A History of Barts, Britain's Oldest Hospital

A History of Bart’s – Britain’s Oldest Hospital

Professor Charles Knight OBE

4th May 2023

Introduction

I am delighted to be here tonight as Chief Executive of St Bartholomew’s Hospital in the City of London to share with you some of its extraordinary history as part of our celebrations of the hospital’s 900th anniversary this year.

St Bartholomew’s, or Bart’s as the hospital has been commonly and affectionately called, has provided continuous patient care, free at the point of delivery on the same site for 900 years - longer than any other hospital in England.

To set this in context, when it was founded in 1123, the Domesday book had only recently been compiled and there were people still living who were born before the Battle of Hastings in 1066. The founding of the hospital predates the British parliament by just over a century. One of our first recorded patients, Alfuine, was admitted here from Suffolk and was cured of his paralysis. The town he came from, Dunwich, now lies under the North Sea.

Our journey will take us from the hospital’s foundation over nine centuries to the present day, stopping on the way to explore key events and developments, and to reflect on those individuals that have contributed to its unique history.

Barts means many things to many people and, whilst a hospital in the heart of the City of London, its reach has extended nationally and internationally through to its contributions to the fields of medicine, education and nursing. The hospital’s loyal supporters and benefactors over the centuries are testament to its significance and place in history.

The hospital’s story is one of adaptability, survival and vision which have enabled it to flourish and to faithfully serve London and its diverse communities. From foundation to dissolution, re-foundation and rebuilding and the birth of medical science and education, the hospital and its people have not stood still.

Foundation - 1123

As many of you may know, the hospital was founded by Rahere, often referred to as a jester in the court of Henry I, but a man that was ambitious and determined to make his way in the court. Indeed, the Rahere that is described in the ‘Book of the Foundation of St Bartholomew’s’ does not immediately appear as a particularly likely or promising candidate to become a champion of the poor and sick:

“he drew to friendship with himself those whom he had soothed with jokes and flatterings” and responded to the goings-on of the court “with jocular flattery desired to attract to himself with ease the hearts of many. There he made it his business all day long to attend spectacles, banquets, jests and the rest of the trifles of the court”.

All this was set to change - during a pilgrimage to Rome, Rahere fell ill, probably from malaria, and, believing he was dying, vowed to “erect a hospital for the restoration of poor men and, as far as he could, would minister to the necessities of the poor gathered together in that place”.

On his return journey to England, he had a vision of St Bartholomew who advised that he had chosen the site of Smithfield in London and also instructed him to build a church:

“Know me truly to have chosen a place in the suburbs of London at Smoothfield, where in my name thou shalt found a church and hospital…Wherefore do thou boldly – neither at the cost of the building doubt thee not. Direct, Build and End this Work”.

The challenges were significant – the chosen site was marshy and the land that was above water was used for executing thieves and carrying out other punishments.

The building took about 10 years to complete and Rahere was to run the hospital for 20 years until his death in c. 1143 when he was buried in the church of St Bartholomew the Great.

Independence and Early Years

Following Rahere’s death, the leadership of the Hospital and Priory was separated between Hagno the Clerk and Thomas of Osyth. The hospital remained, however, under the control of the Priory.

There followed a period of conflict over control of appointments and donations but from about 1200 the hospital had its own seal and was increasingly independent. Papal confirmation of independence for the hospital was finally granted in 1453. Henceforth, the hospital was to be led by a Master.

Written records have survived from the early years of the hospital and these are now kept in the Trust’s archives which include over 15,000 catalogued items for St Bartholomew’s alone. The earliest document is a grant dated 1137 which not only mentions Rahere by name but would also have been sealed in his presence.

John Cok’s Cartulary of the hospital from the early 15th century compiled the hospital’s important documents and also includes one of the first uses of its distinctive black and white shield.

In the early medieval period, the sick were cared for by eight brethren and sisters of the priory who took vows for life – the nursing title ‘sister’ dates from religious hospitals of this time. Income came from charitable donations and the rent from property given to the hospital.

In the early years, rest and food were more likely to be given than medical treatment. Indeed, many of the cures detailed in the Book of the Foundation are attributed to prayers and to St Bartholomew himself rather than to medicine. It is probable, however, that herbal and other traditional remedies would have been used.

