Around 1874, the Department of Health and Hospitals planned for a much larger City Hospital that would have adequate capacity for the metropolitan city St. Louis had become since the 1857 building had been built. The department came up with plans for a large complex of buildings in a formal Italianate style with mansard roofs surrounding a courtyard. Only one part of this grand complex was completed, a brick wing seen in the images below.

The mismatched pair of hospital buildings were quickly overwhelmed with patients but the city's budget allotted only enough funds to keep the operation running on a stopgap basis. Expansion along the lines of the 1874 plan never came to be. A determining event in the hospital's future would provide the final push for construction of a large modern complex: the Great Cyclone of 1896, which destroyed both the 1857 and 1874 buildings. (All images are from the collection of the St. Louis Building Arts Foundation.)