Towards the close of the nineteenth century, Karachi emerged as the cleanest city towards this side of the Indus River, with an estimated population of 105,000 which continued to grow in view of its strategic importance.

Lord Curzon the Viceroy of India visited the hospital in 1900 and unveiled a commemorative plaque to mark the platinum jubilee of Queen Victoria.

The hospital continued to function efficiently until independence as the principal hospital of Karachi and received tremendous impetus after 1945 when the then Governor of Sindh Sir Hugh Dow transferred the medical school provisionally recognized by the Bombay University from Hyderabad to Karachi and laid the foundation of the Dow Medical College in its present location on 10 December 1945, with the Dr. Ruth K.M.

The creation of a new state of Pakistan brought with it the need for a massive relief and rehabilitation efforts for hundreds of thousands of migrated people pouring in from India and addressing all their basic needs including health needs through a largely inadequate and unprepared system.

A 1961 entry by Lady Bird Johnson then spouse of the Vice President of the USA is particularly revealing: It reads: "This has been a visit both heart-breaking and rewarding.

The Emergency department has several sections including an Operation Theatre and Surgical Intensive Care Unit, which are functional around the clock for use in case of mass disasters.