The writings of John Mirfeld, a resident of the Priory, demonstrate that by the late 14th century, treatments based on medical doctrines were known and some may also have been introduced in the hospital. Mirfeld documented diagnoses, therapies and remedies which were copied from the standard medical authorities of the day, mainly classical and Arabic. These also included cures based on folklore and magic which were integral components of medieval medicine.

More bizarre theories and practices were also detailed - special baths were recorded as having importance and one method reportedly being to boil dead puppies and allow the patient to bathe in the water.

There are no records of surgery in the medieval hospital and, if these were carried out, it would have been rare and minimal.

We are all grateful, I’m sure, for the progress that has been made since.

John Wakeryng was Master between 1423 and 1462 and was able to increase and better manage the hospital’s properties. He even managed to obtain the 100s left by Dick Whittington from his executors for relief of the poor, spending the money on a new south gatehouse and secured water pipes from Islington. He also opened a school in the hospital precincts and attracted a number of highly educated tenants.

Dissolution and Re-foundation

The dissolution of the monasteries by Henry VIII had significant impact on hospitals throughout the country, a large number of which were closely associated with religious institutions.

In 1538 the Lord Mayor of London, Sir Richard Gresham, petitioned Henry VIII to request that the City take over the running of London’s hospitals. It was Sir Richard’s son, Sir Thomas Gresham, who founded Gresham College.

For St Bartholomew’s Hospital, the closure of the Priory in 1539 and the seizure of its property, along with that of the hospital, was a significant threat. Despite being regarded as a religious foundation, the hospital was permitted to continue its work but, without income from its property, the future was unclear. And being valued at £371, the third wealthiest hospital, also made the hospital vulnerable.

The hospital was re-founded in 1544 but without funds. The situation deteriorated and at one point in the 1540s the hospital was running short of bed sheets.

Fear of the impact from reduced provision for the sick poor and of the possibility of a plague outbreak, led the citizens of London to ask the Lord Mayor to petition Henry VIII to grant four hospitals in the City, including Barts. Two documents were subsequently issued – the first granted the hospital to the City of London in December 1546 and the other, Letters Patent of January 1547, endowed it with properties and income.

All in the nick of time as the King died just a fortnight later on 28th January 1547. Finally, the hospital, along with Bethlem, St Thomas’ and Bridewell, became one of the four Royal hospitals managed by the City.  

The New Administration

The Re-foundation Charter set out precisely how the hospital was to be run, the type and number of staff and their respective wages and the number of patients. A forerunner perhaps of current NHS business planning.

The Mayor, Commonalty and citizens of the City of London were charged overall with funding the hospital which would provide care for 100 men and women.

A governing body with 12 governors was set up to administer the hospital and there were paid officials including a Renter-clerk, a steward, a porter, butler and eight Beadles. Nursing staff comprised one Matron and twelve nursing sisters and there were also three surgeons. There had also been originally been provision for a physician but the first person was not appointed to this role until 1562. A priest called a Hospitaler was also to be appointed.

By 1600, the hospital cost £3,000 per annum to run but owned 100,000 acres and so was one of the richest landowners in England. Buildings were repaired and advanced care and treatment given for the period

The constitution and governance arrangements that were set in place did not alter until the creation of the National Health Service in 1948. We continue to this day the annual tradition dating from this period of holding a View Day when the Lord Mayor and leading dignitaries from the City would inspect the hospital.

The Start of Formal Modern Medicine

We also owe the effective formalization of the requirement for trained medical staff to the provision made in the 1547 Charter.

Thomas Vicary was the first superintendent of the hospital. He was also the Serjeant-surgeon to Henry VIII, Edward VI, Mary I and Elizabeth I. Shortly after he wrote the earliest known English textbook of anatomy “A Treasure for Englishmeen, containing the Anatomie of Man’s body”

From the mid-16th century, there were normally three surgeons working in the hospital. Whilst they were supposed to be paid £20 per annum, in practice they received smaller sums plus separate payments for treating particular cases and dressing wounds and sores. Specialist bone-setters and cutters of wens (tumours) were also employed.

