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.

The Wards of Old London: Bishopsgate Without - Death and Insanity

Having explored the ward of Cripplegate Without, we now go back on ourselves to look at the ward of Bishopsgate Without, which I passed over last week, not wanting to explore it until I had the chance to see the exhibition on Bedlam that has just opened at London's Wellcome Collection.

The line of Ermine Street, the Roman road that connected London to Lincoln, York, and, ultimately, Hadrian's Wall, runs north through the ward, out towards Stoke Newington and Tottenham, linking up with the modern Great North Road (A1) at Godmanchester (Roman Durovigutum).

Ermine Street. image: Neddyseagoon (licensed under GNU).

The Romans, quite sensibly (although perhaps by reason of superstition, as much as hygiene), did not permit the burial of the dead within cities, so the roads running in and out of major settlements were always lined with tombs and graves; those of the wealthiest families lying closest to the roads themselves. This was as true of London as it was of Rome.

Plan of Roman London, showing the position of the northern cemetery. Image: Drallim (licensed under CCA).

A tombstone from Roman London, Museum of London. Photo: Udimu (licensed under CCA).

Tombs along the Appian Way. The large tower on the right is the Mausoleum of the Curiazi, dating to the First Century BC. Photo: Nicolo Musmeci (image is in the Public Domain).

The Elizabethan chronicler, John Stow, records a discovery of Roman graves north of Bishopsgate, as early as 1576, when clay was being dug to make bricks:

" ... many earthen pots, called urnae, were found full of ashes, and burnt bones of men, to wit, the Romans that inhabited here ... Every of these pots had in the with the ashes of the dead one piece of copper money ... some of them were of Claudius, some of Vespasian, some of Nero, of Antoninus Pius, of Trajanus, and others. Besides those urns, many other pots were there found ... divers dishes and cups of a fine red-coloured earth, which showed outwardly such a shining smoothness as if they had been of coral: those had in the bottoms Roman letters printed ... "

This account is, I think, the first piece of specifically archaeological (as distinct from historical) writing about London, and is among the very earliest examples in the World. The first entry in the Oxford English Dictionary for the word "archaeology" dates to 1607, but Stow is here doing archaeology: on the basis of material evidence alone, he is describing the graves, the excavation of which he witnessed; dating them; and even describing the artefacts in such a way that we can, with some confidence, identify them (the shining red vessels must surely be "Samian ware" - mass-produced pottery found on almost all Roman sites, including many in London).

Samian ware bowl found in London, but made in southern France, British Museum. Photo: AgTigress (licensed under CCA).

The Priory of the New Order of Saint Mary of Bethlehem was established, close to the present location of Liverpool Street Station, in 1247. Its patron was the Bishop-elect of Bethlehem, Goffredo de Prefetti, but he almost certainly never visited. The land on which the priory stood was donated by a London alderman, Simon FitzMary, on his return from a pilgrimage to the Holy Land. The priory provided accommodation and food for the needy, but its real purpose was fundraising for the Crusades. This, however, was, with the benefit of hindsight, already a lost cause: Bethlehem was in Muslim hands; its bishop in exile in France; and the crusading impetus much diminished. The priory became a hospital and, in 1403, we have the first record of its being used to house men who were mente capti - of unsound mind.

Medieval Bethlehem Priory, as reconstructed by Daniel Hack Tukes (1882). Image: Project Gutenberg (Public Domain).

By the early Seventeenth Century, "Bedlam," as it had now become known, a secular rather than a religious institution, was clearly functioning as an asylum for those considered to be insane. One keeper-physician, Helkiah Crooke, who clearly lived up to his name, was dismissed by Charles I in 1631 for embezzlement and misappropriation, his inmates apparently starving as he stuffed his own money-bags with the funds intended for their support. Already, by this time, the public were admitted to the institution, presumably for a fee, to be entertained by the antics of the "lunatickes."

Two of London's early theatres, The Theatre and The Curtain, were located nearby (beyond the boundary of the ward), and several Seventeenth Century plays include "madhouse" scenes, probably inspired by Bedlam. In one of these, The Changeling, by Thomas Middleton and William Rowley (1622), a character, Lollio, remarks:

"We have but two sorts of people in the home, and both under the whip, that's fools and madmen; the one has not wit enough to be knaves, and the other not knavery enough to be fools."

The distinction, in modern terms, is presumably that between mental disability and mental illness. The character, Alibius (a corrupt quack-doctor, quite possibly inspired by Crooke), replies:

"I do profess the cure of either sort:
My trade, my living tis, I thrive by it.
But here's the care that mixes with my thrift:
The daily visitants that come to see
My brainsick patients I would not have
To see my wife. Gallants I do observe
Of quick, enticing eyes, rich in habits,
Of stature and proportion very comely ..."

As early as 1598, Bedlam had been condemned as overcrowded and unsanitary, its "common jacques" used casually by Londoners who had no sanitary facilities of their own. In 1675, a new hospital was built nearby, to a Baroque design by Robert Hooke: a fine building, but an institution that had little more to offer in terms of the treatment of mental illness. It continued to be open to the public, and William Hogarth's portrayal of it, in The Rake's Progress, is hardly more complimentary or optimistic than that in The Changeling.

Hooke's New Bethlem Hospital, by Robert White, 1676 (image is in the Public Domain).

Bedlam, from Hogarth's The Rake's Progress, Sir John Soane's Museum (image is in the Public Domain).

In 1810, the hospital was moved to a new site, south of the Thames (the building now occupied by the Imperial War Museum), and the land in Bishopsgate Without redeveloped with cheap and unsanitary housing for some of the thousands of new Londoners recently arrived from the countryside.

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.