Boston Consumptives Hospital, River Street

The Boston Consumptives Hospital (a.k.a. Boston Sanatorium) is located at 249 River Street in Boston’s Mattapan neighborhood. The site historically contained 52 acres, which are currently being subdivided into several smaller lots. The complex is situated in the midst of a residential neighborhood characterized by single and multi-family houses, primarily from the second half of the 20th century. The site includes 19 buildings, 18 of which were historically associated with the hospital facility.

Statement of Significance

The former Boston Consumptives Hospital (a.k.a. Boston Sanatorium) possesses integrity of design, location, setting, materials, and workmanship and meets Criteria A and C at the statewide level. It is significant as a mid-19th century rural retreat, and later as a sanatorium for the treatment of tuberculosis. It is notable as having been the largest tuberculosis treatment facility in the State. The complex is also significant as an intact collection of buildings representing a number of architectural styles, including Italianate, Craftsman, Art Deco, and several Revival styles.. The Boston Consumptives Hospital campus is a collection of 19 buildings, designed by architects Maginnis & Walsh and James H. Ritchie & Associates, ranging in date from ca. 1856 to the mid-1990s. Only one building was constructed outside the period of significance.

In the early years of the 20th century tuberculosis was running rampant in this country, particularly in densely populated communities, and treatment was in its infancy. Boston, like most large cities, was hard hit. In 1907 tuberculosis was responsible for more deaths in this city than any other disease except pneumonia, causing more invalidity than all other diseases combined. In 1906 roughly 10% of all deaths in Boston were the result of pulmonary tuberculosis (also known as consumption). While there are other forms of tuberculosis, they are far less common. Boston’s death rate from consumption was the third highest in the nation, behind New Orleans and San Francisco. The estimated number of consumptives in Boston in 1906 was 10,000 and it was believed that 6,000 to 8,000 of those were in the advanced stages of the disease. Statistics show that the highest occurrences of tuberculosis were in the less affluent sections of the city where crowded living conditions, related to the massive population expansion at the turn of the 20th century, resulted in rapid spread of the disease.

Although treatment was still being explored, it was known that tuberculosis primarily struck young adults, was curable, and was even preventable if identified and treated early on. While there was suitable care for the incipient cases among Massachusetts residents, primarily at the State Sanatorium at Rutland, facilities for the advanced cases were grossly insufficient. The Long Island Hospital in Boston Harbor could accommodate about 60 advanced consumptives and there were several other private institutions that together could provide beds for about 200 more.

In an effort to address the growing problem of treating tuberculosis and stopping its spread, the City of Boston set up the Consumptives Department in 1906. The new department was given the task of establishing a hospital to treat city residents suffering from advanced cases of tuberculosis. The department’s annual report for 1908 notes that “this work of fighting tuberculosis is new and we believe that Boston is now showing the way for the rest of the United States….” The report further states that “it is only within very recent years that an intelligent, comprehensive, sanitary surveillance on the part of the state or municipality has been inaugurated.”

The Consumptives Hospital Department considered “a score or more of sites in Boston” for the hospital location but settled on the former estate of Hon. John Conness in the Boston’s Mattapan neighborhood. This rural farm was considered ideal, given that fresh air and open surroundings were prescribed to combat tuberculosis. The Conness property was purchased in 1906 for $65,000. At the time, the estate included an Italianate style main house (Thompson House/Superintendent’s House – Map #1, photo #4), originally constructed for Joshua P. Thompson. Also on the site was a small Vernacular cottage (Conness Cottage – Map #6, photo #1), a barn and two sheds. The main house and cottage are all that remains of the Conness buildings today. Joshua Thompson was a merchant from Dedham, Massachusetts who purchased a four acre farm along River Street in 1856 and constructed the Italianate house by 1859. The Thompson family were owners until 1865 when they sold to Tilden Ames of Marshfield, Massachusetts. The property remained in the Ames family until 1869 when it was acquired by Edmund and Susan Stowell of Dorchester. The following year, the Stowells sold to John Conness of New York City for $12,000. For three and one-half decades the prominent Conness family retained the property. Irish-born John Conness was a California senator in the 1860s and was known to be a friend of Abraham Lincoln. Apparently, Coness purchased the house as a place of retirement. Locally, he was a trustee of Cedar Grove Cemetery, where he is buried. By the time Conness and his wife Mary sold the estate to the City of Boston in 1906, the land had grown to 51 acres through purchases in 1872 and 1883.

