BRIEF HISTORY DURING THE SNOW ERA (1813-58)
The Unique Origin
Saint Bartholomew's is the oldest hospital in London. The institution is more formally known as The Royal Hospital of Saint Bartholomew. It remains at the site of its foundation, established in 1123 by Rahere (see picture), a religious man of humble birth and little education. He was a traveling entertainer who had become attached to the court of King Henry I. While on a pilgrimage to Rome, he became deathly sick and vowed that if allowed to recover and return home, he would found a hospital dedicated to the poor. During his return trip to London, he recovered and saw a vision of St. Bartholomew. The image told him to create his hospital and a church in Smithfield, a region just outside the walls of the City of London. King Henry owned the area as well as the Smithfield market. With the support of the local Bishop and the encouragement of the King, Rahere carried out his vision. The church and hospital was built in the ensuring six years and consecrated in 1129.
Over the years, St. Bartholomew's was both a source of medical and surgical care for the sick poor, and a hospice and almshouse. As such it provided care for the aged, orphans and abandoned children, and passing strangers or homeless wanderers. In the mid-1500s, King Henry VIII was separating from the Catholic Church and striving to be supreme head of the Church of England. In his zeal to establish his British religion, King Henry suppressed the activities of all Catholic institutions, including hospitals. St. Bartholomew's was subsequently turned over by the King to the City of London. In January 1547, King Henry signed the necessary passage documents, a mere two weeks before his death. The institution's title became, The House of the Poor, commonly known as St. Bartholomew's Hospital near West Smithfield in the City of London of the foundation of King Henry VIII. It was to provide care for 100 patients at any given time.
The first physician, Dr. Rodrigo Lopez, was appointed to the hospital in 1562. He became chief physician to Queen Victoria I but after being accused of attempting to poison her, was hanged. The first apothecary was appointed to the staff in 1567 and survived with no unusual outcome. The hospital expanded in 1566 with two new wards.
During the next two hundred years, more medical staff of multiple specialties were appointed and space was added here and there as needed. The hospital hired the architect James Gibbs in 1723 to plan a new facility. His intention was to build four separate blocks around a square, the construction of which took place between 1730 and 1769 (see picture for one side). In 1791, a lecture theater was added to the complex for St. Bartholomew's surgeons. While the hospital continued to tend to the poor, it gradually became standard practice to take fees from patients at admission.
Nineteenth Century Hospital and Cholera
The system of fees was abolished in 1821, and the staff was compensated with increased salaries. The wards were well attended, and their sanitary condition was favorably described by reviewing authorities. A new out-patient department was built in 1841 in the northeast corner of the hospital. Out-patients and casualties had increased four-fold from 21,300 in 1832 to nearly 86,000 in 1855. In-patients also increased from 450 beds in 1800 to 650 beds in 1858.
During the cholera outbreak of 1831-2, the hospital did not admit cholera patients to the wards. Instead, they were lodged in a nearby house which was demolished at the end of the epidemic. When the next epidemic started in the summer of 1849, the Hospital admitted 478 cases, of whom 199 died. The patients were isolated in two wards at the top floor of the hospital. In 1854, 322 cholera cases were admitted and 105 died. None of the physicians or nursing staff were recorded to have been infected.
Students have long attended medical practice at St. Bartholomew's. Earliest were those who practiced with surgeons, as was recorded in 1664. During the seventeenth century, the College of Physicians encouraged students to apprentice with doctors in hospitals, although the exact number doing so at St. Bartholomew was not recorded. During the eighteenth century, three classes of students emerged: apprentices who were associated with a surgeon for a specified period of time; dressers who were attached to a surgeon for a shorter period, but perhaps had been an apprentice elsewhere; and hospital pupils who were not attached to a specific surgeon but were undergoing a five-year apprenticeship. Many physicians at St. Bartholomew's lectured to students and received educational fees during the the late 1700s and early 1800s, even though a medical school had not been formally created.
A new building for a proposed medical school was built at St. Bartholomew's in 1834-5 west of the original four-building site. The new facility included a library, anatomical museum, a dissecting and lecture room, and medical and chemical theaters. Students were charged to attend. The process became more formal in 1843 when a Medical Council was established at the hospital and a residential college was set up with quarters on Little Briton street, just to the east of the hospital complex. Years later, in 1900, the medical school became a constituent college of the University of London, 42 years after the death of John Snow.
Whitteridge G, Stokes V. A Brief History of the Hospital of Saint Bartholomew, 1961.
Weinreb B, Hibbert C (eds). The London Encyclopaedia, 1993.