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City Hospital, St Louis

The Old City Hospital in St. Louis operated from 1845 to 1985. The present-day structure dates to 1896. Initially founded to deal with a severe cholera outbreak, the City of St. Louis owned and operated the hospital for nearly a century and a half. Let’s take a look at the story of City Hospital, St Louis.

Old City Hospital in St. Louis occupied five city blocks at the intersection of 14th and Lafayette Avenue. A public hospital serving the poor and uninsured, it had a capacity of approximately 1,100 beds.

Old City Hospital, St. Louis

old City Hospital, St. Louis

This is City Hospital in 1913, about a year after it opened. Its appearance from the front has changed very little to the present day.

There would be little tolerance for the City of St. Louis owning and operating a hospital today. But in 1845, it solved a real problem. The city was dealing with a severe cholera outbreak, and it attacked the problem on multiple fronts. First, it established a checkpoint on the Mississippi River about 15 miles south of downtown. Doctors at the site examined would-be travelers, and any they found ill stayed at the checkpoint until they either recovered or died. This checkpoint, in modern day Oakville, became the site of Robert Koch Hospital.

The checkpoint helped keep visitors from coming into St. Louis and bringing more cholera with them. But they also needed to deal with those in the city who were already ill. Having its own hospital helped the city manage that problem. The cholera pandemic still killed between 6 and 10 percent of the city’s residents, and it lasted in the United States until 1860.

Over time, the city shifted its treatment of cholera and other highly contagious diseases to Quarantine Hospital, which became Robert Koch Hospital in 1910. City Hospital served as a general-purpose hospital. Both facilities treated the poor and uninsured. Doctors were often scarce, so the hospital relied heavily on nurse practitioners for care. It was good experience for the nurse practitioners, who attended the adjacent nursing school. City Hospital experience made it easy for them to get jobs.

Noteworthy events

old City Hospital, St. Louis

In 1941-42, City Hospital in St. Louis added the 14-story tower and the X-shaped Malcolm Bliss building, at a cost of $4.5 million. They were razed in 2002.

The original City Hospital burned in 1856. The city, still dealing with cholera, rebuilt it in 1857. The Great Cyclone of 1896 destroyed the second structure, which stood 39 years.

The architect Albert Groves designed the Georgian Revival style structure that stands today at 1515 Lafayette. Construction finished in 1912. By 1970, the complex had over a dozen structures, including its own power plant. Contrary to rumors, the smokestack in the back of the building wasn’t some kind of crematorium. It burned coal.

The city expanded the facility several times throughout its service life. The most major expansion took place starting in 1941, with the addition of a 14-story tower behind the administrative building and the Malcolm Bliss Mental Health Center at a cost of $4.5 million. These additions raised the hospital’s bed capacity to 1,104. In the 1960s, the city added the Snodgras laboratory. In the late 1960s or around 1970, the city added another nameless building that filled in the gaps and connected all the others. At this point, further future expansion became impractical.

City Hospital has a certain stigma among people old enough to remember it, but there was more to it than the perception of the people it treated. City Hospital was one of the first hospitals in the country to allow Black doctors to practice. It also treated the first AIDS patient in the country, in 1968. Yes, sixty eight.


For much of their existence, St. Louis practiced segregation in its hospitals. City Hospital was white. In 1919, city opened City Hospital #2, at Garrison and Lawson avenues in north St. Louis for Blacks. This 177-bed hospital was inadequate, and a larger facility at 2601 N. Whittier Street opened in 1933. The larger facility was named for Homer G. Phillips, a Black attorney who was shot and killed advocating for the larger hospital.

In 1955, Mayor Raymond Tucker ordered the hospitals to desegregate. Homer G. Phillips Hospital remained primarily Black due to the makeup of the neighborhood around it, but both hospitals would admit anyone regardless of race or belief.

The end of old City Hospital, St. Louis

As early as 1961, the city started proposing merging City Hospital with Homer G. Phillips Hospital. The neurological and psychiatric facilities moved to City Hospital in the late 1960s. Then, the city abruptly closed Homer G. Phillips Hospital on August 17, 1979.

The merger didn’t have the intended effect, and the City Hospital complex proved inadequate for the increased load. With the hospital facing obsolescence, the city decided the most cost effective solution would be to purchase a newer facility.

In another move that probably wouldn’t fly today, St. Louis commandeered the old St. Luke’s Hospital at 5535 Delmar, which was then owned and operated by Charter Behavioral Health. In June 1985, Charter sold the hospital to St. Louis, who moved the facilities from the Old City Hospital on Lafayette to 5535 Delmar over the course of two weeks, and the city eased its way out of the hospital business, like many other cities did starting in the mid 1980s. The new facility took on the name St. Louis Regional Medical Center, and operated as ConnectCare from 1997 to 2013 before going bankrupt.

The city had plans to redevelop the old City Hospital site, and some of the buildings changed hands, but none of the early development plans came to fruition. In 1992, the city turned the entire facility over to the city’s Land Reutilization Authority.

The hospital deteriorated quickly as it awaited redevelopment. The top floor of the main building was frequently covered in grafitti, visible from Interstate 55. Vandals broke in and stole pipes and wiring and any other valuable materials they could find. At the height of the facility’s indignity, shrubs were visible from the building’s roof.


City Hospital became listed on the National Register of Historic Places in 2001, which made it eligible for much-needed federal grants. This made a full-scale rehabilitation possible, including removal of all the old asbestos, lead paint, underground storage tanks, and any other hazardous material. Redevelopment of the complex started in 2002 with selective demolition to make the complex more manageable, including the 14-story tower behind the administrative building whose architecture clashed with the rest of the complex. Work halted afterward and didn’t resume until 2005, with the first phase completing in 2006. The old administrative building was the first project. It is now known as The Georgian Condominiums, with over 100 residences inside. Subsequent redevelopment took longer but progressed over the next decade. The old power plant is now an indoor gym. Other buildings in the complex house various small businesses.

At the site of the Malcolm Bliss building, a satellite location of A.T. Still University, a medical school, now stands.

What Old City Hospital, St. Louis buildings were demolished

In the 2002 timeframe, developers demolished five buildings as part of the redevelopment. One of the buildings, Building E, deteriorated under neglect more than the others in the 17 years the grounds stood vacant. There wasn’t enough material left to reinforce the crumbling concrete to save the building.

The remaining buildings, the 14-story tower, the Malcolm Bliss Center, the Snodgras laboratory, and a nameless two-story building that connected them, fell due to adding little to no visual interest to the site and, in the case of the tower, being too large and unwieldy to be worth the effort of redevelopment. They were added between the 1940s and 1970 and their style can be most politely described as generic international style. A guy I knew in college called it East German Architecture.

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