Bart’s Hospital

St Bartholomew’s was refounded in the reign of Henry VIII. Courtney Dainton describes how, for nearly two centuries, it was one of only two major hospitals in England for the care of the general sick.

'Barts in Medieval Times'. Wellcome Collection.

Henry VIII’s statutes for the suppression of religious houses brought about the disappearance of many hospitals, for most of them were closely associated with the monasteries; and a desperate situation was created, particularly in London.

Some of the leading citizens persuaded the Lord Mayor to submit a petition to the King for the refoundation of St. Bartholomew’s and St. Thomas’s Hospitals, which were among those that had ceased to function. Henry authorized the refoundation of St. Bartholomew’s, and Edward VI instructed the citizens to repair St. Thomas’s. For nearly two centuries after their refoundation these two hospitals were the only important ones for the general sick in the whole of England.

It is not until after the refoundation of St. Bartholomew’s that we find any record of trained medical men on the staff. Three surgeons were appointed in 1549 and a physician in 1568. Some years later there were four surgeons and four physicians, and these numbers remained unchanged until 1895, although there were also assistant surgeons and assistant physicians.

One of the first surgeons appointed at the hospital was Thomas Vicary. In 1548 he wrote a book called A Treasure for Englishmen, containing the Anatomie of Man’s Body - the earliest English textbook of anatomy. Vicary was the first Master of the newly-formed Barber-Surgeons’ Company. Until 1540 there was often trouble between the surgeons, most of whom had received a fairly good education and training, and the barbers, who acted as the general practitioners of the time, drawing teeth and carrying out minor surgery.

When they became united in one company, the barbers agreed to restrict their surgery to dentistry, and the surgeons undertook to cease to practise as barbers. By an Act of Parliament the new company was allowed to fine unlicensed practitioners in London and to have the bodies of four executed criminals each year for dissection.

The company aimed to raise the status of surgery; to this end lectures and demonstrations were arranged which all members had to attend. The surgeons were forbidden to administer medicines for internal disorders; this was the province of the physicians, who were not allowed to carry out operations, even such simple ones as blood-letting.

Nevertheless, there were many who practised medicine without any qualifications or training whatsoever. Their victims were often later taken to hospitals, in the hope that the physicians and surgeons there could undo the work of the quacks. Thomas Gale, who was Serjeant-Surgeon to Queen Elizabeth I, has left an account of what happened:

‘In the year 1562 I did see in the two hospitals in London called St. Thomas’ Hospital and St. Bartholomew’s Hospital to the number three hundred and odd poor people that were diseased of sore legs, sore arms, feet and hands, with other parts of the body, so sore infected that a hundred and twenty of them could never be recovered without loss of a leg or of an arm, a foot or a hand, fingers or toes, or else their limbs crooked so that they were either maimed or else undone for ever.

All these were brought to this mischief by witches, by women, by counterfeit rogues that take upon them to use the art, not only of robbing them of their money but of their limbs and perpetual health.

And I, with certain others, diligently examining these poor people, how they came by their grievous hurts and who were their chirurgeons that looked unto them and they confessed that they were either witches, which did promise by charms to make them whole, or else some women which would make them whole with herbs and suchlike things, or else some vagabond rascal which runneth from one country to another promising unto them health only to deceive them of their money.’

Once a week all the doctors at St. Bartholomew’s made a tour of the wards together, led by the physician and the surgeon who had examined the new patients on the preceding admission day. They were accompanied by members of the staff carrying the ward books, in which the names of all the patients were written. The physicians sat down in each ward, and the patients were brought to them. After each one had been examined, the treatment for him was written in the book.

When all the patients in the ward had been dealt with, the book was taken to the apothecary and, unless they were too ill to do so, the patients had to go to him and collect their medicine. It seems that the physicians were regarded as far superior to the surgeons, for the apothecary was not allowed to make up any medicine for them unless the prescription was countersigned by a physician.

There is one description of an amputation carried out at the hospital by John Woodall, a surgeon who lived from 1569 to 1643. He wrote:

‘The patient was a certain poor maid or woman servant in London, named Ellen French, of whom there were made books and ballads, that were sung about the streets of her, namely, that whereas the said maid or servant was given to pilfering, and being accused thereof by her master and mistress, used to curse and swear and with words of execration to wish, that if she had committed the crime she stood accused of, that then her legs and hands might rot off, the which thing accordingly, no doubt by the providence of God, came to pass, as a judgment upon her, namely that both her legs almost to the gartering place, with parts of seven of her fingers, did rot off, the which wretched woman nevertheless, being referred to me in Saint Bartholomew’s Hospital to be cured, by God’s mercy and permission, I healed her perfectly, by cutting off both her sphacelated (i.e. gangrenous) legs in the mortified parts with also parts of her seven fingers, as is said, all in one morning without pain, terror or any loss of blood unto her, in the taking them off, and made her per-fectiy whole in a very short time, namely within three months, so merciful is God unto us vile creatures, when we are most unworthy of such of his mercies.’

