The Genealogy Of Mass General


As Boston grew and prospered in the two decades after the Revolution, the inadequacies of the almshouse became more and more disturbing to the local citizens. The lack of a hospital, however, was hardly felt as a deficiency of medical care in the sense we now think of it. It was normal and proper to care for the sick at home; even surgery was better performed on a kitchen table than in a hospital, according to the prevailing wisdom.


What marked the need for a hospital in Boston was the emergence of a new social class: people who were respectable but nevertheless did not live in their own homes. As commerce and industry burgeoned, ever increasing numbers of journeymen mechanics—young laborers in manufacture and on the waterfront—were drawn into the city. They lived in boardinghouses, where their accommodations were “sufficient, but nothing more than sufficient, in health,” as the advocates of a hospital wrote. Moreover, these men were at risk of occupational accidents, something increasingly common as the pace of business picked up.

SERVANT GIRLS ALSO had need of such a facility. The aggressive economy of Boston Harbor at the end of the eighteenth century had covered Beacon Hill with mansions for the merchants and industrialists, and the domestic economy of these great houses depended on servant girls to get the work done. If one of these girls was incapacitated, her mistress hardly could take care of her and assume the undone chores of the household.

These two kinds of people, journeymen mechanics and servant girls, were explicitly identified in fund-raising efforts as the main classes of people for whom the hospital was intended: “generally those of good and industrious habits, who are affected with sickness, just as they are entering into active life.” In addition, women and children without means or a man to protect them—another by-product of urbanization—deserved special mention.

Of course, the poor in general might benefit from hospital care. But the fund-raisers had to tread lightly when making this suggestion, because of the nineteenth-century concept of “welfare chiselers.” Then as now, paupers—able-bodied but indolent persons dependent on public charity—were widely thought to be the product of social welfare programs. To counter this fear, the advocates of a new hospital for Boston wrote in 1810, “When in distress, every man becomes our neighbour, not only if he be of the household of faith, but even though his misfortunes have been induced by transgressing the rules of both reason and religion. ” Even these, “when labouring under sickness, must be considered as having claims to assistance.”

The authors of this generous sentiment were John Collins Warren and James Jackson, young physicians and professors of the Medical Institution at Harvard (now Harvard Medical School) who had decided to campaign in earnest for a hospital. As members of the medical faculty, their reasons extended beyond the purely charitable. Short of traveling to Philadelphia, they pointed out, New England’s medical students found it “impossible to learn some of the most important elements of the science of medicine, until after they have undertaken for themselves the care of the health and lives of their fellow-citizens …”

Medical education had begun in Boston in 1783 with the opening of a medical school loosely allied to Harvard. The quality of instruction could not have been terribly high at that time; some of the students appear to have verged on the illiterate. And clinical training was hampered for want of patients on whom to demonstrate. The Overseers of the Poor were first approached with a request to use the almshouse inmates for this purpose, but they refused out of fear that their budget would be strained by fees charged for the inmates’ care. What clinical instruction could be given, therefore, depended on the willingness of private patients to be used for the purpose.

By 1809 there was a general feeling that medical education at Harvard had begun to stagnate, and an effort was begun to improve it. The Overseers of the Poor were approached once again, and this time the appeal succeeded. But the professors had to accept two conditions: they must give their care free, and they themselves must pay for any medicines they prescribed to the inmates.

Warren and Jackson, the principal proponents of a hospital, had themselves had the benefit of training abroad before they started their practices in Boston. John Collins Warren, a driven, puritanical man, was utterly dedicated to his profession of surgery—so much so that his will called for his bones to be “carefully preserved, whitened, articulated and placed in the lecture-room of the Medical College near my bust; affording, I hope, a lesson useful, at the same time, to morality and science.” Starting in 1799, the young Warren spent three years studying in London, Edinburgh, and Paris. He returned to Boston as perhaps the best-trained surgeon in America.