One of the earliest references to an operation at Barts is recorded in the hospital’s ledger for 1547 where a surgeon, Martyn, was paid 10 shillings for removing a bladder stone.

John Caius was a renowned physician (1510 - 73) who lectured at the hospital each week on anatomy and Timothie Bright was a physician at Barts from 1584 to 1591 and wrote “A Treatise on Melancholie’ in 1586, the first psychiatric text to be published in England

Surgeons at this time, and for several centuries to come, were trained by apprenticeship. Of particular note is that they were regarded as of a lesser status to the hospital’s physicians and not permitted to give internal medicine. Rules drawn up by William Harvey in 1633 show that the surgeons could not operate without his permission.

Nevertheless, some of the early surgeons at Barts were regarded as skilled practitioners and highly distinguished in their day. William Clowes, surgeon from 1576 to 1585, wrote a number of books which became standard works of the period and have been described as some of the best surgical writings of the Elizabethan Age.

William Harvey

The most significant physician from this earlier period in the hospital’s history was undoubtedly William Harvey, whose discovery of the circulation of the blood is still regarded as one of the most significant advances in the history of medicine. Based on his observations and experiments, Harvey’s work provided a model for later medical science and also helped to establish Barts’ reputation.

Physician between 1609 and 1643, this was Harvey’s hospital.

An extract from the minutes of the Governors of St Bartholomew’s Hospital 15 October 1633 details Harvey’s rules:

Patients

• Only curable patients
• Limited length of stay
• Discharged if refused to take their medication
• That none lurke here for reliefe only or for slight causes
• That all such as are certified by the doctor uncurable & scandalous or infeccous shal be putt out of the said howse or to be sent to an out-howse

Surgeons

• Should not admit patients they do not want to treat
• Must confer with the Physician on difficult cases
• Must not operate without the Physician’s approval
• Must not give drugs without the Physician’s approval
• Must supervise their apprentices
• Must attend the weekly consultation with the Physician (along with the apothecaries, matron and sisters

Harvey was a formidable character and is described as sitting in the Great Hall once a week, in his purple cap and robes as patients were brought to him:

“the arthritic, the apoplectic, the paralysed, the pox-ridden, the jaundiced and the syphilitic’ were brought up one by one by the sisters, sometimes on stretchers”.

Following examination of both pulse and urine, Harvey would instruct the attending apothecaries as to the prescription for medical cases. For surgical cases, he would call one of the surgeons and provide detailed orders as to how to proceed.

When a patient was deemed well enough to be discharged, he was presented, kneeling to the physician in the Great Hall and waited for Harvey to pronounce him cured. The patient then gave praise to God and to the hospitals staff. For discharge, money, clothes and a passport were provided.

18th Century Re-building

The hospital was fortunate to have avoided damage from the Great Fire of London of 1666 when so many buildings were destroyed in the City, although it did lose many estates properties which impacted on income in subsequent years. However, by the beginning of the 18th century, most of the hospital buildings were in a poor condition and overcrowded, unable to cope with the increasing number of patients. Whilst London’s population had increased significantly by this period, this had not been matched by an increase in the number of hospitals.

In 1723 the Governors decided to build a completely new hospital. James Gibbs, a governor of the hospital and a renowned architect, prepared a plan which was approved in 1729 and work began the following year.

The design included four standalone buildings located around a central square which aimed at ensuring resistance to both fire and disease. The East, West and South Wings contained wards and accommodation for 504 patients in total. The basic layout of the wards did not change until the beginning of the 19th century and were light and airy, each with a big open fireplace and well-spaced beds.

The North Wing was built first which was only for administrative/hospital business purposes. It also provided accommodation for the Clerk, the hospital’s chief official. There was a room for the admission and discharge of patients and the famous Great Hall was designed to be used for meetings and banquets of the hospital governors. The walls record the names of all the major benefactors to the hospital going back to 1547, a practice which continued up to 1905. The Great Hall has hardly changed since it was finished in 1737.

Designed to impress, the staircase leading to the Great Hall has two huge paintings by William Hogarth. These depict the parable of the Good Samaritan and Christ at the Pool of Bethesda and aimed to emphasise the work of the hospital in caring for the sick and injured.

