us”—how would a new Children’s Center sustain the innovation that sustained the Harriet Lane Home and CMSC? “We decided to remain independent but also part of this campus and connected with our adult colleagues, which would allow us to do things in pediatrics a freestanding children’s hospital cannot do,” Dover explained. “Emergency medicine is better in Bloomberg Children’s Center because it’s connected to adult medicine. We’re now closer to basic scientists, bioengineering and public health specialists because they will become even more important partners in our future.”
Also, Dover noted, the Children’s Center recently expanded its pediatric clinical outreach in places like Washington, D.C. and Florida, which also expanded its capacity to do bench research and clinical trials. “In the new building, too, we have the capacity to do clinical trials,” Dover said, “but we have to be cautious here. What distinguishes us is not just how well we treat a particular condition but the people we attract and the innovations in pediatric medicine we develop. Just as our new building is more cross disciplinary, our research needs to become increasingly cross-disciplinary, too. Subspecialty focus on research alone will not be enough, and in the future we may have to increasingly look at preventing adult diseases as well as treating childhood diseases. Collaborative core labs, rather than single labs, will facilitate that.”
Dover concluded, “Pediatrics blossomed here not because of buildings alone—but because of patients, families, doctors and nurses and their commitment to each other over a century to change medicine. What we need to do in The Charlotte R. Bloomberg Children’s Center is continue to set the standard for care, and we will do that by both attracting and teaching the very best, and adapting our research to the new realities.”