The last exit on I-255 in Missouri before the Illinois border is Koch Road. Turn right on Koch Road, in a community now known as Oakville, and you run into the curiously named Robert Koch Hospital Road, which runs through a residential area. But where’s the hospital? It turns out Robert Koch Hospital was demolished in 1989. But stories of this hospital, including rumors the site is haunted, spread through generations of St. Louisans, even those who don’t know the hospital’s name. Its presence explains why a 500-acre swath of land along the Mississippi River in a popular upper middle class suburb remains an isolated, lonely place. Even if you don’t believe in ghosts, the site seems cursed.

Robert Koch Hospital was established to help St. Louis deal with a cholera epidemic that killed 6 percent of its population. It survived for decades, mostly treating tuberculosis, until medical advancements alleviated the need for an isolated quarantine hospital in the area.

A little bit of Stranger Things, right here in St. Louis

Robert Koch Hospital

This is the main administrative building of Robert Koch Hospital near St. Louis as it appeared in 1984. It was built in 1907. Three years later, it changed its name and its focus shifted to treating tuberculosis.

I don’t know if I believe in ghosts, so I don’t know if the Koch Hospital site has ghosts. But the site is haunted. If nothing else, the site is haunted by the memory of what happened there. And St. Louis keeps repeating the same mistakes. Some years the price is lower than others, but in 2020, it’s not cheap.

The Koch Hospital site is about the closest thing St. Louis has to Stranger Things. A forbidden, off-limits hospital in the woods. A military installation in close proximity. Sinkholes and death. The possibility of frightened escapees hiding among the trees. No monsters, but there was a giant witch’s hat to loom over you as you approached, and the rumor of ghosts. And death. Lots of death. But it wasn’t monsters killing people, it was a series of diseases contemporary medicine was still trying to understand.

Today, those rumors and legends are about all that remain of the site, besides the road leading nowhere that bears the defunct hospital’s name. But the No Trespassing and Danger Keep Out signs that dot the perimeter of the woods around that lonely road contribute to the atmosphere.

Koch Hospital was one of three hospitals owned and operated by the city of St. Louis, along with City Hospital and Homer G. Phillips Hospital. All have colorful histories that ended within a decade of each other. But Koch Hospital is the spookiest.

Robert Koch Hospital history

Koch Road exit off I-255

If you take the Koch Road exit off Interstate 255, it leads you to a road named for the razed Robert Koch Hospital that loops through the woods before finally emerging in a mid-century subdivision. It was the middle of nowhere in 1875. Now the empty site stands out for its emptiness.

In about 1854, the city of St. Louis purchased 100 acres of land 15 miles south of the city limits, in present-day Oakville to control cholera. A cholera outbreak that began in 1849 killed at least 6 percent of the population of St. Louis. Riverboats traveling upstream to St. Louis stopped at the site during epidemics, where doctors would check riverboat passengers before they could dock. Those who had contagious diseases stayed at the site until they recovered or died. Those who died were buried at Quarantine Cemetery, which was part of the site.

The city expanded the site in 1875 to include Quarantine Hospital, to quarantine and treat patients suffering from cholera, yellow fever and smallpox. In 1910, it received the name Robert Koch Hospital, and its focus turned to tuberculosis and other infectious diseases. The dreaded tuberculosis, popularly known as TB, killed more residents than all other infectious diseases combined. The hospital provided free medical care to victims of the disease.

The name came from Robert Koch, a German bacteriologist who pioneered germ theory, identified the cause of cholera, anthrax, and tuberculosis and won the Nobel Prize in 1905.

The hospital at its peak had 19 buildings, its own post office, and even its own town, Koch, Missouri. The 19 buildings that survived to 1989 were all built between 1907 and 1939. It consisted of a 426-bed intermediate care facility, a 39-bed hospital, and a 166-bed residential-care facility. The site was bounded by Jefferson Barracks on the north, Telegraph Road on the west, Cliff Cave County Park on the south, and the Mississippi River on the east.

