such as are more easily prevented in a small than a large town.
There are many others who would find great relief in a hospital, and
many times have life preserved when otherwise it would be lost. Such
especially are the subjects of accidental wounds and fractures among the
poorer classes of our citizens; and the subjects of extraordinary diseases,
m any part of the Commonwealth, who may require the long and careful
attention of either the physician or surgeon.
" It is possible that we may be asked whether the almshouse does not
answer the purposes for which a hospital is proposed. That it does not,
is very certain. The town is so much indebted to the liberality of those
gentlemen who, without compensation, superintend the care of the poor,
that we ought not to make this reply without an explanation. The truth
is that the almshouse could not serve the purpose of a hospital, without
such an entire change in the arrangements of it as the overseers do not
feel themselves authorized to make, and such as the town could not be
easily induced to direct or to support.
' The almshouse receives all those who do not take care of themselves,
and who are destitute of property, whether they be old and infirm, and
unable to provide means of assistance ; or are too vicious and debauched
to employ themselves in honest labour ; or are prevented from so employ-
ing themselves by occasional sickness. This institution, then, is made to
comprehend what is more properly meant by an almshouse, a bridewell
or house of correction, and a hospital. Now, the economy and mode of
government cannot possibly be adapted at once to all these various pur-
poses. It must necessarily happen that in many instances the worst mem-
bers of the community, the debauched and profligate, obtain admission into
this house. Hence it has become, in some measure, disreputable to live in
it; and not unfrequently, those who are the most deserving objects of
charity cannot be induced to enter it. To some of them, death appears
less terrible than a residence in the almshouse.
'" It is true that the sick in that house are allowed some greater privi-
leges and advantages than are extended to those in health ; yet the general
arrangements and regulations arc. necessarily, so different from those re-
quired in a hospital, that the sick â€” far from having the advantages afforded
by the medical art â€” have not the fair chance for recovery which nature
alone would give then. Most especially they suffer for the want of good
CLINICAL ADVANTAGES AT HARVARD 571
nurses. In these officers must be placed trust and confidence of the highest
nature. Their duties are laborious and painful. In the almshouse, they
are selected from among the more healthy inhabitants ; but, unfortunately,
those who are best qualified will always prefer more profitable and less
laborious occupations elsewhere. It must, then, be obvious that the persons
employed as nurses cannot be such as will conscientiously perform the
duties of this office.
" In addition to what has already been stated, there are a number of
collateral advantages that would attend the establishment of a hospital in
this place. These are the facilities for acquiring knowledge, which it
would give to the students in the medical school established in this town.
The means of medical education in New England are at present very lim-
ited, and totally inadequate to so important a purpose. Students of medi-
cine cannot qualify themselves properly for their profession, without in-
curring heavy expenses, such as very few of them are able to defray. The
only medical school of eminence in this country is that at Philadelphia,
nearly four hundred miles distant from Boston ; and the expense of attend-
ing that is so great, that students from this quarter rarely remain at it
longer than one year. Even this advantage is enjoyed by very few, com-
pared with the whole number. Those who are educated in New England
have so few opportunities of attending to the practice of physic, that they
find 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. This care they under-
take with very little knowledge, except that acquired from books ; â€” a source
whence it is highly useful and indespensable that they should obtain knowl-
edge, but one from which alone they never can obtain all that is necessary
to qualify them for their professional duties. With such deficiencies in
medical education, it is needless to show to what evils the community is
'To remedy evils so important and so extensive, it is necessary to have
a medical school in New England. All the materials necessary to form
this school exist among us. Wealth, abundantly sufficient, can be devoted
to the purpose, without any individual's feeling the smallest privation of
any, even of the luxuries of life. Every one is liable to suffer from the
want of such a school ; every one may derive, directly or indirectly, the
greatest benefits from its establishment.
