The State was involved to the following extent: it granted a charter to incorporate the Massachusetts General Hospital; it contributed some real estate along the banks of the Charles River; it contributed granite for construction of the building; and it supplied convict labor to build it.

The designer of the building was Charles Bulfinch, Jr., a leading architect and son of a prominent physician. With its dome, the building was an architectural marvel of its time, and was considered the most beautiful structure in Boston for many years afterward. Organizationally, too, it was quite advanced; it was patterned upon the English urban teaching hospital as exemplified by Guy's Hospital in London.

The new institution was not, however, immediately popular with Boston citizenry. The first patient appeared on September 3, 1821, but no other applied until September 20, and the hospital never ran at full census until after 1850, when massive emigration from Ireland increased the city population fourfold.

This early reluctance to use the newly founded institution is frequently attributed to experiences with earlier hospitals, such as the military hospitals of the Revolution (which Benjamin Rush said "robbed the United States of more citizens than the sword"), the pesthouses, and the almshouses.

But in fact it is perfectly understandable if one considers the state of medical science when the hospital first opened its doors.

In 1821, the concept that cleanliness could prevent infection was unknown. There was little systematic attempt to keep the hospital clean; physicians went directly from the autopsy room to the bedside without washing their hands, and surgeons operated in whatever old street clothes were considered too shabby for other purposes.