City Hospital: From Lifeline to Landmark
By Amy Blankenship, Show Me History Podcast
Once the center of St. Louis’s public healthcare system, the old City Hospital spanned 18 buildings over 10 acres. It treated thousands, survived fires, tornadoes, and decades of change — before falling into ruin and eventually rising again as a revitalized urban landmark.
A Hospital for the City’s Poor
On July 10, 1845, the city passed an ordinance to build a tax-supported hospital for the poor. Eight acres of city land near Soulard were set aside, and by June 1846 the hospital was admitting patients to its 90 beds — mainly for cholera outbreaks.
In those early days, hospitals weren’t places of recovery for the wealthy. They were where the poor went for care — or to die. Few doctors were on staff, and most care came from untrained nurses or volunteers. Patients shared large open wards, and at night only watchmen were on duty.
Disaster and Rebuilding
Over the next decade, the hospital expanded — until May 15, 1856, when a fire destroyed the complex. Amazingly, only one person died: a psychiatric patient who re-entered the burning building.
A new building opened in 1857, accommodating 450 patients. But tragedy struck again in 1896, when a tornado demolished the hospital, killing three patients. For nearly a decade afterward, care was provided at a temporary location until the new Georgian-style complex opened in 1905, spanning four city blocks.
A Growing Medical Center
The new campus included an administration building, surgical facilities, labs, wards, an isolation building, and a powerhouse. By 1907, Washington University medical students were studying and conducting autopsies there.
In 1915, the St. Louis City Hospital Training School for Nurses opened. Washington University appointed many of the staff physicians — a practice that continued until 1980.
During World War I, the federal government used parts of the hospital. That year, patient numbers soared: in 1917–1918, 18,793 patients were admitted.
Depression-Era Strain and New Deal Expansion
The Great Depression filled every bed, and outpatient services often had to turn people away. In 1934, a $7 million bond issue funded new buildings: a power plant, services building, laundry, and later, a 14-story medical tower and the Malcolm Bliss Mental Health Center. By 1941, patient capacity reached 1,104.
Challenges in the Modern Era
In 1968, City Hospital treated Robert Rayford, later identified as the first known AIDS patient in the U.S.
By the 1970s, budget cuts, outdated facilities, and declining city funds strained operations. When Homer G. Phillips Hospital closed in 1979, City Hospital absorbed its patients — and many others rejected by private hospitals for lack of insurance. It became a “dumping ground” for the city’s uninsured, often receiving trauma patients in critical condition with little or no prior care.
Reports from the time are shocking: stabbing victims transferred with knives still in them, skull fractures untreated until arrival, and hospitals openly requiring a $1,000 down payment before admitting uninsured patients.
Decline and Closure
The hospital’s infrastructure was crumbling — no air conditioning in wards, manual elevators, and outdated equipment that forced lab work to be outsourced. Washington University ended its affiliation in 1980, and by 1983, Mayor Vincent Schoemehl announced the hospital would close.
City Hospital officially shut down in 1985, moving operations to the former St. Luke’s Hospital on Delmar Boulevard under private nonprofit management. The Lafayette Avenue complex was abandoned.
Two Decades of Decay
For nearly 20 years, the once-grand Georgian-style building sat vacant, vandalized, and overgrown. Windows were shattered, pipes stolen, graffiti spread across the walls, and even trees grew inside.
Several failed redevelopment attempts followed until the site was listed on the National Register of Historic Places in 2001, making it eligible for grants.
Revival and Reuse
In 2002, redevelopment began. Hazardous materials were removed, unsalvageable buildings demolished, and the historic administration building restored. In 2006, it reopened as The Georgian Condominiums, with 100 units featuring high ceilings, wood floors, large windows, and gas fireplaces. Today, two-bedroom units sell for around $200,000.
Other parts of the old campus have also been repurposed:
Power plant → indoor rock-climbing gym
Malcolm Bliss site → AT Still University satellite campus
Remaining buildings → restaurants and small businesses
And that “silo” you see? It’s the power plant — not an old crematorium, despite local rumors.
From Public Service to Private Living
City Hospital’s story mirrors St. Louis itself: ambitious beginnings, decades of service, economic decline, and eventual reinvention. From a vital safety net for the city’s poor to a vacant ruin to a thriving residential and business hub, its history is etched into the bricks of Lafayette Avenue.
You can find more at:
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Until next time, I’ll see you in the Lou.