The same surgeon gave the following instructions for an amputation, in his book The Surgeon’s Mate, published in 1639:

‘The amputation once resolved upon and all things ready for the work, let the Surgeon with all his assistances and friends not forget before the beginning of the work heartily to call upon God for a blessing upon their endeavours, and let the patient the day before have notice given him that he may also take time to prepare himself with true resolution of soul and body to undergo the work, as being never performed without danger of death, which done, then let the Surgeon prepare himself also with his helpers, namely at the least five persons beside himself, as for example, one to sit behind the patient to hold him, a second for a holder, who by the surgeon must be instructed to stand fast before him and to bestride the limb to be amputated and to hold the limb; and a third to hold and stay the lower end of the diseased member to be taken off.

A fourth to receive and bring back the sharp instruments; a fifth, to attend the Artist and deliver him his needles and buttons, restrictive rollers, bolsters, bladder, and so soon as possibly may be to stay with the palm of his hand the medicines applied to the end of the amputated stump that being the duty of the fifth helper and the sixth is the Artist himself that dismembereth. Six and not fewer are the least for the work of taking off a member proceeding by a wound by Gun-shot, done in the lacerated not totally mortified part.’

When the hospital was first opened early in the twelfth century, its founder, Rahere, had directed that it should have four sisters, in addition to a master and a number of brethren. In 1544 the number of sisters was increased to five, and in 1551 a further seven were appointed. Each of them received an annual grant of six yards of cloth, from which to make her uniform. The colour of the uniforms had originally been grey, but in the sixteenth century this was changed to blue.

One of the sisters acted as matron. Among her duties she had to see that the other sisters did not come out of the women’s ward after 7 P.M. in winter or 9 P.M. in summer ‘except for some great and special cause as the present danger of death or needful succour of some poor person’. The regulations governing the sisters’ conduct enjoined them to ‘avoid and shun the conversation and company of all men’, unless this was absolutely necessary in the course of their duties.

The matron did not live in the common dormitory with the sisters, but occupied a separate house where, until the eighteenth century, she had the strange privilege of augmenting her wages by selling beer. Her salary was less than £3.50 a year, while the sisters received only £2.00 a year.

It is not known when night nurses were first employed. They certainly existed in the middle of the eighteenth century, although they were called ‘watchers’. Apparently they worked only when circumstances warranted it, for they lived outside the hospital and were called in when they were required.

After the hospital’s refoundation its administration was placed in the hands of a master and four chaplains, but they proved to be so incompetent that in 1547 the City authorities decided to make sweeping changes. A Court of Governors was appointed; its members consisted of men belonging to the Court of Aldermen and the Common Council and also of some persons who had made gifts to the hospital. The Lord Mayor presided over the Court of Governors. Their chief official, whose appointment was permanent, was called the Treasurer.

There was also an officer known as the hospitaller, who was a person in holy orders. Besides being responsible for the religious ministration of the hospital, he looked after the food supplies and dealt with the patients’ property. Religious observances formed an important part of the patients’ daily routine. There was a morning service at 8 a.m., an afternoon service at 4 p.m., and evensong three hours later.

They were quite lengthy services: that in the morning consisted of prayers and responses, two psalms, an anthem, another psalm, a lesson, the Benedicite, the Kyrie and the Creed, and ended with more prayers and responses. The hospitaller must have been a busy man; yet he somehow managed to do some of the doctors’ work as well, for he sometimes claimed payments for setting bones and joints.

The date of the founding of the medical school at St. Bartholomew’s is unknown. It seems to have been a gradual development. From 1540 to 1745 all surgeons practising in London or within seven miles of the city had to be licensed with the Barber-Surgeons’ Company. Licences were granted only to men who had served a seven years’ apprenticeship. The apprentice, or his father, had to pay fees to the Company and to the surgeon with whom he served.

The surgeons at the hospital could offer better opportunities than those working elsewhere, and so they were able to take their pick of the apprentices and also to charge higher fees. It became the practice for an apprentice to be appointed to fill his master’s post when a surgeon retired or died, and so for many years the surgical staff lacked experience of work and ideas from outside the hospital. This system continued until the eighteen-thirties.

It is fortunate that the journals of the governors’ meetings have been preserved from the very first occasion on which they gathered to transact business. This was on October 4th, 1549. It must have been a very short meeting, for the minutes consist of only one sentence:

‘At the assemble yn the persons of Mr. Dobbs, Mr. Whyt, Mr. Lyon, Aldermen: Mr. Clarke, Mr. Vycars, Mr. Morton and John Blundell, thes thynges were don:

The master coke, the butlar, the porter the viii bedelles and the matrone shall have for ther wynter lyuerys to Marche russett frysse for ther cottes and for a pettycotte.’

(The ‘viii bedelles’ were the eight beadles who had been on the hospital’s establishment since 1546. Their duty was to go around London and bring to the hospital any sick, aged and impotent people whom they found.)

