As regards St. Bartholomew’s Hospital, Mr. Morrant Baker has written a most interesting monograph, entitled “The Two Foundations,” to which I am indebted for much that I have to say under this head. This hospital owes its origin to Rahere, who is said to have been a minstrel jester at the court of Henry I. Concerning this pious founder, an aged chronicler (one of the monks of the Priory of St. Bartholomew) tells us: “Man born and sprung of low kynage, and when he attained the flower of youth he began to haunt the households of noblemen and the palaces of princes; where under every elbow of them, he spread their cushions with japes and flatterings, delectably anointing their eyes, by this manner to draw to him their friendships. And still he was not content with this, but often haunted the king’s palace (Henry I.), and, among the noiseful press of that tumultuous court, informed himself with polity and cardinal suavity, by that which he might draw to him the hearts of many a one.” It does not seem at all likely that Rahere ever wore a cap and bells as a professional jester; but that he was rather a persona grata about the court, alike for his merry tongue and his handsome presence, concerning which his effigy in the church of St. Bartholomew the Great speaks clearly enough. Dr. Norman Moore, by reference to an early manuscript, has clearly shown that Rahere was no professional jester. He was early in life a Canon of St. Paul’s, and Dr. Moore thinks that he was possibly famous for his wit, just as Sydney Smith was famous. His fashionable and giddy life seems to have told upon Rahere, and he ultimately turned serious, made a pilgrimage to Rome, fell ill there, saw visions, notably one of St. Bartholomew the Apostle, who commanded him to go home and build a church and asylum for the sick and weary in Smithfield. Rahere’s persuasive powers were effectual in obtaining a site in the King’s Market, Smithfield, and the foundation of the church and hospital took place in 1123. As to Smithfield, the monk’s manuscript continues: “Right unclean it was; and, as a marsh, dungy, and fenny, with water almost every time abounding and that that was eminent above the water, dry, was deputed and ordained to the jubeit or gallows of thieves, and to the torment of other that were condemned by judicial authority.” Rahere seems to have brought his histrionic talents to bear on his good work, for the chronicler records that by feigning idiocy he attracted the reverence of the superstitious, and “drew to him the fellowship of children and servants, assembling himself as one of them; and with their use and help, stones and other things profitable to the building lightly he gathered together.” It is needless to say that many miracles were performed in the early days of the Priory and Hospital of St. Bartholomew. It was distinctly a monastic institution, and more resembled, as Mr. Baker suggests, the sick and lying-in ward of a modern workhouse than a hospital as we understand the term. Mr. Baker further suggests that the jousts and tournaments of Smithfield, as well as the horse and cattle fair which had been held there from time immemorial, may have provided the monks with not a few surgical casualties.
For the following facts concerning St. Thomas’s Hospital I am indebted to a paper by Mr. Rendle, read in 1882 before the Royal Society of Literature:—
Those who have travelled from London Bridge to Cannon Street by the railway, must have noticed the fine Church of St. Saviour’s, Southwark. This church marks the site of the ancient Priory of St. Mary Overy, which was the original home of St. Thomas’s Hospital. Southwark, in ancient times, was largely occupied by the clergy. Not far from the Priory of St. Mary was the Abbey of Bermondsey, and the palatial residences of the Bishops of Winchester and Rochester. In 1207 the Priory of St. Mary was burnt down, and with it the Hospital of St. Mary. At Winchester House was living at that time Peter de Rupibus, Bishop of Winchester. This prelate decided to rebuild the hospital in a better form and on a better site, and accordingly set to work to obtain funds by means of the usual Charter of Indulgences addressed to the faithful in 1228. “Behold,” says Bishop Peter, “at Southwark an ancient hospital, built of old to entertain the poor, has been entirely reduced to cinders and ashes by a lamentable fire; moreover, the place wherein the old hospital has been founded was less suitable, less appropriate for entertainment and habitation, both by reason of the straitness of the place and by reason of the lack of water and many other conveniences; according to the advice of us, and of wise men, it is transferred and transplanted to another more