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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 reason, 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, continued 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.

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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 income 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 conversion 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, commonalty, 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. Nevertheless, a part of 'the property was kept for educational purposes and teachers were appointed for various trades, such as branches of the textile in- dustry, glove-making, the manufacture of pins and nails, and baking. It was always intended that the educational establishments should be complementary and, for example, the bread for Christ's Hospital in 90 THE ROYAL HOSPITALS OF THE CITY OF LONDON those early years was baked at Bridewell, while as late as 1834 some boys came daily from Christ's Hospital to learn trades at Bridewell, while younger children from Bridewell went to Christ's for schooling. The assumption by the City of such great responsibilities was not without some anxiety in respect of the finances. The voluntary collec- tions in the churches had fallen off and it became necessary to address precepts to several wards pressing for weekly alms not to be withheld; but that all inhabitants well able to give some of their substance for the relief of the poor should stir themselves. Guilds which were neglect- ing the contributions were brought to book with the threat of their wardens being attached. Each hospital was to provide a 'strong, sure, chest to be their treasure chest', having three locks and keys, one to be kept by the president, one by the treasurer, and the third by an 'ancient' governor, being a comtoner. Nevertheless, by 1588 Christ's Hospital was overspent and in 1600 suspended payment of the £200 due annualy to Bart's. The auditors of the other hospitals were ordered to audit its account and devise the best means of paying its debts. In the following year a similar reference was made to the auditors to devise means how Bridewell might be maintained. It itranspired that the whole of the revenue given by Edward VI to the three hospitals had for a long time been wholly received by St. Thomas's and it was ordered that £100 be paid within fourteen days, £100 more at the feast of St. Bartholomew, and £200 a year afterwards, payable quarterly, and an Act of Common Council was passed accordingly. The royal hospitals had been constituted a corporate body, governed by the ordinances passed by the City's Court of Common Council in 1557 providing for a General Court of governors comprising 14 aldermen and 52 commoners, of which two aldermen were to be governors general of all the hospitals and three of the remaining aldermen and 13 common councilmen constituted the ordinary courts, one for each hospital (Bethlem being at that time associated with St. Thomas's). Each hospital court was to meet previously and agree upon the nomination of new members to succeed those who had served two years. The General Court then met on St. Matthew's day, when the election was held and the results presented in writing to the Court of Aldermen's next meeting. However, with the passing of time confirmation by the General Court and the Court of Aldermen became a formality and the actual elections were dealt with by the hospital courts themselves, so that the Corpora- tion's influence diminished, except that the aldermen still controlled the hospital seal by which transactions in property were legalized. Being a governor for one of the royal hospitals had become a sought- after appointment for its prestige, if not for its privilege of personally nominating recipients of benefit. Some of the hospitals which needed ad- 91 SIR LIONEI, DENNY ditional funds had started to attract donations to their hospital by granting what came to be known as 'donation' governorships, to dis- tinguish them from corporation governors. More often than not these additional governors were not freemen of the City, so that as the numbers proliferated the Corporation's share in the administration dwindled. Then came the Fire of London in 1666. Bart's, St. Thomas's, and Bethlem were untouched; Christ's and Bridewell suffered loss. But all the royal hospitals suffered severe loss of income from the destruction of their income-producing property in the City of London; besides which the weighhouse and Blackwell Hall were burnt down. A special court of justice was established, presided over by three or more judges of the King's Bench, to settle disputes between landlords and tenants; such settlements were usually arrived at by the grant of an extension of the lease at a reduced rent in order to assist tenants to rebuild promptly. As the 17th century proceeded friction was developing between the Court of Aldermen and the governors of the respective royal hospitals. The need to supplement revenues had led to a considerable increase in the numbers of donation or special governors from outside the City, and the courts of the hospitals were complaining at what they described as interference by the Court of Aldermen in their management. In reply the aldermen called for a return as to governors who were tenants of hospital properties, indicating justifiable concern. Once again the practice of admititing governors was referred to a Corporation committee and the sealing of leases was held up. The aldermen relied for their authority upon the charters of Henry VIII and Edward VI, since which ilt must be remembered a century and a quarter had passed. Charles II had been on the throne for up- wards of 18 years and some surgeoins and physicians of the royal hlospitals held appointments in the royal household, enjoying the ear of the king, so the grant of a new charter was very real. Further to this, Samuel Pepys, as Secretary to the Admiralty and treasurer of Christ's Hospital, had interested the king in the need for teaching navigation and a better supply of officers ito the navy, resulting in the king's foundation, within Christ's Hospital, of a Mathematical School for the maintenance of 40 scholars to be instructed in the 'art of navigation and the whole science of arithmetic'. Thus it was not surprising that, in March 1681, the Lord Mayor ac- quainted the Court of Aldermen that His Majesty had by letters patent appointed commissioners for visiting St. Thomas's Hospital, and the commissioners expected the original charters and ordinances to be pro- duced to them. In reply the Court ordered three aldermen to attend the Lords Commissioners and humbly to represent to them that the charter being granted to the mayor, commonalty, and citizens of the 92 THE ROYAL HOSPITALS OF THE CITY OF LONDON City, the Lord Mayor and aldermen could not deliver same without the consent of the commons in Common Hall assembled. Nothing further is recorded in reference to this matter and it may be considered that the City had succeeded in making the point that, while donations from outside had, in that age, conitributed to the maintenance of the royal hospitals, their adaptation, if not their actual erection, had been founded upon the taxation and generosity of the citizens.

