Due to the need in the mid 1800's for a hospital to care for the sick poor, the city initiated plans for the construction of a city hospital. Chapter 113 of the Acts of 1858 established a City Hospital. Construction began in 1861 and the Boston City Hospital opened on June 1, 1864. The Hospital was under the charge of a Board of Trustees. Over time, besides the main hospital, the Trustees had charge of the South Department for contagious diseases, the Sanatorium Division at 249 River Street, Mattapan (for tuberculosis patients), Long Island Division (for chronic diseases) and East Boston Relief Station. Relief Stations were closed to patients on March 15, 1938; East Boston Relief Station was reopened on a twenty-four hour basis on October 15, 1945. The trustees were initially incorporated by Chapter 174 of the Acts of 1880 and authorized to receive and hold real and personal estate bequeathed or devised to said corporation to an amount not exceeding $1,000,000. By the 1950s, the trustees were authorized to receive and hold real and personal estate bequeathed or devised to said hospital corporation to an amount not exceeding $10,000,000. The Hospital Department and the Health Department were merged as the Health and Hospitals Department by Chapter 656 of the Acts of 1965. The Board of Health and Hospitals by this same statute was incorporated as the Board of Trustees of Health and Hospitals.
From 1970 through the early 1990s, great effort was made to reorganize and modernize Boston City Hospital's physical plant, including building a new Boston City Hospital. However, in 1996, the Mayor's Special Commission on Health Care was formed to study the challenges of health care provision and administration in the twenty-first century and the Commission recommended that the Department of Health and Hospitals merge with Boston University Medical Center. The consolidation of the Department of Health and Hospitals and the Boston University Medical Center created the Boston Medical Center, which subsumed the former Boston City Hospital.