With central heating, flush toilets and an abundance of fresh air, Massachusetts General Hospital's Bulfinch Building, opened in 1821, helped change public perceptions of what a hospital should be.

When the fledgling Massachusetts General Hospital opened the Bulfinch Building for patients in 1821, it promised state-of-the-art medical care like New Englanders had never seen. Among other things, Mass General trustees took great pride in being able to offer patients a fresh breeze. “The hospital is situated at the western part of Boston on a small eminence forming part of the Charles River or bay,” said a front-page article in the Oct. 27, 1821, edition of the Columbian Centinel, a Boston newspaper of the day. “It is so placed that it must be forever open and accessible to the air from the south, west, and east; and on the north there is a considerable space between it and the nearest buildings.”

In a city that had never had a general hospital, clean water, sunlight and heat were other healthcare amenities then considered remarkable. Until the Bulfinch Building was opened, the only significant public facility for the sick was the almshouse, where conditions were notoriously dismal and desperate. Before the advent of anesthesia and antiseptics, hospitals themselves were largely thought of as places for paupers and hopeless cases. In the early 19th century, people who could afford it paid physicians to treat them at home.

By 1810, human compassion was only one of the reasons that led Bostonians to begin raising funds to build what would become Massachusetts General Hospital. The physicians-in-training had a hard time getting practical experience. Moreover, New York and Philadelphia — Boston’s primary competitors for commerce — already had hospitals of their own.

Inmate Granite Cutters

After years of fitful fundraising, in 1816, the Mass General trustees hired Charles Bulfinch, a prominent Boston architect who had already designed Massachusetts’ gold-domed State House. By the time the cornerstone was laid for the Bulfinch Building in 1818, the architect had left Boston for Washington, D.C. to work on the U.S. Capitol. The Mass General project was completed by Alexander Parris, one of Mr. Bulfinch’s former students.

Replete with windows on all sides, the Greek Revival-style building was constructed of Chelmsford granite, cut by inmates at a nearby state prison.

With five usable floors, including a cellar, the 36,000 square-foot building consisted of two wings built around a central area which, on the various floors, contained rooms for administrators and staff. Wards and smaller rooms for patients were located in the wings. A pump room in the cellar kept water circulating through the building, whose “water closets” included at least rudimentary toilets.

Early Central Heating

While some critics would later complain that the Bulfinch’s four chimneys spoiled the view of the graceful dome over its operating theater, they were part of a central heating system involving a system of flues connected to a cellar furnace.

In many practical respects, the Bulfinch Building was ahead of its time. Nearly 40 years after it opened, famed British nurse Florence Nightingale published “Notes on Nursing” and “Notes on Hospital.” Destined to become hugely influential in hospital design, both books underscored the importance of adequate heat, light and ventilation in caring for the sick.

By then, in Boston, the Bulfinch Building helped spawn dramatic changes in the public perception of a hospital. Its operating theater was redubbed the Ether Dome after it hosted the first public demonstration of ether as an anesthetic, in 1846. As demand increased, new operating rooms were built and the Ether Dome was eventually retired from such service.