Original text of the letter of petition, also known as “The Circular Letter,” widely accepted

to be the cornerstone of the establishment of the Massachusetts General Hospital.

Boston, August 20, 1810

SIR,

I t has appeared very desirable to a number of respectable gentlemen, that a hospital

for the reception of lunatics and other sick persons should be established in this town. By the
appointment of a number of these gentlemen, we are directed to adopt such methods, as shall
appear best calculated to promote such an establishment. We therefore beg leave to submit for
your consideration proposals for the institution of a hospital, and to state to you some of the
reasons in favour of such an establishment.
It is unnecessary to urge the propriety and even obligation of succouring the poor in sickness.
The wealthy inhabitants of the town of Boston have always evinced that they consider themselves
as “treasures of God’s bounty”; and in Christian countries, in countries where Christianity is
practised, it must always be considered the first of duties to visit and to heal the sick. 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 both of reason and religion.
It is unnecessary to urge the truth and importance of these sentiments to those who are already
in the habit of cherishing them; to those, who indulge in the true luxury of wealth, the pleasures
of charity. The questions, which first suggest themselves on this subject, are whether the relief
afforded by hospitals is better than can be given in any other way; and whether there are in fact so
many poor among us, as to require an establishment of this sort.
The relief to be afforded to the poor, in a country so rich as ours, should perhaps be measured only
by their necessities. We have then to inquire into the situation of the poor in sickness, and to learn
what are their wants. In this inquiry we shall be led to answer both the questions above stated.
There are some, who are able to acquire a competence in health and to provide so far against
any ordinary sickness, as that they shall not then be deprived of a comfortable habitation, nor of
food for themselves and their families; while they are not able to defray the expenses of medicine
and medical assistance. Persons of this description never suffer among us. The Dispensary gives
relief to hundreds every year; and the individuals who practice medicine gratuitously attend many
more of this description. But there are many others among the poor, who have, if we may so express
it, the form of the necessaries of life, without the substance. A man may have a lodging, but it is
deficient in all those advantages, which are requisite to the sick. It is a garret, or a cellar, without
light and due ventilation, or open to the storms of an inclement winter. In this miserable habitation
he may obtain liberty to remain during an illness; but, if honest, he is harassed with the idea of his
accumulating rent, which must be paid out of his future labours. In this wretched situation the sick
man is destitute of all those common conveniences, without which most of us would consider it
impossible to live, even in health. Wholesome food and sufficient fuel are wanting; and his own
sufferings are aggravated by the cries of hungry children. Above all, he suffers from the want of
that first requisite in sickness, a kind and skilful nurse.
But it may be said that instances are rare among us, where a man, who labours with even
moderate industry, when in health, endures such privations in sickness as are here described. They
are not however rare among those, who are not industrious; and who, nevertheless, when labouring
under sickness, must be considered as having claims to assistance. In cases of long protracted
disease, instances of such a description do occur amongst those of the most industrious class. Such
instances are still less rare among those women, who are either widowed, or worse than widowed.
It happens too frequently that modest and worthy women are united to men, who are profligate
and intemperate, by whom they are left to endure disease and poverty under the most aggravated
forms. Among the children of such families also instances are not rare of real suffering in sickness.
To all such as have been described, a hospital would supply every thing which is needful, if not
all they could wish. In a well regulated hospital they would find a comfortable lodging in a duly
attempered atmosphere; would receive the food best suited to their various conditions; and would
be attended by kind and discreet nurses, under the directions of a physician. In such a situation the
poor man’s chance for relief would be equal perhaps to that of the most affluent, when affected
with the same disease.
There are other persons also, who are of great importance in society, to whom the relief afforded
by a hospital is exceedingly appropriate. Such are generally those of good and industrious habits,
who are affected with sickness, just as they are entering into active life, and who have not had time
to pro-vide for this calamity. Cases of this sort are frequently occurring. Disease is often produced
by the very anxiety and exertions, which belong to this period of life; and the best are the most
liable to suffer. Of such a description, cases are often seen among journeymen mechanics, and
among servants.
Journeymen mechanics commonly live in small boarding houses, where they have accommodations
which are sufficient, but nothing more than sufficient, in health.—When sick, they are necessarily placed
in small, confined apartments, or in rooms crowded with their fellow-workmen. They are sheltered
