Just as stately trees in Forest Park were coming down to make way for the 1904 World's Fair, elegant homes-- designed by the city's best architects and occupied by its elite-- were springing up on surrounding streets, as a vast building boom began. And that was the start of the St. Louis neighborhood called the Central West End, which quickly grew from a sleepy rural outpost to an address for fashionable people and shops, fine cultural institutions and congregations, high-class hotels and hospitals.
That halcyon period did not last, however. Through the years, various factors-- the growth of the suburbs, white flight, the cost of maintaining huge homes, the rise of rooming houses, the disheartening effect of smoke-- drove some of the well-to-do farther west, and the Central West End foundered. Though residents, religious groups, and some politicians tried to stop the slide, fine homes disappeared and hospitals moved away. At this point, the Washington University Medical Center also faced a choice: stay or go? They decided to hold their ground and mounted a revitalization effort that succeeded, with the support of the resilient community.