Plans for development of the site were drafted by architects Maginnis & Walsh, who were also responsible for the design of the earliest buildings erected for the hospital. Boston architects Charles Maginnis and Timothy Walsh practiced in partnership between the years 1908 and 1954. They are most well known for their design of early 20th century buildings associated with the Archdiocese of Boston. Their work includes buildings at St. John’s Seminary in Boston, numerous churches, several buildings at Holy Cross College in Worcester, and a number of Catholic schools. The Consumptives Hospital Department annual report of 1908 states that “their design is as simple as possible, and throughout the uses to which each building is to be put and economy of administration have been considered, and not architectural display.” All the buildings were designed to provide maximum sunlight and fresh air, with numerous windows and open floor plans. The Maginnis & Walsh scheme consisted of a series of buildings joined by tunnels (both above and below ground), some of which were used for foot traffic and others which carried mechanical equipment.

By 1907, when construction of the Boston Consumptives Hospital commenced, the most widely-accepted method for dealing with tuberculosis was treatment at a sanatorium. The beginning of the sanatorium movement can be traced back to 1859 when doctor Hermann Brehmer built a small sanatorium in Görbersdorf, Germany. A tuberculosis sufferer himself, Brehmer had been inspired by the observations of George Bodington, an English physician who found in his travels to rural areas that those people living in the country were much less prone to tuberculosis than those living in crowded cities and towns. Seeking a healthier climate, Brehmer traveled to the Himalayas where he succeeded in ridding himself of the disease. His great success on his own behalf lead him to establish the Görbersdorf facility, which became the blueprint for the subsequent sanatorium movement throughout the world. In addition to exposing his patients to pure mountain air, Brehmer advocated regular exercise. While the treatment prescribed at the numerous sanatoria was essentially the same, the facilities were widely varied, catering to patients from varying walks of life, from public institutions to exclusive private retreats. The more enlightened American sanitoria were described as follows:

“The majority of patients were in the age group 20-35 years. The basic remedy was “bed rest” in its most stringent form: 24 hours flat. Meals were spooned to each patient by registered nurses, youngsters who looked and felt normal but who had shadows – even small shadows – on their chest X-ray films. All this in an effort to halt the persistent and almost inevitable trend for such small lesions to advance and destroy the patient. The average patient spent more than a full year in bed, many others much more. Careers were abandoned, marriage was discouraged and pregnancy forbidden. Stress in any form and to any degree must be avoided.” (Ryan: p. 27)

Despite efforts to control tuberculosis, more than half the victims of the disease died within five years of its onset. As late as 1930, 90,000 Americans still died from the disease. The first American sanatorium was established by Edward Livingston Trudeau in the Adirondacks at Saranac Lake, New York in 1885. While the success of sanatorium treatments in curing tuberculosis is debatable, it is certain that they had a dramatic effect in isolating the infected from causing further spread of the disease. By that time, there were 600 sanatoria in the United States. By 1922, Massachusetts had five state sanatoria, six county institutions, 20 municipal hospitals that handled tuberculosis patients, 56 clinics, 20 preventoria camps, and 7 private sanatoria. Of these, the Boston Sanatorium was the largest, with 420 beds. Rutland State Sanatorium was the second largest, having 350 beds, followed by the State Sanatorium at Tewksbury, which had 340 beds. Although surgical procedures were also used early on to treat patients, the greatest weapon against the disease proved to be drug therapy. It was not until the 1940s that antibiotics were first successfully used to cure tuberculosis. Over the following 30 years drug therapy and vaccine resulted in a rapid decline in the incidence of the disease. The number of deaths in the United States resulting from tuberculosis dropped from 188 per 100,000 to about 1 per 100,000 by 1980. With the decline of the disease, funding for public health programs was dramatically, curtailed and the sanatoria were either abandoned or put to other uses.

The Trustees and medical staff of the Boston Consumptives Hospital believed, as many did, that sanatorium treatment was only effective for patients in the early stages of the disease. They complained that while sanatoria had success in curing the incipient cases, which represent only about 10 to 15 percent of those infected, it had little impact on the advanced cases. The annual report of 1908 notes that “sanatorium treatment does not touch the root of the evil, namely, the chronic case, or infectious focus.” Given that the Boston Consumptives Hospital was established to care for the advanced cases (incipient cases were referred to the State Sanatorium in Rutland), it is not surprising that they did not embrace the sanatorium treatment as the only method to be used. While they recognized the value of sanatoria for patients in the early stages of the disease, they felt that a hospital setting was most appropriate for treating the advanced cases.