William Hogarth had been born close by in Bartholomew Close and baptised in the church of St Bartholomew the Great. When Hogarth heard that the governors had considered a Venetian artist, Jacopo Amigoni, to paint the staircase, Hogarth offered his own services free of charge.

It is assumed that Hogarth used patients from the hospital as his models for the people around the Pool of Bethesda and using the depicted diseases as teaching aids was a tradition in the past.

There were delays to construction due to problems with the supply of Bath stone which subsequently crumbled so much in the London air that it was replaced by Portland stone. The last wing to be built, the East wing, was stopped in 1760 as the hospital treasurer, John Tuff, had siphoned off the funds to support his lifestyle and absconded to France. Nevertheless, all four wings were complete by 1769. The famous Fountain in the hospital’s square was added in 1859.

The hospital gates were the sales point for ‘King of the quacks, William Salmon. A brilliant self-publicist, Salmon sold an ‘elixir of life’ and ‘anti-nymphomaniac lemonade’ to patients and passers-by.

Barbara Adams worked for over a decade as Barts’ first barber. She earned 27 pounds and 18 shillings a year ‘shaving patients by order of the surgeons’. In 1761 Barbara lost her job due to ‘improper conduct on diverse occasions’.

Sisters Mary and Ann Hogarth ran a dress-making business on Long Walk, facing the hospital cloisters. The Hogarth family were baptised in St Bartholomew the Great and Mary and Ann’s enterprising older brother William designed the sisters’ trade card.

Jonathan Strong - 1765

We are also proud to have given refuge to the enslaved and injured Jonathan Strong for four months – a cause celebre that Granville Sharp used to advance the cause of abolition. Strong’s case was the first of a series of legal battles which ultimately proved that slavery was not legal in England.

“I could hardly walk, or see my way, where I was going. When I came to (Granville Sharp) and he saw me in that condition, the gentleman take charity of me…

He sent me to (St Bartholomew’s) hospital: and I was there four months and a half. All the while I was in the hospital the gentleman find me clothes, shoes and stockings and when I come out, he paid for my lodgings, and a money to find myself some necessaries” Jonathan Strong 1765

The tower of the Church of St Bartholomew the Less is now the only medieval building left at the hospital. The Less was previously a chapel of the Priory but, on the re-foundation of the hospital, became a parish for the hospital’s staff and patients with its own Hospitaler. In 2015 the parish joined with the parish of St Bartholomew the Great to form the parish of Great St Bartholomew. Bart’s is unique amongst English hospitals in being a parish in its own right.

The hospital is also famous for its Henry VIII Gate which used to be the main entrance to the hospital from West Smithfield. Dating from 1702, this contains the only statue of the king left in London.

Percivall Pott who is generally regarded as one of the two greatest surgeons of the 18th century, served his apprenticeship with Edward Nourse, assistant surgeon at the hospital, and was admitted to the Barbers’ Company in 1736. He became assistant surgeon at the hospital in 1744 and full surgeon from 1749 to 1787.

Pott had a wide and long lasting influence on medicine and modern understanding of disease. He introduced important procedural innovations and a number of conditions still bear his name including Pott’s disease of the spine and, Potts fracture of the ankle.

Pott also found a link between exposure to soot and a high incidence of scrotal cancer in chimney sweeps which was effectively the first link between occupational work and cancer. This work helped lead to the Chimney Sweepers Act of 1788

Pott was also a firm believer in patient education and distributed a range of pamphlets on a range of conditions. A man ahead of his time. Links with the hospital did not end with retirement as Pott became a governor on retirement in 1787.

Villains

We have also had our share of villains – one of our first physicians, Dr Rodrigo Lopez, met an undistinguished end when he was hung, drawn and quartered for allegedly attempting to poison Queen Elizabeth I whom he had served as physician-in-chief for over 20 years. It is now thought likely, however, that the case was false.

Dr William Palmer, the Victorian “Prince of Poisoners” was also a Barts alumnus. As he stepped onto the gallows, Palmer is said to have looked at the trapdoor and asked “Are you sure it’s safe?”