Rapid expansion

The hospital expanded in 1920, 1933 and 1934 but still couldn’t keep up with demand. In 1939 the city made plans to expand the hospital to 1,000 beds to eliminate the waiting list, but couldn’t secure an appropriation from Congress to fund it. By the government’s own standards, the appropriate sizing for the hospital would have been 1,200 beds, due the the average number of deaths in the St. Louis area topping 600 at the time.

Why Robert Koch Hospital was necessary

Robert Koch Hospital, St. Louis

A subdivision sprung up near the Robert Koch Hospital site in the 1950s. The houses become more scarce between Bordeaux and Hickory Hill roads, and end abruptly at Hickory Hill.

The 2020 Pandemic provides a modern illustration for why a quarantine hospital was necessary. Cholera was highly contagious, and much like COVID-19, it took time for doctors to understand how it spread and how to treat it. When untreated, Cholera’s mortality rate exceeded 50 percent. Treatment improved the chances of survival, although modern treatments were still far off. The modern mortality rate of 1% was only a dream in the 1800s.

Providing medical care 15 miles from the city near the bank of the Mississippi River served a dual purpose. It helped keep patients from spreading the disease, and it alleviated strain on the city’s other hospitals. The latter problem became relatable in 2020, when COVID-19 filled hospitals over capacity. What about healing the disease? That took time. The progress we made in treating and preventing COVID-19 in 2020 was unheard of in the 1800s. It took decades in those times to get this far.

By the time Quarantine Hospital was established, treatments that were at least somewhat effective did exist, even if doctors’ understanding of why they worked was still forthcoming. Much of what the hospital was about was damage control: keeping the disease from spreading, curing who they could, and doing their best to make the remaining a little less uncomfortable.

The shift to tuberculosis

Koch Hospital

The grounds around Koch Hospital were kept up like a park. After the hospital closed, teenagers would sneak onto the grounds to drink, or to break into abandoned buildings to explore.

Once cholera, smallpox, and yellow fever were no longer raging out of control in the city, Koch Hospital saw a second career treating tuberculosis. Like the diseases it was founded to control, the prognosis for tuberculosis wasn’t good. The 18th century world feared tuberculosis much the same way we fear cancer today, if not more so. And without modern antibiotics, doctors didn’t have a lot of options. In the late 18th century, doctors noticed that patients in Colorado had a better prognosis than elsewhere in the country. High elevations and fresh air helped slow the bacteria from spreading person to person and progressing through infected lungs.

Koch Hospital, situated on a hill overlooking the Mississippi, wasn’t Colorado. But it was the closest St. Louis had. Those who didn’t have the means to go to Colorado for treatment went to Koch Hospital instead.

Robert Koch Hospital architecture

Robert Koch Hospital No Trespassing

The architecture of Koch Hospital was designed to be comforting and reassuring. Today all that’s left are signs reminding you that you can’t come here.

The buildings that made up Robert Koch Hospital in St. Louis were generally a combination of Italian Romanesque and Italian Renaissance. Hospital design in the early 20th century needed to provide an attractive and appealing facade and landscape to convey a sense of hope, while retaining flexibility due to rapidly changing medical practices.

In the first half of the 20th century, sometimes the best medical treatment we could provide was psychological. The architecture and the location overlooking the Mississippi River on grounds maintained like a nice park at least provided that.

The main administrative building was designed by the firm of Barnett, Haynes, and Barnett. George and Tom Barnett were the sons of George Barnett, the leading architect in St. Louis in the mid-19th century. City architects Edward Christopher, the designer of Union Market, and Albert A. Osborg, the designer of Soulard Market, designed the subsequent buildings.

Today, the traditional, old-fashioned architecture serves as a reminder that for at least parts of its history, medicine had few answers for the desperate people who came to the site.