In planning for the new facility, the types of patients to be treated were divided into two classes, those requiring bed treatment (the most seriously advanced or dying patients) and those who were advanced cases but could be up and about during the day. For the first class of patients, the Trustees of the hospital proposed to erect large two-story ward buildings (Wards A, B, and C). The principal goal was to isolate these patients so that the source of infection could be eliminated from the public. The medical staff of the Boston Consumptives Hospital went so far as to promote that sufferers in the advanced stages be “forcibly removed from their homes by the health authorities.” The ward patients were made as comfortable as possible and strenuous efforts were made to stop the spread of the disease by properly disposing of sputum, disinfecting linen, etc.

For patients in the second classification (moderately advanced cases), those not requiring constant bed treatment, a day camp building and open cottages were to be erected. These were patients for whom there was some hope of cure. As with the first class of patients, great emphasis was placed on preventing further spread of the disease. These patients were educated and closely supervised while at the Boston Consumptives Hospital. The day camp was established for those patients who had homes to which they could return in the evenings. The routine for these patients is similar to that of the sanatoria, consisting of “life in the open air throughout the entire day, with an abundance of nourishing food.” An early photograph of the hospital complex shows formal gardens on the property (no longer extant), presumably established for the enjoyment of the more mobile patients. For patients of this second class who were either homeless or whose homes were not suitable to their care, cottage wards were constructed. Patients of the cottage wards were typically ambulatory so they would remain outdoors or on the veranda during

day camp, but they would spend the night at the cottages in the evenings. The hospital Trustees also promoted “careful administration of graduated work” for these and the day camp patients.

By 1908 construction work had begun on the first ward building (Ward A – Map #11, photo #11), the Power House (Map #5, photo #2), and a tunnel connecting the two. In addition, designs were completed for a Day Camp Building (no longer extant), which contained the hospital’s first kitchen and dining room. The former Thompson House was occupied by the hospital superintendent and also served as temporary housing for nurses and the business office. The Conness Cottage was renovated to house members of the hospital staff.

Each floor of Ward A (identical to the later Ward B) was designed with a centralized staff area (kitchen, storage rooms, bathrooms) flanked by two large open wards (14 beds each). At the south end of the buildings, on the first floor, are large open air porches. Connecting Wards A and B is a two-story screened porch that was used by patients who were in or out of beds. What appears to be a solarium on the roof of Ward A (north end) was actually a mattress room “with glass roof and sides” where mattresses were aired out. The room could also be made air-tight by closing doors and louvers so the contents could be disinfected using formaldehyde gas.

The hospital was opened to patients in July of 1908. Plans for the first open air cottage were completed (Cottage Ward/Ward M – Map #9, photo #6) and construction began that same year. The Cottage Ward/Ward M is a small one-story T-shaped building. It has a sitting room centered on the south elevation, flanked by two open wards with 12 beds each. The rear wing was designed with dressing rooms, a bathroom, nurses offices, and storage rooms. A long open porch runs along the south elevation. Ward B (Map #12, photo #11) was completed in 1909 as was the Cottage Hospital (no longer extant). The First Administration Building (later Ward D – Map #13, photo #12) was built in 1912, as was the Children’s Ward (Map #15, photo #14). Prior to that time, young patients were treated in a small area within Ward B but as the number of afflicted children increased it became apparent that a separate ward was warranted. The Children’s Ward is a T-shaped building. On each floor a large sitting room is centered on the south elevation, flanked by two open wards with 12 beds each (boys on the first floor, girls on the second floor). The rear wing of the building was designed to contain a few private rooms, a dining room, school room, lavatories, and storage rooms. There was a playroom in the basement. The Boston School Committee maintained an open-air school (no longer extant) adjacent to the Children’s Ward for a number of years. By 1915 Ward C (Map #14, photo #13) was completed. Similar to the large Wards A and B, Ward C has a long central corridor and a kitchen, storage rooms, bathrooms, and nurses office at the center of the building. Instead of the large open wards, Ward C was designed with

smaller, more private rooms with one to five beds in each. Each floor has an open porch at the southern end. Also by 1915 two wings had been added to the Cottage Ward (Map letters D & F – no longer extant) and the building became known as Ward P (no longer extant). Work had also begun on two additional open wards, Wards N and O (Map letters G & H – no longer extant). These open wards were occupied by patients with moderately advanced cases.