from the weather, and have food of some sort, and these must in many cases be the extent of their
accommodations. Persons of this description would do well to enter a hospital, even if they had to
pay the expense of their own maintenance. In most cases they would suffer less, and recover sooner
by so doing. When, as sometimes happens, they have not the means of payment, they become
objects of charity; and the welfare of such persons should be considered among the strong motives
in favour of establishing a hospital.
Servants generally undergo great inconveniences at least, when afflicted with sickness; and
oftentimes much more than inconveniences. With so much difficulty is the care of them attended
in private families, that many gentlemen would pay the board of their servants at a hospital, in
preference to having them sick in their own houses. In some cases however, neither the master
nor servant can afford the expense of proper care in sickness. Not uncommonly a young girl is
taken sick in a large family, where she is the only servant. She lodges in the most remote corner of
the house, in a room without a fire-place. The mistress is sufficiently occupied with the unusual
labours, which are thrown on her, at a time, perhaps, when she is least fitted to perform them.
Under such circumstances how can the servant receive those attentions, which are due to the sick.
Of what use is it that the physician leaves a prescription to be put up at the Dispensary. He goes
the next day, and finds that there has not been time, even to procure the remedies, which he has
ordered; meanwhile the period, in which they would have been useful, has passed by, and the
incipient disease of yesterday has now become confirmed.
Persons of these descriptions would not be disposed to resort to a hospital on every trivial
occasion. But, when afflicted with serious indisposition, they would find in such an Institution an
alleviation of their sufferings, which it must gladden the heart of the most frigid to contemplate.
There is one class of sufferers, who peculiarly claim all that benevolence can bestow, and for
whom a hospital is most especially required. The virtuous and industrious are liable to become
objects of public charity, in consequence of diseases of the mind. When those, who are unfortunate
in this respect, are left without proper care, a calamity which might have been transient, is prolonged
through life. The number of such persons, who are rendered unable to provide for themselves, is
probably greater than the public imagine; and of these a large proportion claim the assistance of the
affluent. The expense, which is attached to the care of the insane in private families, is extremely
great; and such as to ruin a whole family, that is possessed of a competence under ordinary
circumstances, when called upon to support one of its members in this situation. Even those, who
can pay the necessary expenses, would perhaps find an Institution, such as is proposed, the best
situation, in which they could place their unfortunate friends. It is worthy of the opulent men of this
town, and consistent with their general character, to provide an asylum for the insane from every
part of the commonwealth. But if funds are raised for the purpose proposed, it is probable that the
Legislature will grant some assistance, with a view to such an extension of its benefits.
Of another class, whose necessities would be removed by the establishment of a hospital, are
women, who are unable to provide for their own welfare and safety, in one of nature’s most trying
hours. Houses for lying-in women have been found extremely useful in the large cities of Europe;
and although abuses may have arisen in consequence, these are such as are more easily prevented
in a small, than in 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
in 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 subsistence; or are
too vicious and debauched to employ themselves in honest labour; or are prevented from so
employing 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
purposes. It must necessarily happen that in many instances the worst members 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 privileges and advantages, than
are extended to those in health. Yet the general arrangements and regulations are, necessarily, so
different from those required in a hospital, that the sick, far from having the advantages afforded
by the medical art, have not the fair chance for recovery, which nature alone would give them.
Most especially they suffer for the want of good 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 limited, and totally inadequate
to so important a purpose. Students of medicine cannot qualify themselves properly for their
profession, without incurring 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 attending 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, compared
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 undertake with very little knowledge except
that acquired from books;—a source whence it is highly useful and indispensable that they should
obtain knowledge; but one, from which alone, they never can obtain all that is necessary to qualify
them for their professional duties. With such deficiences in medical education, it is needless to
show to what evils the community is exposed.
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 well bestowed ?
The amount required for the institution proposed may, at first sight, appear large. But 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 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
contribute 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 worlds; 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