The Establishment of the Medical College 1822

Although there had previously been medical students at St Bartholomew’s, there was no formal medical school until 1822 when John Abernethy, a hospital surgeon and lecturer, persuaded the hospital governors to give the school formal recognition.

Born in the City of London, John Abernethy was apprenticed in 1779 to a surgeon at the hospital and attended lectures by Percivall Pott. Abernethy became assistant surgeon in 1787 and began to give lectures at his home in Bartholomew Close in the early 1800s which supported his case for a medical school and lecture theatre.

Abernethy was principal surgeon from 1815 until retirement in 1827. Abernethy is also well known for his ‘Surgical Observations on the Constitutional Origin and Treatment of Local Disease’, one of the earliest popular works on medical science.

Known for his brusqueness, the acerbic workaholic who was on the wards on his wedding day, once told a well cushioned duchess that she didn’t need a doctor, she needed a skipping rope. And a rubicund city worthy who enquired about a cure for gout was told he should “live on sixpence a day and earn it”. Patients deemed to be hypochondriacs were directed to a certain Doctor Robertson of Inverness – who did not exist.

Abernethy also believed was that diseases were often caused by issues with the digestive organs and is credited with the creation of the Abernethy digestive biscuit.

The Barts Medical school soon became the largest medical school in London.

St Bartholomew’s Nurses

Early nurses were untrained and responsible for cleaning and other manual work and it wasn’t until the 19th century that the beginnings of more skilled nursing were introduced. The first ‘probationers’ or student nurses, started in 1877 when a School of Nursing was founded.

Ethel Bedford Fenwick, née Gordon Manson, was a Barts matron, appointed in 1881 when only 24, who played a major role in the history of nursing in the UK. She encouraged a high standard of training and campaigned for the state registration of nurses. The campaign was achieved in 1919 when the Nurses Registration Act was passed and Ethel Bedford Fenwick is ‘Nurse No. 1” on the register.

Ethel Bedford Fenwick also founded the Royal British Nurses’ association in 1887 and was instrumental in founding the Florence Nightingale International Foundation of which she was president for the first five years. Ethel was in post until 1887 when she married - nurses had to leave the profession on marriage right up until the 1950s.

Ethel was followed by Isla Stewart who also campaigned tirelessly for the registration of nurses. Isla also developed and advanced further the training programme for nurses which became four years in duration, also co-publishing a ‘Practical Nursing’ guide in 1899. Isla founded the Barts League of Nurses in 1899, which is the oldest league of nurses in the UK, and was one of the founding members of the International Council of Nurses, the first international organization for professional women.

Isla Stewart stated that:

“A nurse’s position towards the world is that of a woman wishing for independence, willing by her own hands to obtain it and maintain it, and to have a profession…owing no man anything”

Other notable contributions to the field of nursing included the formation at Barts in 1894 of the Matron’s Council, one of the earliest professional nursing bodies.

The first degree course nursing students at Bart’s started in 1968.

Changes 1800 – 1948

The 19th century saw many medical advances which transformed health care. Barts was one of the first hospitals to encourage the use of anaesthetics which led to an increase in different types of surgery. X-rays were first used in the hospital in 1896 and by the end of the century, the first specialised department had been created.

In 1819, it was recorded that 93,300 leeches were used from a huge aquarium in the dispensary at a cost of 7s/100. A wooden head in our museum shows that trephining was carried out.

In contrast, by 1863, there were 417 operations per annum. This increased to 2,446 by 1899. There were 672 beds in 1872 and 101,000 outpatients per annum. Mortality was halved and anaesthesia and asepsis routine practice.

Sir James Paget a surgeon and pathologist both studied and worked at St Bartholomew’s, discovering the pathogen for trichinosis as a medical student.

Due to poverty, Paget funded himself by writing for medical journals and preparing the catalogues of the hospital museum and of the pathological museum of the Royal College of Surgeons. As early as 1836 he was made curator of the St Bartholomew’s pathology museum.

In 1843 Paget became lecturer on general anatomy and physiology and warden of the hospital college, responsible for students for a number of years and his physiological lectures contributed to the success of the medical school.

Paget is widely regarded as one of the founders of scientific medical pathology, particularly due to his emphasis on the use of the microscope, and is remembered for naming Paget’s disease, as well as his publications, ‘Lectures on Tumours’ and ‘Lectures on Surgical Pathology”.