A hospital is an institution absolutely essential to a medical school, and
one which would afford relief and comfort to thousands of the sick and
miserable. On what other objects can the superfluities of the rich be so
"The amount required for the institution proposed may, at first sight,
appear large. Rut it will cease to appear so, when we consider that it is
to afford relief, not only to those who may require assistance during the
572 HARVARD MEDICAL SCHOOL
present year or present age, but that it is to erect a most honourable
monument of the munificence of the present times, which will ensure to its
founders the blessings of thousands in ages to come; and when we add
that this amount may be raised at once, if a few opulent men will con-
tribute only their superfluous income for one year. Compared with the
benefits which such an establishment would afford, of what value is the
pleasure of accumulating riches in those stores which are already groaning
under their weight?
" Hospitals and infirmaries are found in all the Christian cities of the
Old World ; and our large cities in the Middle States have institutions of
this sort, which do great honour to the liberality and benevolence of their
founders. We flatter ourselves that in this respect, as in all others, Boston
may ere long assert her claim to equal praise.
" We are, sir, very respectfully, your obedient servants,
" James Jackson.
"John C. Warren."
A charter was obtained from the Legislature on February
25th, 181 1, incorporating James Bowdoin and fifty-five others,
â€” "good citizens of the Commonwealth", â€” under the name of
the Massachusetts General Hospital. The Governor, Lieu-
tenant-Governor, the President of the Senate, the Speaker
of the House, and the Chaplains of both Houses were con-
stituted a Board of Visitors. Twelve Trustees were made
managers of the institution, four of them to be chosen by the
Board of Visitors. The Province House Estate* was granted
upon the condition that an additional sum of one-hundred
thousand dollars should be obtained by private subscription
within the five years following. Unfortunately, the war of
18 1 2, which followed immediately, put an end to the under-
taking until the year 18 16. A resolve passed by the Legisla-
ture in that latter year repealed many of the troublesome con-
* This embraced a tract of land covering about half an acre between
Marlborough (now Washington) street and Province street. The House
was the ancient seat of the Governors of the Commonwealth. Its value in
1816 was twenty thousand dollars. Its value today would probably be
something over eight hundred thousand dollars. It was leased to David
Greenough in 181 7, for ninety-nine years, for the sum of thirty-three
thousand dollars. It will revert to the Hospital in 1916.
CLINICAL ADVANTAGES AT HARVARD 573
ditions imposed by the previous Act, and gave authority to
sell the Province House, with the distinct understanding that
the proceeds of the sale should go into the State Treasury,
unless, within one year from the sale, the sum of one hundred
thousand dollars should be obtained. The stone work in build-
ing the institution was to be done by convicts from the State
Prison. Several hospital sites were proposed. Such physi-
cians as Rand, Hayward, Warren, Jackson and Dexter fa-
vored that newly made land, now the Boston Public Garden.
In January, 1814, a remarkable address to the public was
issued, saying, among other things, "that no plea arising from
'the hardship of the times', 'the general embarrassment of
affairs', or 'the claims of other charities', can or ought to
avail the community. If such a proposal as this fail, it will
be, in the judgment of the undersigned, decisive of the fate
of the establishment. It will then be apparent that the will is
wanting in the public to patronize such an undertaking; and
that the honor of laying the foundation of a fabric of charity
so noble and majestic must be left for times when a higher
cast of character predominates, and to a more enlightened and
sympathetic race of men".
On May 18, 1814, a communication from George Park-
man* was received in which he stated his intention to erect
a Hospital for the Insane. Â§
In April, 18 16, a second address from the promoters of
the Hospital was sent out, in which it was stated that the
prescribed time limit for raising a specified amount of money
had been extended and modified, and that subscriptions could
be directed to be applied to either the Hospital department or
to the Insane department. The following letter sent to vari-
ous towns shows the practical method then inaugurated :
* George Parkman was graduated A. B. at Harvard in 1809; M. D.
Aberdeen 1813 ; died 1849.
Â§ The Almshouse had accommodations for eight insane patients only.
574: HARVARD MEDICAL SCHOOL
"BOSTON, May, 1816.
"THE inclosed papers will explain the object of this communication.