The journals make very interesting reading, besides revealing a great deal about the work and administration of the hospital through the centuries, as the following items show:

1551.    A gift of three gurds of turpentine was reported.

1554.    A butcher agreed to supply beef and mutton at one penny a pound.

1555.    The surgeons requested the provision of a hot house for the poor to sweat in.

1558.    The matron was allowed fresh soap for washing her clothes. (Before this, she had to use wood ashes.)

1568.    On a day in March the governors met at 7 A.M. to make a general view of the hospital buildings and land.

1571.    In November a man wanted to have his leg amputated, but the governors decided that the time of the year was unsuitable and sent him to a lazar-house until the following spring. (From this entry it appears that the final decision as to whether an operation should be performed rested with the governors, and not with the surgeons.)

1577.    William Story, the guide of the lazar-house at Highgate, was paid 13s. 4d. for the expenses he incurred when he caused the leg of a woman patient to be amputated.

1580.    The payment to the sisters for board wages was raised from 16d. to 18d. a week. (In addition to this they received a yearly stipend of £2.)

1587.    The steward was given permission to get married.

1612.    The hospitaller complained that because of the increased cost of living his salary of £10 a year was insufficient. It was raised to £15.

1634.    The governors decided not to attend the funeral of Alderman Sir Martin Lumley because he had left no legacy to the hospital.

1647.    Two soldiers complained that a sister in Soldiers’ Ward had made reviling speeches against Sir Thomas Fairfax; she had also used provoking language to the patients and denied them things with which they should have been provided. The sister was suspended from duty ‘until further consideration’.

1649.    A patient named Katherine Shaw wanted to bring her child into the hospital when she was admitted. She was allowed to do this and the governors each gave a shilling from their own purses to pay for the child’s maintenance.

1652.    A widow was provided with a wooden leg at a cost of three shillings.

1653.    It was decided that the porter should have a cloth gown every three years and should carry a staff tipped with silver and decorated with the arms of the hospital.

1654.    Mary Kidder, the buttery woman, was dismissed for marrying.

1655.    It was ordered ‘That the Cellar for stronge beare in this hospitall shalbe shutt upp every Sabbothday untill fiue of the clock in the afternoon, and then not to continue open longer than one hower, and alsoe that dureing that hower noe person or persons be suffered to drink therein but only to fetch what beare or ale they shall want into their severall wards.’

1669.    It was decided that any governor who arrived late at a meeting or left before its business was completed should put a shilling in the poor box.

1675.    A deficiency of £243. 11s. 6d. was discovered in the accounts. The committee were unable to find out how this had occurred, but they decided that the clerk’s book-keeping system was unsatisfactory and ordered him to alter it.

1681.    The apothecary reported that 100 patients required mutton diet and broth in the spring and the autumn. The mutton provided by the matron was not sufficient and she was ordered to ensure that each patient had a pint of broth and a mutton chop.

1684.    The cook was dismissed for refusing to receive the Sacrament according to the usage of the Church of England.

1685.    Mr Mollins was too ill to operate for stone and appointed a stranger to perform the operation without first getting permission for this arrangement. The governors ordered that no stranger should be nominated to cutting for the stone without leave.

1687.    The following new diet table was approved:

Sunday    10 ounces of Wheaten Bread

6 ounces of Beefe boyled without bones

1 pint and a halfe of Beef Broth

1 pint of Ale Cawdell

3 pints of 6 shilling Beere

Monday     10 ounces of Wheaten Bread

1 pint of Milk Pottage

6 ounces of Beefe

1½ pints of Beefe Brothe

3 pints of Beere

Tuesday    10 ounces of Bread

Halfe a pound of Boyled Mutton

3 pints of Mutton Broth

3 pints of Beere.’

1696.    Because out-patients had become so numerous it was decided that none should be allowed to attend without a certificate of poverty.

1699.    It was decided that a surgeon should be paid 6s. 8d. for every amputation. A regulation was made that no patient should have a limb amputated without the approval of the treasurer and governors and the concurrence of all the surgeons. The patient’s friends must be notified of the operation.

The sister of Charity Ward was dismissed after admitting that she was a Roman Catholic.

1703.    In October the bakers asked to be relieved from a contract they had made in April to supply bread at 7½ d. per dozen, as this caused them loss. It was agreed to pay them 9½ d. per dozen from Midsummer to Michaelmas.

1704.    Elizabeth Bond offered to clear the beds and wards of bugs for 6s. per bed. The governors offered her 40s. to clear the sisters’ room of bugs.

1707.    It was decided that the room over the cellar where the matron sold beer and ale should be made into a ward.

1714.    Orders were given that the stones taken from patients who were operated upon should be brought into the counting house and shown to the treasurer and governors, and then hung there. (This appears to have been the beginning of the pathological museum.)

1744.    It was decided that patients should forfeit their dinner on any Sunday or holiday if they did not go to church.

1752.    Until this year patients who developed smallpox after admission were allowed to remain in the general wards. It was at last understood that this helped to spread the infection, and it was decided that a patient who became ill with smallpox should be removed immediately to a ward set aside for persons with this disease.

These extracts summarised from the minute books give some idea of life in one of England’s leading hospitals during the sixteenth, seventeenth and eighteenth centuries. Today, 850 years after its foundation, St. Bartholomew’s - or Bart’s as it is often called - still cares for the sick, and is the oldest hospital in this country still standing on its original site.