commodious site, where the air is more pure and calm, and the supply of water more plentiful. But whereas the building of the new hospital calls for many and manifold outlays, and cannot be crowned with its due consummation without the aid of the faithful, we request, advise, and earnestly exhort you all, and with a view to the remission of your sins enjoin you according to your abilities, from the goods bestowed on you by God, to stretch forth the hand of pity to the building of this new hospital, and out of your feelings of charity to receive the messengers of the same hospital coming to you for the needs of the poor to be therein entertained, that for these and other works of piety you shall do you may after the course of this life reap the reward of eternal felicity from him who is the recompenser of all good deeds and the loving and compassionate God. Now we, by the mercy of God, and trusting in the merits of the glorious Virgin Mary and the apostles Peter and Paul, and St. Thomas the Martyr and St. Swithin, to all the believers in Christ who shall look with the eye of piety on the gifts of their alms—that is to say, having confessed, contrite in heart and truly penitent—we remit to such twenty days of the penance enjoined on them, and grant it to them to share in the prayers and benefactions made in the church of Winchester and other churches erected by the grace of the Lord in the diocese of Winchester. Ever in the Lord. Farewell.” The Prior of St. Mary Overy assisted in the good work, and several popes confirmed the acts of their subordinates, and thus St. Thomas’s Hospital was founded on the site now occupied by part of the London Bridge Railway Station—a site which was its home from 1228 to 1862. In 1535 there were forty beds at St. Thomas’s Hospital. In 1507 the hospital was enlarged and repaired, “the void ground,” called the “Faucon,” and afterwards the “Tenys Place” and “Closshbane” (probably connected with the game of skittles), was acquired, and the following was the bill: “Paid to Mr. Scott of Kent, and Ann, his wife, for the land forty marks, and for a gown cloth of damask for the said Ann £3 16s. 8d.—in all £31 13s. 4d.” When this land, or very nearly the same, was sold to the South-Eastern Railway Company in 1862 it fetched £296,000. The total cost of land and buildings erected in 1507, with the legal expenses, was £311 6s. 1½d. About the year 1527, James Nycolson, of “St. Thomas’s Spyttell in Southwark,” had a printing press within the precincts of the hospital, and among other notable books produced the Bible known as “Nycolson’s Coverdale.”
THE ROYAL HOSPITALS.
When the religious houses were suppressed by Henry VIII., these hospitals and asylums, which were part and parcel of them, were suppressed also, and for a time the poor found themselves deprived of much assistance to which they had become accustomed. It was therefore found necessary to re-establish these institutions on a new footing. This was done by Henry VIII. and Edward VI., and when we speak of these monarchs as founders we must remember that they refounded in a better form that which Henry had previously destroyed. St. Bartholomew’s was refounded in 1548, and St. Thomas’s in 1553; and in 1557 the four Royal hospitals—St. Bartholomew’s, St. Thomas’s, Christ’s Hospital, and Bridewell—were, in a sense, incorporated together for purposes of management. Dr. Payne has kindly permitted me to inspect a little book bearing the date 1557, and entitled “The Order of the Hospitalls of K. Henry the viii.th and King Edward the vi.th—viz., St. Bartholomew’s, Christ’s, Bridewell, St. Thomas’s. By the Mayor, Cominaltie, and Citizens of London, Governours of the Possessions, Revenues and Goods of the sayd Hospitals.” From this it appears that “one Hospital, called St. Bartholomew’s the little,” was founded by King Henry VIII., and the other three by his successor. The governors were to be sixty-six at least, fourteen aldermen and fifty-two grave commoners, whereof four were to be scriveners, “to the intent that in every house may be one or more.” Two of the aldermen were “governors-general,” one to be called controller and the other surveyor, while the remaining sixty-four were divided equally among the four hospitals, three aldermen and thirteen commoners to each, whereof one was to be their treasurer. The governors were appointed at a general court held on St. Matthew’s Day (Sept. 21st), and held office for two years from Michaelmas Day (Sept. 29th). On appointment a solemn charge was read to them, in which the objects of the four hospitals are thus set forth: “Idelnes, the enemie of all vertue, is suppressed and banished; the tender youth of the nedy and idle beggars vertuously brought