Koch Tubercular Cemetery

Koch Hospital water tower

This stone water tower, built in 1879, was the oldest structure on the Koch Hospital grounds. Its appearance, especially the pointed roof that resembles a witch’s hat, gave generations of thrill seekers the creeps, especially at night. If you sneaked into the woods hoping to see a ghost, this tower was the first structure that would come into view. If first impressions matter, this made one.

In the application to put the site on the National Register of Historic Places, the City of St. Louis estimated 18,000 former patients lay in unmarked graves on the old site. Old bones from washed-out graves still surface from time to time. I have seen some claims, though unsubstantiated, that the number could be closer to 25,000.

In 2018, the St. Louis Public Library stated a fire destroyed some, but not all, of the old cemetery and hospital records in the 1880s. There are about 70 marked graves on the site, most dating from the 20th century. Many of the graves once had wooden markers, but weathering and theft destroyed them. But some graves never had markers. During epidemics, it wasn’t uncommon to use sinkholes on the property as mass graves for the deceased patients.

The last burials in the cemetery took place sometime in the 1940s.

Are the grounds haunted?

When we understand this history, it’s clear to see why people believe the hospital and cemetery are haunted. It is a troubled place. People suffering from infectious diseases went there, isolated from their loved ones, to receive treatments that weren’t certain to work. At the worst of times, they died in numbers that overwhelmed the staff. Even in less bad times, it was the place poor people whose living conditions had made them sick went when they could afford no better treatment.

Koch Hospital was a free hospital, funded by the City of St. Louis and the State of Missouri. The crowded living conditions and poor sanitation in St. Louis’ poor neighborhoods created, or at least exacerbated the problem Koch Hospital existed to control. The roots of the St. Louis Delmar Divide run deep.

I’m not sure that I believe in ghosts, personally, but I do believe in consequences. Reading the obituaries of people who died of COVID-19 in 2020, it’s easy to find people who in death cursed the societal conditions that made them sick and caused them to die in agony, isolated from their loved ones. In an era when the telephone was the pinnacle of technology, the isolation must have been even more crushing.

The consequence of not providing better living conditions for poor people in St. Louis in the 19th century means a swath of approximately 500 acres along the Mississippi River in a now-wealthy suburb can’t be used for anything. Even those who don’t believe in ghosts and curses don’t want to live on top of old human remains.

Ghost stories

Koch Hospital, St. Louis

This is the women’s building, with the administrative building in the background, as they appeared in 1924.

Thrill seekers who visited the site over the years report feeling a sense of dread and strange presences on the grounds. The site can’t escape the idea of something being wrong. When I made trips to the Wal-Mart on Telegraph Road with friends growing up, someone always pointed across I-255 at the Koch site and said something about ghosts.

No one I knew well was familiar enough with Oakville to sneak into the site. But the adjacent subdivision dates to the late 1950s, which made the hospital less isolated than it had been in generations past. Anyone of Baby Boomer age or younger who grew up in Oakville probably knows someone who tried to sneak onto the grounds. But if you don’t live there, it’s risky.

The closest thing to the site is the Oakville Elks Lodge, which is private property and dates to 1933. The Elks don’t want the attention and call the police if people park in their lot to go exploring. They have plenty of practice, after nearly a century as the hospital’s nearest neighbor. And the lodge isn’t as close as it looks. The distance from their parking lot to the old water tower is nearly 2/3 of the distance from their lot to Robert Koch Road.

I rarely have reason to travel that road, but the handful of times I have been there, I just didn’t like it there, even before I knew what Robert Koch Hospital was and had connected the hospital with the abandoned cemetery my friends pointed at and whispered about in the Wal-Mart parking lot. Even today it feels isolating, and it’s a tense isolation, not a peaceful one.

Reutilization, sale and demolition

Koch Hospital danger sign

Faded danger signs delineate the grounds of the old Robert Koch Hospital. The greatest danger probably is from the nearby quarry, though potentially if you accidentally come in contact with old bones from a washed-out grave it could make you sick.

