THE ROYAL HOSPITALS OF THE CITY OF LONDON SIR LIONEL DENNY G.B.E., M.C., D.Sc. THE THOMAS VICARY LECTURE commemorates the union, by Act of Parliament, of the Barbers and the Surgeons Companies of London, which endured from 1540 to 1745, when they were separated and the Surgeons Company eventually became the Royal College of Surgeons of England. Fig. 1. Thomas Vicary, 1490-1561. (By courtesy of the Wellcome Institute.) Thomas Vicary (Fig. 1) was sergeant-surgeon to King Henry VIII, King Edward VI, Queen Mary, and Queen Elizabeth I: a former master of the Surgeons, he was the first master of the united company and he Thomas Vicary Lecture delivered on 2nd October 1972 (Ann. Roy. Coll. Surg. Engi. 1973, vol. 52) 86 THE ROYAL HOSPITALS OF THE CITY OF LONDON occupied the chair in three subsequent years. He witnessed the effects of the dissolution of the religious houses and was, undoubtedly, largely responsible for the union of the two companies, which aided the dis- semination of knowledge and attempted to replace the simple services provided by the priories. Nevertheless, in London great distress was being suffered by the sick, disabled, and helpless poor. There had been four great houses for such unfortunates: one, St. Helen's, was given by the king to the Master of the Jewels as a dwelling-house, and the others, which were being laid waste, were: (1) St. Mary of Bethlehem, founded in 1247 by Simon Fitzmary, alderman and twice sheriff of the City, commonly called Bethlem or Bedlam, lying outside the Bishop's Gate, the site now covered by Liverpol Street railway station. In 1346 the master and brethren had been obliged to petition the City for help and it was put under the supervision of the Court of Aldermen. It is interesting to note that as early as 1403 six patients were men deprived of their rea- son, for since then Bethlem's ministrations to the mentally sick have contiinued unbroken. (2) The priory of St. Bartholomew, founded by Rahere in 1123. Actually its hospital, being separately endowed, con- tinued as best it could when the priory was suppressed; but the aldermen feared that it was likely to be seized as part of the priory. (3) The Hospital of St. Thomas the Apostle, founded by Richard, Prior of Bermondsey, as a house of alms for converts and children on the site now occupied by London Bridge station, in what was then a liberty of the City. In 1538, with the fear of plague ever present, the presence of a host of destitutes gave rise to considerable concern, as a result of which Sir Richard Gresham, the Lord Mayor, petiltioned King Henry that he and his brethren of the Couirt of Aldermen might have 'the order, rule, disposition and governance of the spytells [or hospitals] of St. Mary, St. Bartholonew, and St. Thomas for the aid of the poor, sick, blind, aged and impotent persons not having any certain place wherein they may be lodged cherished and refreshed, until they be holpen of their diseases and sickness by physicians, surgeons, and apothecaries'. The petition also reminded the king that the churches and lands of the grey, black, and white friars in the city were vacant and might be better employed. Henry did not respond favourably, as a result of which two years later, in 1540, at the time of the union of the Barbers and the Surgeons Companies (Fig. 2), the City Corporation authorized the mayor and aldermen to make diligent suit to the king for the purchase of the property and to make an offer of 1,000 marks for them 'yf thei can be gotten no better chepe'. Henry upbraided the City for being pinchpenny; but nothing better was forthcoming and in 1543 the plague returned 87 SIR LIONEL DENNY and conditions grew worse. The king was preparing for war with France, and just before setting sail he issued letters patent, on 23rd June 1544, establishing on the late hospital of St. Bartholomew a new hospital consisting of a master, a priest, and four chaplains, and later, in 1546, by a deed of covenant with the City, he endowed the hospital with property of the yearly value of 500 marks and the City bound itself for the annual payment of a like sum. Finally, Henry relented, four weeks before his death, by the grant of the house of the grey friars and Christchurch, Newgate, together with the church and property of St. Bartholomew, as well as the governance of Bethlem Hospital and control df its revenue for the relief of the poor. Surely it is not too much to presume the influence of Thomas Vicary herein. sick, os n h ital. T 5 c as pan an the.Guil of Sren, 14, afte .r^............th pantn by............... Holbi a In the nex<tyear,| th@ firjst o>>.8ufte reign< of KingIEdar VI, th