up; the number of sick, sore, and miserable people refreshed, harbored, and cured of their maladies; and the vile and sturdy strumpet compelled to labour and travaile in profitable exercises.” The latter paragraph refers especially to Bridewell, which was originally established as a house of correction “for the strumpet and idle person, for the rioter that consumeth all, and for the vagabond that will abide in no place.” Bridewell has been rendered immortal by Hogarth’s fourth plate of the “Harlot’s Progress,” but as an institution it disappeared in 1863. Among the officers of the Royal Hospitals were “scruteners,” who performed the duties of “collectors” of legacies and other gifts. The charge to these officers concluded as follows: “And finally, when you shall hapen to be in the company of good, vertuous, and welthy men, you shall to the best and uttermost of your wits and powers, advance, commend, and set forth the order of the said Hospital and the notable commodities that ensue to the whole realme of England, and chiefly to the citie of London, by erection of the same; and also how faithfully and truly the goods geven to their uses are by the Governours thereof ministered and bestowed.” They were also enjoined to exhort scriveners to remind testators of the hospital when making their wills, and to provide the said scriveners with prospectuses for their information. They were further enjoined to exhort the bishop and clergy, and especially the preachers at “Pawles Crosse”: “That they twise or thrise in the quarter at the leaste, do move and exhort the people to further the said work.” The officers attached to each hospital were “the clerke, the matron, the nurses and keepers of wards, the steward, the officer appointed to warne the collectors and church wardens, the cooke, the butler, the porter, the shoemaker, the chirurgian, the barbour, the bedles.” Another institution having a similar origin to the Royal Hospitals is Bethlehem Hospital, or Bedlam. This was founded by Henry VIII., on the site of the suppressed Priory of our Lady of Bethlehem. At the end of the seventeenth century it was moved to a new building in Moorfields, and finally, at the beginning of the present century, it was established where it now is, in St. George’s Fields, Southwark.
EARLY HOSPITAL PRACTICE.
We get an insight into the methods of practice in the London hospitals in the sixteenth and seventeenth centuries from a series of papers in the St. Bartholomew’s Hospital Reports, written by Sir James Paget, Dr. Church, and Dr. Norman Moore. In the eighteenth volume of St. Bartholomew’s Hospital Reports Dr. Norman Moore gives some interesting facts with regard to the first medical officer, Thomas Vicary, who was appointed somewhere near the year 1550. He lived in the hospital, wore a smart livery which cost fifty-three shillings, was sergeant-surgeon to Henry VIII. and his three successors, and wrote a book on anatomy. Thomas Vicary is represented in Holbein’s picture of Henry VIII. granting a charter to the Barber-Surgeons. He appears to have served abroad with the army, and to have been a person of considerable experience, and to have had a proper sense of his duty as a professional man and a citizen. Not so much is to be said for the first physician to St. Bartholomew’s, Dr. Lopus, a Portuguese Jew, appointed in 1561, whose main object in this world appears to have been to get money. He was convicted of conspiring with the Spaniards to compass Queen Elizabeth’s death by poison, and in 1594 was hanged at Tyburn. Dr. Norman Moore gives another graphic picture of an Elizabethan surgeon in William Clowes, a man who was an army surgeon attached to the Earl of Leicester, and who in the intervals of foreign service was attached to St. Bartholomew’s. Clowes appears to have been a man of learning and experience, devoted to his art, and well able to do battle with irregular practitioners. Of these encounters he doubtless had many, and he gives a lively description of an interview with a quack vendor of a balm and plaster. “Then riseth out of his chayre, flering and gering, this myraculous surgeon, gloriously glittering like the man in the moon, with his bracelets about his armes, therein many precious jewels and stones of St. Vincent his Rockes, his fingers full of rings, a silver case with instruments hanging at his girdle, and a gilt spatula sticking in his hat, with a rose and crown fixed on the same.” Clowes was surgeon to Christ’s Hospital, and we learn the interesting fact that in his day twenty or thirty children had the scurvy at a time—a fact due to a diet largely composed of fish and other salted provisions, with a scanty allowance of vegetables and a total absence of potatoes.