After World War II, new drugs, including antibiotics, revolutionized the treatment of most infectious diseases.  This included the dreaded tuberculosis. And the discovery of vaccines made them much more preventable. All of this greatly lessened the need for a quarantine hospital. The hospital that was far too small in 1939 was bigger than it needed to be by the 1950s.

The city considered selling the hospital, then decided to repurpose it. It held indigent elderly patients from 1961 until November 1983, when it closed for good, and the city sold the perimeter acreage.

In 1984, the city of St. Louis successfully nominated the complex for the National Register of Historic Places. However, this distinction did not save the hospital buildings. In 1985, the city sold the remaining buildings to Bussen Quarries. The new owners demolished the buildings in 1989. The buildings had problems with vandalism after the hospital closed in 1983, possibly fueled by thrill seekers who thought the grounds were haunted. That probably played into the decision to raze the site.

The presence of the cemetery means the site remains empty. Rumors of health hazards persist, though the more likely problem is the incomplete records increasing the likelihood of disturbing unmarked graves. If not for the cemetery, the area would have been redeveloped years ago, as Oakville has experienced explosive growth since the 1980s.

The Robert Koch Hospital site today

Robert Koch Hospital Road turns sharply and makes a loop through undeveloped land before straightening out and cutting through a residential area. The old hospital site was south of the loop. There is no access from the road, and the site is private property, but you can see some of the old paths and driveways from Google satellite view. The abandoned roads south of Robert Koch Hospital Road and west of Bussen Underground Road that seemingly lead nowhere are the remnants of the site. I don’t recommend going there, but thanks to modern technology, you can explore it with your computer. You can even hunt for what might remain of that old witch’s hat if you want.

Comparing the satellite view with this old map helps you see what stood where those remaining paths lead and what used to be there.

Robert Koch Hospital site mapThe legendary water tower that scared thrill seekers stood at the southwest corner of the site. Coincidentally, the tower stood on the edge of the site nearest the adjacent residential area. For kids who sneaked onto the grounds through the woods, both during and after its time as a functioning hospital, the old water tower with the witch’s hat was the first impression of the place. Someone already nervous about the possibility of getting caught, running into a ghost, or running into an escaped patient isn’t likely to take comfort in the sight of a ginormous witch’s hat.

Nothing of the tower is still visible from Google’s satellite view, but to gauge its approximate location, find the Elks Lodge and look for the fork in the abandoned road in the woods directly to the east.

Significance in 2020

Through the lens of 2020, everything about Koch Hospital seems eerily appropriate. It was a product of the Gilded Age, a time of rapid economic growth, but also poverty and disease. The hospital was the city’s way of trying to control the problem. Advances in medicine eventually made the hospital unnecessary, so we tore it down in the 1980s. And then the pandemic of 2019-2020 hit. Another period of wealth, poverty and disease. Not everyone got sick, and fewer died, but everyone knew at least one person who died. Lots of people said it was only a small percentage, but to those who lost a loved one and couldn’t be with them as they passed, it wasn’t a small percentage. It was a 100 percent terror.

Not everyone lost their job, but everyone knew at least one person who did, or at least got their hours cut. To those who couldn’t pay their bills, it wasn’t a small percentage. That was a 100 percent terror too. And not every rich person was in a position to profit off it, but those who did profited handsomely and we all heard those stories too. Half the population argues with the other half whether a small percentage of that might trickle down.

Seeking to make sense of it all, some people looked to the past for parallels. And there was that ghost hospital again. It’s all cyclical. And if nothing else, scaring ourselves with ghost stories provides a distraction most of us probably need.

And we learn a couple things about the good ol’ days. In a way, maybe the good ol’ days weren’t so good, because pandemics could go on for years, even a decade or more. But maybe we handled it better too. In 1880 if you were sick and poor and had no options, we at least tried to do something for you. Not so much today.