City:@,i,EiSo--& i . Se|% fi; fiso ceti pbic wig-hose r ems s wel as fesdeiedfo imports_ofwn n ihit h iy Tayors pai £20memresetively,th AndoUinbeweMercrsb24:poothe Compaie paid Basrltte's fumak,littlervngo13.Bovert£2. Affuther seloure ofstincome. wasthprovidedaby theCitysCutof Commoein CouKnciEdapplyIng the pro- fitsof cetain,h purbliei-ugh-ousesobeigams,ese as well as fees dherivmedfro imsportsofvinedb and fitysh inuto o omnCuclapynthe ity. 88 THE ROYAL HOSPITALS OF THE CITY OF LONDON By 1552 aldermen and senior councilmen had been appointed for St. Bartholomew and St. Thomas, while reparations were begun at the latter, which the C-ity had purchased for £2,461. Further the Lord Mayor, Sir Richard Dobbes, caused appeals to be nmade in the parish churches for the three hospitals and for a new hospital, to be known as Christ's Hospital, for poor, fatherless, and helpless children; 380 children had been admitted by September 1552. Christ's Hospital was given the in- come of Blackwell Hall, where imported fabric and leather had to be measured and taxed, and out of this £200 per annum was to be paid to Bart's. At the same time Nicholas Ridley, Bishop of London, was Fig. 3. Edward VI presenting the charter for Bridewell Royal Hospital to the Lord Mayor and aldermen, accompanied by the Bishop of Ely, the Lord Chancellor. (By courtesy of the Wellcome Institute.) writing to Lord Cecil, the young king's secretary, craving for 'the large empty house of the king's majesty, called Bridewell'. In due time Ridley was invited to preach before the king at Westminster and in the folilow- ing June a charter was signed by the dying king granting the palace of Bridewell to the City with an income of 4,000 marks and other property, for the sustenance of the newly erected hospitals of Chirist and St. Thomas, as well as Bridewell (Fig. 3). It is said that the ailing king ex- claimed, 'Lord, I yield Thee most hearty thanks that Thou hast given me life thus long to finish this work to the glory of Thy name'; he died ten days later. The indenture specifies the disused palace, together with 89 SIR LIONEL DENNY certain rents and furnishings from the Savoy palace, for the reception of vagrants and mendicants, where they should be taught and set to work at useful trades and the youths bound as apprentices. Mary's coming to the thronie, with the return to Catholicism, involved some delay in taking possession, and not until 1556 did the queen re- linquish the palace of Bridewell, where the Spanish ambassador had already taken up residence. Thus at the commencement of 1the reign of Queen Mary, in 1553, the Corporation of the City was,in possession of three hospitals for the sick, Bart's, Thomas's, and Bethlem, a school, Christ's Hospital, and, at Bridewell, a workhouse or place of correction for vagrants and a house of occupation where the young could be taught useful trades. Substantial expenditure had been incurred by the City in the con- version of 'the buildings; but each was only endowed to a limited extent, supplemented by the voluntary donations raised in the churches and by taxes levied on the citizens -and the guilds; while the very objects of these institutions made a strong appeal to the wealthier citizens who, in the course of the following centuries, gave handsome gifts and legacies of property to respective hospitals. Acts of the Court of Common Coun- cil, that is to say the Corporation of the City, were passed appointing the Lord Mayor for the time being and such of the aldermen, common- alty, and the citizens of the City to be governors of the respective hospitals. A common seal was made for the sealing of documents of any of the royal hospitals, after examiniation by three aldermen and four commoners. Ordinances were published in 1557 for St. Bartholomew's, Christ's, Bridewell, and St. Thomas's, to be read 'in every of the said hospitals at a full court once every quarter'. These ordinances laid down the responsibilities of the respective courts and provided detailed conditions for the election of governors, admissions, and granting of pensions, as well as the duties of the presidents and governors, treasurers, renters, the clerk, matron, and nurses, dtown to the cooks, butlers, and porters. Bethlem was not mentioned and at that time it was governed with St. Thomas's. At first, Bridewell became an example of a house of correction which spread to other cities and towns where 'bridewells' were established, although these were nothing but ordinary gao]s. Indeed, in the Cilty of London Bridewell proved a convenient place of detention for wrong- doers, heretics, military prisoners, and, later on, disseniters.