The Wards of Old London: St Bartholomew - Physick and Surgery in the City

A visitor to London, walking up the Great North Road (Aldersgate Street) can take any one of a number of small passages leading to the west, and thus pass from the Ward of Aldersgate Without into that of Farringdon Without. Such a visitor should, however, allow time for the possibility of getting lost in the confusing maze of alleys and passages, with names more evocative than most of the surviving buildings (the area was badly hit by bombing during the Second World War): Half Moon Court; Cloth Fair; Bartholomew Place; before arriving in a quarter of the City that did not entirely survive the Reformation of the Sixteenth Century, but did, for the most part, survive the Blitz of the Twentieth.

It seems that, in the Twelfth Century, a man named Rahere, who was certainly both a priest (a Canon of Saint Paul's from 1115) and a courtier (his counsel greatly valued by King Henry I), and who may also, according to some accounts, have been a jester and minstrel at some point in his life, made a pilgrimage to Rome. On the way, he was taken ill, and experienced a vision of Saint Bartholomew, who told him that, on his return to London, he must build a hospital. This he did, in 1123, and the hospital, part of an Augustinian priory dedicated to the saint, was London's first.

The tomb of Rahere, in the Church of Saint Bartholomew the Great. Photo: Mike Dunn (licensed under CCA).

The priory itself, like London's other religious houses, was suppressed under Henry VIII, but he re-established the hospital as a secular institution. Elements of the Medieval priory, however, are preserved in two parish churches, Saint Bartholomew the Great, and Saint Bartholomew the Lesser.

Saint Bartholomew the Great, one of London's best preserved Medieval churches. Photo: David Iliff (licensed under CCA; CC-BY-SA 5.0).

Saint Bartholomew the Lesser. Photo: ChrisO (licensed under GNU).

The professions of medicine ("physick") and surgery ("chirugery") were quite separate from one another in the Medieval and Early Modern eras. The most famous medical director of "Barts," as the hospital is still known, William Harvey (1578-1657), was a physician trained at the Universities of Cambridge and Padua, and laid down rules that chirugians (who learned their trade by apprenticeship) should operate only under the strict supervision of physicians.

William Harvey, by Daniel Myters (1627), National Portrait Gallery (image is in the Public Domain).

Harvey, who acted as personal physician to James I and Charles I, conducted pioneering research into the human circulatory system, and took his students into the nearby slaughterhouses of Smithfield, so that they could observe the parallels between the circulation of blood in humans and animals, as the last drops bled from the bodies of cattle, sheep and pigs. In an age in which human corpses for dissection were hard to come by, each student could examine, in detail, the hearts and other organs of a freshly killed beast.

Harvey's illustration of veins in the human arm. Image: Wellcome Collection (licensed under CCA).

Four generations later, one of the hospital's most eminent surgeons, Percivall Pott (1714-88), noted an unusually high incidence of scrotal cancer in chimney-sweeps, making him the first to identify environmental factors as potential carcinogens.

Percivall Pott, by Edward Hedges, after Nathaniel Dance-Holland (image is in the Public Domain).

The hospital buildings that can be seen today were built in Pott's lifetime, and William Hogarth, one of the leading artists of the day, was commissioned to decorate them with murals.

The main entrance to Bart's Hospital. Photo: Nevilley (licensed under GNU).

William Hogarth's mural of Christ at the Pool of Bethseda. Photo: Nevilley (licensed under GNU.

Plan of Bart's Hospital in 1893. Image: Wellcome Trust (licensed under CCA).

When, back in the Twelfth Century, Henry I had lent his support to Rahere's plan to build a hospital, he also instituted an annual fair within the precincts of the priory, to help with fundraising. "Bartholomew Fair" took place every August, initially over three days, but this increased to two weeks under Charles II: it was a cloth fair, attracting merchants from all across Britain, but it was also an occasion for much rowdy revelry. Because Saint Bartholomew's lay outside the city walls, the gates could be closed at the normal times, containing the revelers without.

Bill for a puppet-show at Bartholomew Fair, 1700. Image, Houghton Library, Harvard University, TS 555.1 (Public Domain).

Bartholomew Fair, 1721. Image: Wellcome Collection, V0014666 (Public Domain).

By 1855, however, with most of the City's gates demolished, this containment was no longer possible. The fair was abolished by the City authorities, but the medical tradition continued, and "Bart's," where the functioning of the human heart was first explained in detail, now supports one of the most important coronary care units in Europe.  

An operation at Bart's in 1908. Photo: Wellcome Collection, L0018253 (licensed under CCA).

Mark Patton's novels, Undreamed Shores, An Accidental King, and Omphalos, are published by Crooked Cat Publications, and can be purchased from Amazon. He is currently working on The Cheapside Tales, a London-based trilogy of historical novels.