By 1916 there were beds for 400 patients at the hospital. During that year, a total of 1,020 patients were admitted and 380 of those died before being discharged. While this represents a high mortality rate, it is lower than it had been when the hospital first opened (nearly half those admitted died before discharge in 1908). While the number of patients admitted to the hospital gradually decreased from a high in 1916, the mortality rate remained very high for those admitted. Admissions were particularly low in 1918 because the hospital was quarantined for five weeks due to an influenza epidemic, and no patients were admitted during that time. In 1919 685 patients were admitted, 326 of whom died.

In addition to establishing a hospital, the Consumptives Hospital Department set up a clinic to provide outpatient care for those in the early stages of consumption. The outpatient clinic was located in a renovated house on another site, where staggering numbers of patients were treated. As an example, the clinic handled over 10,000 patients in 1916, the year the largest number of patients was admitted to the hospital.

Housing the hospital staff was a constant problem for the trustees. In 1916 they were forced to rent a house off-site to help ease overcrowding on the hospital grounds. Particularly pressing was the need for a nurses home. The hospital Superintendent was continually requesting construction of an on-site residence for nurses but after the completion of Ward O in 1918 no new construction was undertaken for 10 years.

In 1921 the name of the facility was changed from the Boston Consumptives Hospital to the Boston Sanatorium. It is not known why this occurred, but after 1916 the number of patients being admitted to the hospital gradually decreased. It may be that the number of advanced cases was decreasing, and sanatorium rather than hospital treatment may have become more appropriate for the population at the site, but this is just speculation. In 1927 the Boston Sanatorium, formerly under the supervision of a Board of Trustees, became the Sanatorium Division of the Boston Hospital Department, supervised by the Trustees of Boston City Hospital. This change appears to have been the result of the State Sanatorium being closed to Boston cases. The new administrators undertook an extensive study of the operations and conditions at the Mattapan site and made sweeping recommendations to improve the quality of care and the physical plant. The recommendations included construction of a large new

administration building, a nurses home, additional modern wards, a large kitchen/dining facility, a recreation building, and expansion of the Power Plant. Eight new buildings were constructed in the relatively short span between 1929 and 1933, following designs of architect James H. Ritchie. It appears that Ritchie was responsible for the design of all the buildings constructed at the Boston Sanatorium between 1929 and 1935. Ritchie’s firm is well known for their institutional, ecclesiastic, and municipal buildings. The firm, which is still in operation, designed numerous buildings of these types throughout Massachusetts in the first half of the 20th century. Among their Massachusetts work are the Male Dormitory at the Metropolitan State Hospital (Waltham), Wrentham State School (Wrentham), Middlesex District Courthouse (Newton), and Cable Memorial Hospital (Ipswich).

Four major buildings were constructed in 1929, the Administration Building (Map #2, photo #1), Nurses Home (Map #3, photo #2), Women’s Open Air Ward (Map #10, photo #7), and Men’s Open Air Ward (Map #16, photo #5). The Women’s and Men’s Open Air Wards are virtually identical. These two-story buildings were designed with two large open wards (11 beds each) flanking a central nurses station at each floor. A small rear ell contained kitchens and storage rooms. Also in 1929, the Children’s Ward was renovated for use by female adult patients. In 1930 the large Kitchen/Dining Building (Map #7, photo #9) was constructed and the addition to the Power House was completed. The following year the Recreation Building (Map #8, photo #8) and the Garage (Map #4, photo #3) were erected. It appears that the final building to be constructed for the Boston Sanatorium was the Doctors Residence (built between 1930 and 1933 – Map #17).

The Boston Sanatorium remained in use, with the treatment of tuberculosis as its primary function, through the mid 20th-century. As the number of tuberculosis cases decreased, the focus of treatment shifted toward mental health and, later, rehabilitation. Most of the care presently undertaken on the site is in the Administration Building, known as the Boston Specialty Rehabilitation Hospital. The Nurses Home houses a short-term addiction rehabilitation program, while the former Doctors Residence is currently used for the Boston Police Stress Program. The ward buildings have been vacant for some time.

Plans are underway to renovate the vacant buildings as Certified Rehabilitations. The Administration Building and Women’s Open Air Ward will also be rehabilitated.

For a pdf of the full National Register nomination, see