Sir Thomas Lauder Brunton is a less well-known physician that worked at St Bartholomew’s but one that deserves a particular mention due to his use of amyl nitrate in the late 19th century to treat angina. I would be keen to know his thoughts on the hospital’s heart centre today.

By the early 20th century, the most senior doctors were still generalists and expected to have a wide and general knowledge of most conditions. They were also unpaid, except for an honorarium of 50 guineas a year which results in physicians and surgeons earning their living through teaching and private practice.

However, the beginnings of specialization were emerging. Opthalmology was one of the first specialist departments at Barts and two eye surgeons were appointed in 1870. The system of ‘firms’ or medical/surgical teams was well established by 1900, each having their own wards. A firm was made up of a surgeon or physician, a deputy, house officers each service for a year and medical students attached as dressers or clinical clerks. Throughout the 20th century more new departments were added, each with their own wards or allocation of beds and outpatient clinics.

In the 20th century, five new theatres were created in a new surgical block (King George V), which replaced the original Gibbs’ South block and opened in 1930 with state of the art facilities.

In 1936 Barts became the first hospital in the country to offer mega-voltage radiotherapy for cancer patients. Other medical specialities included endocrinology and immunology.

Lucy May (Maisie Holt) was a medical psychologist at Barts and is celebrated for initiating the first effective treatment for dyslexia.

From the NHS to ‘Save Bart’s, 1948 – 1990’s

In 1948 St Bartholomew’s became part of the NHS, a significant change from a charitable to a state institution. Following re-organisation in 1974, it became the teaching hospital for the new City and Hackney Health District.

By the 1980s, there were major specialities in cardiology, cardio-thoracic surgery, endocrinology, paediatric oncology and medical oncology.

In 1991, a day surgery centre opened, reflecting developments towards minimally invasive surgery and improvements in anaesthetics. When the John Abernethy suite opened in 1993, it contained the most technically advances operating theatres in Europe.

However, the publication of Sir Bernard Tomlinson’s Report of the Inquiry into the London Health services in 1992 challenged the future of the hospital and recommended its closure. Three possible options were then proposed for Bart’s including closure, retention as a small specialist hospital or merger with the Royal London Hospital and the London Chest hospital. There followed huge public debate and a campaign in which over one million people signed a petition to save the hospital.

Derek Jarman, who would later die at Barts in February 1994 wrote in the Independent newspaper on 4 May 1983:

“Sir: I have been here now for two weeks…I escape to the 18th-century courtyard and read in the pavilion to the sound of the fountain, before retiring to the hospital church of Saint Bartholomew, which itself is cool and filled with the peace of time…Without our past our future cannot be reflected, the past is our mirror. Every profession has a history and the medical profession’s starts here…To shut Barts would be a crime against the past and against the metropolis which needs its great institutions and would be impoverished without them…Barts is my second home and my life here is cherished”

In April 1994, the third option was the winner from public consultation and the three hospitals merged to form the Royal Hospitals NHS Trust. In 1996 the Queen Elizabeth Hospital for Children joined the Trust. In the same year, the Medical Colleges of St Bartholomew’s Hospital and the Royal London Hospital merged with Queen Mary and Westfield College and, as the Barts and the London School of Medicine and Dentistry, became part of the Queen Mary University of London.

In 1999, the Royal Hospitals NHS Trust was renamed Barts and the London NHS Trust and, when Whipps Cross and Newham University hospitals joined in 2012, the new Trust became known as Barts Health NHS Trust.

Barts was saved but a threat to its future remained as approval of the £1bn private finance redevelopment was awaited. After many revisions, the works began at Barts in 2010 and the Barts Heart Centre and new King George V wing opened in 2015.

Today

Today, in addition to James Gibbs’ beautiful Grade I listed buildings, Bart’s has a state-of-the art building and some truly world-leading clinicians, academics and departments. We have evolved from a general to a specialist hospital and are the UK’s largest cardiac centre and London’s second largest cancer centre. We also have world-renowned endocrinology and respiratory departments.