The legislature of the Commonwealth having made it the duty of the
Trustees of the General Hospital to solicit the aid of the public for this
important institution, they have considered that no mode was more likely
to be acceptable and successful than to request a number of liberal and
influential gentlemen in each town of the Commonwealth to obtain a small
specific sum in such town ; thereby equalizing the exertion and the contri-
bution, and enabling every part of the Commonwealth to share in the
honor of its foundation, and to have an equal claim to partake in its ad-
" In the amount requested from each Town, the Trustees have carefully
restricted their request to a sum in no case exceeding and in almost all
cases, less than its relative ratio of wealth, as far as they could obtain
information on the subject, leaving by far the greatest part of the burden
of this contribution to be borne by the Capital, and by towns distinguished
for greatness of wealth and population.
" With these views the Trustees request you Gentlemen to act as a
Committee for the Town of Toppan and to obtain and remit to< James
Prince Esq., Treasurer of the Massachusetts General Hospital Corpora-
tion, if possible, a sum not less than 170 dollars, by subscription, in any
form and in any amount, which will be likely best to effectuate the object
and to equalize this charity among the benevolent.
"Lest this establishment should be considered of a local nature, the
Trustees take the liberty to observe that it is the great object of this insti-
tution to enable persons in all parts of the Commonwealth to avail them-
selves of the best medical and surgical aid, which our country affords,
under the most advantageous circumstances. The Trustees also hope that
the proposed asylum for the insane, by the liberality which they trust will
characterise the contributions to it, will, at no distant period, relieve, not
only many individuals, labouring under this heaviest of human calami-
ties, but also all the towns of this Commonwealth of a great part, if not
the whole of the burden, to which they are at present subject for their
superintendance and support.
" We rely, gentlemen, upon your co-operation in our exertions to attain
this great object, and request that a return may be made of the result in
your town, to either of the Trustees, or to the Treasurer, JAMES
PRINCE, ESQ. on or before the first day of August next.
" We are Gentlemen, respectfully yours, &c.
" T. H. Perkins. " Daniel Sargent.
"Joshia Quincy. "Tristram Bardnard.
" Jos. May. " Rd. Sullivan."
CLINICAL ADVANTAGES AT HARVARD 575
The Joy Estate at Charlestown was purchased* December
18, 1816, for an Insane Hospital, and land on Leverett Street
was procured upon which to erect the General Hospital "as
soon as the moneys, which they flatter themselves will be
readily subscribed, shall have been collected". The result
of this organized effort was that in three days the subscrip-
tions were $78,802. To this was added $15,167 during the
next six days, making a grand total of $93,969 collected in
nine days. The final total subscription amounted to more
than one hundred and forty-six thousand dollars. After the
consideration of various sites, one on North Allen Street was
selected for the General Hospital.
On April 6, 18 17, Samuel Danforth, Isaac Rand, John
Jeffries, Samuel Hayward, David Townsend, Thomas Welsh,
Aaron Dexter, and William Spooner, were chosen consulting
physicians ; James Jackson, acting physician ; John C. War-
ren, acting surgeon. Plans were drawn by the famous archi-
tect. Charles Bulfinch, and the corner stone of the Hospital
was laid July 4, 1818. Rufus WymanÂ§ was elected Resident
Physician and Superintendent of the Asylum.
The first patient was admitted to the Massachusetts Gen-
eral Hospital on September 3, 1821, and no further applica-
tions for admission occurred until September 20. On Octo-
ber 4th, Jackson nominated Walter Channing as his assist-
ant. Six free beds were established January 10, 1822, and
in November, 1823. a bequest of twenty-five-thousand dollars
was received from John McLean, who donated a further sum
of over ninety-thousand dollars to the Hospital as a residuary
legatee. It was voted by the Corporation, June 12, 1826, that
the best mode of perpetuating the memory of John McLean
was to name the Asylum "The McLean Asylum for the In-
* For the sum of $15,650. In 1817 a tract of die estate not exceeding in
all fifteen acres was purchased for $15,000.
Â§A. B. 1799; A. M. 1804; M. B. 1804; M. D. 1811.
576 HARVARD MEDICAL SCHOOL
sane". The income from this McLean donation was so op-
portune that it was seriously proposed to give the donor's
name to the General Hospital.
The hospital reports prior to 1826 have not been preserved.
