By 1800, seriously ill Europeans were accustomed to seeking care in general hospitals; in the United States, things were different. There were only two general hospitals in the entire nation: Pennsylvania Hospital, which had opened in Philadelphia in 1756, and the New York Hospital, which followed in 1791. For the most part, Americans who fell sick were treated at home by family members and lay healers. Increasing numbers of affluent families sought the services of physicians, but most people viewed institutional medical treatment with distrust. In colonial New England, families expected to care for their own; only individuals without family connections or resources — the destitute, the insane, criminals, or members of the military — were confined in public institutions such as military hospitals and almshouses.

In the early 1800s, reformers began to see civic institutions as a way to address social ills. They established asylums for the mentally ill, criminals, orphans, the poor, the blind, the deaf, and the sick. At the same time, doctors sought to elevate the status of their profession through more uniform and scientific training. Hospitals and medical schools grew hand in hand.

In March of 1810, a group of prominent Boston men set out to create a general hospital that would care for both the physically and mentally ill. The doctors involved in the project realized that having a hospital in Boston would improve the teaching of Harvard Medical School students. Up to that point, the training of men who called themselves doctors varied enormously, ranging from apprenticeship with another physician to self-instruction. A medical school associated with a well-run hospital would provide excellent medical training, attract aspiring doctors, and raise the standards of both medical education and medical treatment in New England. "A hospital," one fundraising letter pointed out, "is an institution absolutely essential to a medical school, and one which would afford relief and comfort to thousands of the sick and miserable."

In February 1811, the Massachusetts legislature granted a charter for the Massachusetts General Hospital. The lawmakers required that the hospital take care of patients regardless of citizenship, social class, or income, although it was of course permitted to exclude women from its training programs.

The legislature bestowed numerous favors on the hospital: it transferred ownership of the Province House, where British governors had resided in colonial times, to the hospital and allowed the hospital to rent or sell it. The legislature also chartered a new life insurance company on the condition that one-third of its net profits go to the hospital. Over the next 130 years, the company would generate more than $1,500,000 for Mass General. The legislature also saved the hospital nearly $30,000 in construction costs by stipulating that the state prison furnish the stone and labor for the first building.

The hospital campaign had wide popular appeal. Between December of 1816 and March of 1817, 1,047 individual donors contributed over $107,000. Not all gifts were in cash: one man donated a pig "of an uncommonly fine breed" another gave an Egyptian mummy, which the Trustees rented out for exhibition, raising $1,200.

The Trustees' highest priority was the opening of a mental hospital. In 1816 they purchased an estate in what was then Charlestown, and on October 6, 1818, the institution that would eventually be known as McLean Hospital admitted its first patient. Meanwhile, a four-acre parcel on the Boston side of the Charles River was acquired for the General Hospital. Architect Charles Bulfinch incorporated state-of-the-art central heating and plumbing into his classic design for the granite building. On September 3, 1821, the Massachusetts General Hospital admitted its first patient. Two years later, the building was complete.

From the day the hospital opened its doors, it afforded Harvard Medical School students and professors the best medical environment in New England. As the first and largest training ground for Harvard medical students, the hospital soon established Boston as one of the nation's premier centers of medical education. Mass General has also evolved into a top-tier medical research institution, with a research budget of more than $800 million and a top recipient of research funding from the National Institutes of Health (NIH). Between the education of medical students and scientific research, MGH has an impact on the health of many beyond the state of Massachusetts. 

MGH's original 73 beds have grown to over 1,000; the hospital's staff care for over 1,500,000 patients a year; around 100,000 of them in its acclaimed Emergency Department. Mass General conducts the largest hospital-based research program in the United States.

The Bulfinch Building is dwarfed by the enormous medical complex that has risen around it, but it still stands, a testimony to the hospital's modest beginnings.