Sir James Paget, in an interesting paper (written in 1846 while he was filling the offices of Warden to St. Bartholomew’s and Lecturer on Physiology) entitled “Records of Harvey,” gives us some facts regarding this very great man, which help us to understand London “hospital practice” as carried on during the reigns of James I. and Charles I. Harvey was appointed physician to the hospital in 1609, seven years after taking his degree at Padua, and seven years before he imparted his great discovery of the circulation to the College of Physicians. He was appointed during the lifetime of his predecessor, Dr. Wilkinson, and was to succeed on the death or retirement of the latter, and, like candidates for hospital appointments of the present day, he came furnished with testimonials, one from the King, and another from the President of the College of Physicians; and it is almost needless to say that his application was granted. On his appointment after the death of Dr. Wilkinson, the following “charge” was read to him:—“Physician,—You are here elected and admitted to be the physician of the poor of this hospital to perform the charge following—that is to say, one day at the least through the year, or oftener as need shall require, you shall come to this hospital and cause the hospitaller, matron, or porter to call before you in the hall of this hospital such and so many of the poor harboured in this hospital as shall need the counsel and advice of the physician. And you are here required and desired by us in God His most holy Name, that you endeavour yourself to use the best of your knowledge in the profession of physic to the poor then present or any other of the poor at any time of the week which shall be sent home unto you by the hospitaller or matron for your counsel, writing in a book appointed for that purpose such medicines with their compounds and necessaries as appertaineth to the apothecary of this house, to be provided and made ready for to be administered unto the poor, every one in particular according to his disease. You shall not for favour, lucre, or gain, appoint or write anything for the poor, but such good and wholesome things as you shall think, with your best advice, will do the poor good, without any affection or respect to be had to the apothecary. And you shall not take gift or reward of any of the poor of this house for your counsel.”
In 1626 Harvey’s stipend, which had been £25 per annum, was raised to £33 6s. 8d., on condition that he relinquished his claim to one of the hospital houses. In 1630 he obtained leave of absence from his hospital duties, having been commanded by the King to travel with James Stuart, Duke of Lenox. Harvey was at this time physician extraordinary to the King, and in the year following was appointed physician in ordinary. Dr. Andrewes appears to have been appointed as Harvey’s substitute during his absence, the governors showing themselves somewhat unwilling to accept Dr. Smith, who was Harvey’s nominee. It appears that the work of the hospital increasing, and Harvey being much occupied at court, Dr. Andrewes was definitely appointed Harvey’s coadjutor, or, as we should say, “assistant physician,” with the yearly stipend of £33 6s. 8d. A set of rules was drawn up by Harvey and accepted by the governors, which are interesting in two particulars: first, as showing that Harvey was impressed with the necessity of limiting the relief afforded by the hospital, and that he foresaw the inconvenience likely to arise from a press of what we should call “out-patients;” and secondly, that in the matter of prescribing internal remedies the chirurgeons were unable to act independently of the physicians. It further appears that there were “lock” hospitals in connection with St. Bartholomew’s, established in Southwark and Kingsland, in the disused Leper Hospitals (leprosy having then disappeared from London), for the reception of venereal cases. That venereal disease had long been very rife in London appears from the statement of William Clowes in 1596, that within five years over 1,000 cases had been cured at St. Bartholomew’s, and he adds, “I speak nothing of St. Thomas Hospitall, and other houses about the city, wherein an infinite multitude are daily cured.” Harvey retired from St. Bartholomew’s in 1643. In Harvey’s time the staff consisted of two physicians, three surgeons, one of whom, John Woodhall, was the author of the “Surgeon’s Mate,” and in his twenty-four years’ service amputated “many more than 100 of legges and armes,” with a mortality of 20 per cent., one surgeon for the stone, two surgeons or “guides” for the lock hospitals, an apothecary, and “a curer of scald heads.” This latter functionary appears to have been a woman, and the salary paid to her for her services varied from £27 in 1623 to £126 in 1642, and there is evidence to show that she received three or four shillings for each scald head cured. According to Dr. Church, at St. Bartholomew’s Hospital, where the diet, owing to the munificence of Dr. Radcliffe, has, since his time at least, been exceptionally good, so late as 1767 potatoes do not seem to have been introduced into any of the diets; greens were given on certain days of the week, but no other vegetables are mentioned.