In that year there were forty-three free beds at the Hospital,
and fifty-seven inmates at the Asylum. The west wing of the
Hospital was completed, and the whole institution was free
from debt,* while fifty thousand dollars had been invested
in the Massachusetts Hospital Life Insurance Company.
In 1828 the Acting Physician and Acting Surgeon were
requested to nominate assistants, "the Trustees deeming it
desirable that occasional changes should be made in those
nominated, when consistent with the welfare of the institu-
tion". The number of patients discharged for the year end-
ing April 1, 1828, was 218. At the close of 1832 there were
fifty-two patients in the Hospital : and fifty-one in the Asy-
lum. During the sixteen years (1818-1833, inclusive) there
had been 1015 admissions to the Asylum.
The growing needs of the Hospital were shown in 1834,
by a petition from the Physicians and Surgeons asking for
a new building or wing.Â§ Here are two instances which show
the zeal and care with which the Hospital was cherished : The
first deals with the election of Luther V. Bell (December 11.
1836) as successor to Thomas G. Lee, late Physician and
Superintendent of the Asylum. Bell was unanimously
elected, "provided a committee then appointed consisting of
Messrs. Eliot and Quincy, shall be satisfied that he will pur-
sue the course of moral and religious treatment of patients
adopted by Dr. Lee, and they shall be so satisfied before com-
municating the appointment". The standard already set by
* The Hospital held a right under the charter of 1814 to grant annuities
on lives, and by subsequent acts a share in all insurances companies'
profits unless otherwise specifically stated in their charter.
Â§ Such wings were erected eleven years later.
CLINICAL ADVANTAGES AT HARVARD 577
Wyman and Lee was advanced by Bell. The second event
was marked by the following resolution April 23, 1837:
" Voted that the Trustees have recently seen, with great pain, that a
violation of the rules of the institution by one of its officers has become
the subject of newspaper animadversion. In an institution like this, to
which it is difficult to attract, and in which it is so important to command,
public confidence, the strictest and most scrupulous adherence to rules,
of which the propriety is unquestioned, is required by a just regard as
well to its usefulness to the public, as to the character of those who have
any agency in its direction and control. Where many persons are con-
nected in different departments, the reputation of all is more or less
affected by the conduct of each ; and all are therefore bound, by respect for
others as well as themselves, to conduct themselves in such a manner as to
give no reasonable ground of complaint. The Trustees have felt unlimited
confidence that no officer of the institution would expose himself to just
centure, and they have on all occasions been but very slightly affected by
remarks which they have had reason to believe were founded on jealously
or misconception. But it is with very different feelings they regard an
accusation of violation of a rule, which, on inquiry, proves to be true ;
and they think it due to themselves to take serious notice of it, and to put
on record their denial of all knowledge of the circumstance at the time of
its occurrence, and to express their hope that nothing may ever again re-
quire a similar expression of their feelings. Lest, however, the breach of
confidence may be imagined to be of a more serious character than it really
was, they think proper to state, that the circumstance to which they allude
was the employment of Dr. J. Mason Warren, a young man not connected
with the Hospital, during the absence of his father, whose turn it was to
The foregoing resolution does not seem to have been taken
very seriously even by the trustees themselves.*
The elder Warren wrote a candid reply, fully and satisfac-
torily explaining the circumstances of the incident, and perma-
nent good feeling was restored.
In 1844 an address from the Trustees to the public was
issued, together with a letter from the six attending Physicians
* J. Mason Warren was elected visiting Surgeon to the Hospital in 1846,
and served until his death in 1867. He was the founder of the Warren
Triennial Prize, established at the Massachusetts General Hospital.
578 HARVARD MEDICAL SCHOOL
and Surgeons, asking for assistance in enlarging the Hos-
pital. Over sixty-two thousand dollars were raised with which
two large wings were erected. An unsuccessful attempt was
made July n, 1845, by J. C. Warren and Jacob Bigelow to
establish a Lying-in department.*
The enlargement of the Hospital necessitated an increase
in the medical and surgical staff, and in February, 1846,
Henry I. Bowditch, John D. Fisher and O. W. Holmes were
added to> the medical staff, and Henry J. Bigelow, Samuel
Parkman and J. Mason Warren were added to the surgical
staff. An Out-patient Department was established in June,
1847, the new east wing being ready for the admission of pa-
tients. The growth of the hospital for the first fifty years
is shown by the following table :
. 1831 -41 4,406
1862 1,888 1,693
1863 2,015 1,742
1864 1,932 1,700
1865 1,430 1,281
1866 1,328 1,223
1867 1.419 i,295
1868 i,474 i,357
1869 1,633 i,498
1870 1,706 1,381
1871 i,78i 1.502
The report for the year 1847 is voluminous, and goes into
*The Humane Society had presented a similar petition in 1831.