We have more than 2,500 staff including 700 doctors, more than 600 beds, including 55 for intensive care, the UK’s largest ECHO and cardiac computerised tomography (CT) and the world’s largest cardiovascular magnetic resonance (CMR) service. As part of Barts Health NHS Trust, we serve a population of 2.5m in east London and beyond. Bart’s continues to lead cardiac and cancer research.

We have come a long way, surviving threats to our existence, war, periods of greatness and decline and huge advances in medical care and research. Our ability to recognize and adapt to the issue of the day, the support we have so generously received and our people have enabled the hospital to flourish.

To commemorate our 900th anniversary, Barts Health NHS Trust is working in partnership with Barts Charity, Barts Heritage, St Bartholomew the Great Church, QMUL and the City of London Corporation to establish landmark projects that span medicine, research, education, heritage and wellbeing for NHS staff. These include a new breast cancer centre at St Bartholomew’s Hospital and a new Clinical Research Facility at the Royal London Hospital. Barts Heritage will renovate historic buildings at the heart of Bart’s, including the North Wing so that the buildings can be brought back into public use and host wellbeing facilities for NHS staff.

Whilst we naturally celebrate the beauty of our buildings and honour the memory of our celebrated predecessors, the most inspiring part of this long story is the kindness, care and compassion of our staff who continue to deliver Rahere’s founding vision of service and healing. We are looking forward to providing healthcare free at the point of delivery for the next 900 years.

Barts in Plague and Pandemic

Bart’s has withstood and responded to a range of infectious disease that threatened the health of Londoners.

The Great Plague of 1665 saw the introduction of social isolation. At its peak, 7,000 deaths were reported per week. Three successive beadles and the surgeon to the hospital died. Zoning was instituted – surgeons were appointed to look after ‘those with pestilence’ while other surgeons were deputed to ‘be excused from special charge sheets of plague patients’. The latter group, unlike the former, were not offered a special regard by the governors at the end of the year. Barts physicians fled the City but care was given by the apothecary Francis Bernard and matron Margaret Blague, assisted by 15 nurses ‘to the great peril of her life’.

Throughout the 19th century, there were repeated influenza outbreaks, often referred to as the “Russian pestilence”. An observer in 1891 noted that arriving at St Bartholomew’s hospital in the morning to find “more than 1,000 patients clamouring for treatment”. It was noted that “male patients were so alarmed that they took themselves to hospital immediately”

The influenza epidemic of 1916-19 led to an estimated death toll world-wide of 50-100 million and was particularly virulent in children. St Bartholomew’s very own doctor and Poet Laureate, Robert Bridges, wrote one of his most moving poems ‘On a dead child’. This epidemic had significant impact on hospital staff, especially nurses.

Again in 2020, with the advent of coronavirus, Bart’s played its role as part of Barts Health NHS Trust’s response to the pandemic, serving as the cardiac surgery hub for London. Over 200 operations were carried out with no Covid infection. In early April 2020 there were 93 Covid admissions plus 13 to ICU to Barts Health in a single day. There were only two deaths from hospital acquired Covid at Barts during this time. The hospital also doubled its ICU and ECMO capacity. Hundreds of staff were redeployed and research studies were initiated at pace. I also became CEO to the Nightingale hospital, a large dedicated facility which was set up and equipped in just nine days in April 2020.

© Professor Charles Knight OBE 2023

References and Further Reading

St Bartholomew’s Hospital museum – located in the North Wing on the St Bartholomew’s hospital site provides a wealth of information about the hospital’s history, with surgical instruments, drug bottles, apothecary tools, sculpture, art and archives including the 1947 Charter. The museum will close temporarily to the public during the North Wing restoration from Friday 2 September 2023.

A special 900th exhibition detailing the hospital’s history and featuring newly researched stories, including some of those included in this lecture, will be on display in the City of London’s Guildhall Yard from 10th May to 6 June 2023. This will then move to Aldgate square from 7 June to 5 July and finally to St Bartholomew’s Hospital between 6 July and 1 August 2023.

Webb, E.A. The Book of the Foundation of St Bartholomew’s Smithfield

A new History “St Bartholomew’s Hospital 900 years” Edited by Ann Robey published on 02/05/23