The Genealogy Of Mass General


James Jackson was a gentler character by far. Oliver Wendell Holmes would remember him as the “warm, ready, self-forgetting friend,/Whose genial visit in itself combines/The best of cordials, tonics, anodynes.” As a young man, however, Jackson too was ambitious. He was in London the first year that Warren was, and there he learned the new technique of vaccination for smallpox. Eager to return home with it and to establish his practice and marry Elizabeth Cabot, his fiancée of nearly four years, Jackson stayed abroad only that year. On October 1, 1800, some two days after his return, Jackson would later recall, “I began business. Vaccination had been introduced [principally by Dr. Benjamin Waterhouse of Harvard] about the time that I commenced my studies, but the practice had not been extensively adopted at that day even in England. …the cow-pox gave me notoriety, and that is a great advantage to a young man if it comes to him fairly, without any tricks.”

Notoriety soon matured into respect and faculty appointments at the medical school for both Warren and Jackson. The first ten years of the nineteenth century must have been an exhilarating time for them, as it was for the society in which they lived. For Jackson belonged to, and Warren married into, the group that would soon combine money and culture to form a distinctive urban aristocracy that Oliver Wendell Holmes later dubbed the Boston “Brahmins.” So, in 1810, when Jackson and Warren addressed a “circular letter” to the newly, and in some cases fabulously, wealthy citizens of Boston, they could be confident that they were addressing their social equals.

Most prominent among the supporters they recruited was Thomas Handasyd Perkins, who had amassed one of New England’s greatest fortunes, first in the China Trade and later in various financial transactions. Perkins would become one of the mainstays of the proposed hospital, both as donor and trustee. Other merchants and industrialists such as Francis Cabot Lowell, Stephen Higginson, Samuel Appleton, and Abbott and Amos Lawrence would also join the endeavor.

The hospital was intended for “those of good and industrious habits.…”

The War of 1812 set back the fund-raising efforts, and by 1816 the hospital had been chartered but lacked funds to begin construction. The trustees wrote, with some acerbity, “That Boston should be almost the only town of equal opulence and population in Christendom without one suitable and exclusive place of refuge for the sick and insane, must be attributed to any cause rather than a want of benevolence.” The town was divided into districts, and a few citizens in each district were designated to go around putting the arm on potential donors. In short order the necessary capital was raised, and the trustees were able to proceed with the purchase of land and then plan and build two hospitals—an asylum for the mentally ill (soon to be known as the McLean Hospital), and the general hospital, which was located on its current site north of Beacon Hill.

The hospital building was partially designed by the eminent Boston architect Charles Bulfinch and was completed by Alexander Parris. A graceful stone structure with such modern features as central heating and running water, Mass General was ready to receive patients on September 1, 1821. The first admission came two days later, and the second followed more than two weeks after the first. By early November, according to the hospital’s first official historian, Nathaniel I. Bowditch, “ten patients had been received at the Hospital, three discharged, one cured, and one relieved.”

Patients did not come to Mass General because they were sick but because they had no place else to be sick. This was true nearly to the end of the nineteenth century. Although Mass General was a hospital, in many ways it was not primarily a medical institution, and doctors played quite a different role from the one they would acquire fifty or sixty years later. For example, before 1837, patients were not, except in an emergency, admitted by the medical staff. A committee of the trustees was responsible for deciding whether admission was warranted, and the criteria they used were as much social as medical. Could other suitable accommodations be found? Was this person of good character and deserving of hospital care? Not until 1881 did the medical staff gain full control over the admission of patients. The trustees also made regular weekly visits to the hospital to monitor the progress of their charges. Thus the officers of Mass General were directly and actively involved in the day-to-day life and operation of the hospital. They obviously regarded it more as a charity than as the highly specialized repair shop for the human body that the modern hospital is today, and they administered it accordingly.