CLINICAL ADVANTAGES AT HARVARD 579
the question of etherization, an important event in the Hos-
pital. We have considered this matter in a separate chapter.
In 1864 (February 28th) it was recorded, "Whereas the
interests of the out-patients will be promoted, the convenience
of the Visiting Surgeons be subserved, and the benefits of
the institution be increased, by the appointment of a surgeon
to that class of patients, "Voted, That a Surgeon to out-pa-
tients be and hereby is established, whose duties shall corre-
spond generally with those of the Physician to the same de-
partment". Algernon Coolidge (Harv. Med. 1853) was
elected to the position.
There were in this year (1864) 1599 patients admitted
to the Hospital proper, 3761 medical cases and 1858 surgical
cases to the Out-patient Department, and 302 cases to the
The Physician and the Surgeon to out-patients were author-
ized to charge each patient for his first visit, whenever such
patient could pay. The number of Physicians and Surgeons
in the Out-patient department was increased from year to
year as the growth of the Hospital required. A new operating
theatre was completed in 1868 which was used for its desig-
nated purpose until 1902. After H. J. Bigelow's retirement
in 1886 it received his name. It is now used for the Zander
apparatus. The new surgical amphitheatre opened in 1902
is known as the Bigelow Amphitheatre.
On June 4, 1869, the Trustees voted that all Hospital out-
patients affected with diseases of skin be assigned to a special
department under the care and treatment of James C. White.*
James C. White was Chemist and Visiting Physician in
1867, and in 1870 resigned to establish a special department
in Diseases of the skin. A Dermatological Ward in the Hos-
* James C. White was graduated Harvard 1853, A. B. ; 1856, M. D. ;
Adjunct Professor of Chemistry; Professor of Dermatology.
580 HARVARD MEDICAL SCHOOL
pital was opened in October of that year. The annual report
shows that White made 2,045 visits to patients suffering from
diseases of the skin. The report of i87iÂ§ contains the fol-
' The experiment of a separate ward for the treatment of patients af-
flicted with skin diseases, though by no means unsuccessful in its especial
results, was regarded by the Trustees as open to some general objections,
and was discontinued at the close of the year. Dr. James C. White had
on his own part made a most faithful trial of the experiment, and had
devoted to it his skill and experience in his specialty. He continues to
serve the institution as Chemist, and Physician to patients with diseases
of the skin."
The upbuilding of a hospital such as the Massachusetts
General was of the greatest importance to the Harvard Med-
ical School. Most of the instructors had had previous oppor-
tunities for teaching in the Hospital. Of course there were
advantages to the School from this fact, and much the same
arrangement with the various Boston hospitals maintains to-
day. Here is the fragment of an ancient letter taken from
the Warren papers, and bearing on the Hospital and School
relationship in the early days of the Hospital's development :
1. ' The Physicians and Surgeons of the Hospital are of an opinion,
that the admission of medical pupils is not desirable at present ; but
having been requested to fix on some terms of admission, they have de-
cided on such as appear to them reasonable. They are not anxious for
pecuniary emolument from this source. Having been engaged for the last
ten or fifteen years in helping forward this establishment, their feelings
are deeply interested in its prosperity and success. The gratification of
seeing so fine an establishment for the relief of the unfortunate, in full
operation, is the highest reward they expect to receive ; and the plans
which are now maturing will, they are satisfied, afford them this pleasure
in a very short time.
' The utility of the Hospital to the promotion of medical science, by
affording a fair view of practice, by the introduction of improvements in
Â§ Page 669. " History of the Massachusetts General Hospital," by N.