Fig. 4. St. Thomas's Hospital, Southwark. From a line engraving published in 1755 for Stow's Survey. (By courtesy of the Wellcome Institute.) Nevertheless, the wrangle between the City and the hospitals over the appointment of governors continued for another century, culminat- ing in an Act of Parliament in 1782-viz. 'an Act to render valid and effectual certain articles of agreement betwee the mayor and commonalty and citizens of 'the City of London, governors of thepossessions, revenues and goods of the Hospitals of Edward King of England the Sixth, of Christ, Bridewell and St. Thomas and the Hospitals of Henry the Eighth, King of England, called the House of the Poor in West 93 SIR LIONEL DENNY Smithfield, near London, and the House and Hospital called Bethiem, and the Presidents Tresurers and Acting Governors of the said several hospitals'. Eight years later the Corporation was again complaining, not with- oult some justification, that so few of their body had been chosn as governors, and as governors had the right of presenting children for admission, the basis of the complaint was that orphans of citizens and freemen were being deprived of ithese splendid charities. The controversy was brought to a head by the Court of Common Council resolving unanimously 'that a statement having been made in the Court ... of a great abuse in the presentation and admission of children into Christ's Hospital, contrary to the rules etc.' an enquiry be held by the

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Fig. 5. St. Bartholomew's Hospital in 1720 From an engraving in the Wellcome Historical Medical Museum and Library. (By courtesy of the Wellcome Institute.) governors to remedy same. This, however, proved abortive because the governors refused to allow inspection of their documents; but, in consequence of the children in question being removed from the school, proceedings in the Court of Chancery were dropped. It is not fair to dwell upon affairs -of ChristVs Hospital; the others had their comnplications too, nearly alil of which arose out of the fact t-hat -the hospitals, although established in the early centuries by money rmis-ed by -the citizens, had by now attracted considerable legacies and benefacti-on-s from a wider public; besides which the royal hospitals were now providing for a metropolis not only the City Further, their government wais no longer in the hands of 26 aldermen and 52 common councilmen of the City, but several hundreds of donation governors 94 THE ROYAL HOSPITALS OF THE CITY OF LONDON or governors by benefaction had been added. The Act of Parliament of 1782 regularized these matters, conditional upon the lists of governors chosen being presented to the Lord Mayor -on St. Matthew's day. It is significant that the govern-ors of Christ's Hospital agreed at that time to halt the appointment of dontation governors until the number was re- reduced to 300. Truly, after 250 years of development the royal hospitals of the City of London were commencing to belong to the metropolis of London, but with strong attachments to the City: indeed, many handsome donations were made by aldermen. Two examples are

Fig. 6. Design for the new St. Thomas's Hospital, Lambeth, 1868. Wood- cut from the Penny Illustrated Paper, 19th May 1868. (By courtesy of thc Wellcome Institute.) those of Sir Robert Clayton, who is well remembered at St. Thomas's for his substantial benefactions, and at Christ"s Hospiital for his building of the n,ew hall after the earlier Great Hall, damaged in the Fire of London, had been found to be irreparable. There is plenty of evidence that members of the Court of Common Council, and particularly the aldermen, were charitably affected to the royal hospitals. The 18th and 19th centuries found the medical hospitals of St. Bar- tholomew, St. Thomas, and Betilem growing vigorously and supporting important medical schools. At St. Thomas's Thomas Guy, a most bene- volent governor, with the best of inentions founded a hospital in one of the wings, which led to difficulties and as a result Guy's Hospital later separated and removed to its present site. Meanwhile, with the coming of the railway the site of St. Thomas's had become very valuable. 95 SIR LIONEL DENN Y The railway company offered £10,000 compensation to allow its line to cross the grounds, which was declined and the dispute submitted to arbitration, a's a result of which £296,000 was awarded. After considering 44 sites, it was decided to negotiate for land on the proposed Albert Embankment and 81 acres facing the Houses of Parliament were purchased for £100,000. The new hospital was opened in 1871 by Queen Victoria and later that year the new medical school was opened. In 1675 Bethlem had built and moved into palatial premises nearby on leased land in Moorfields; but only a century later the building was unsound-it hiad been built on the city ditch without proper foundations and a further move became imperative. At thiat time Bethilem was

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Fig. 7. Bethiem Royal Hospital in the 18th century. (By courtesy of the Wellcome Institute.) unique, being the only public institution for the insane in the country. The original priory had only held up to 60 patients: the Moorfields hospital at first held 120, all of whom were maintained free. They were allowed to remain for 12 mon-ths, by which time if they had not re- covered they were deemed incurable and diischarged into the care of those who had given security for their admission. Subsequently, an en- dowment h-aving been set up for incurable cases, two wings had been added for their acconumoda,tion, bringing the capacity up to 250. A site was acquired att St. George's Fields, Lambeth, and the building, begun in 1812, was occupied in 1815. The government contributed £70,000 for the Cri'mi-nal Lunatic Department to be included. Thi's building, less its itwo great wings, still stands and is occupied by the Imperial War Museum. The Criminal Department was removed to Broadmoor-the women iin 1863 and the men in 1864. About that time Sir Charles Hood was appointed the first resident medical superinten- 96 THE ROYAL HOSPITALS OF THE CITY OF LONDON dent and he initiated Bethlem's reputation as a teaching centre, which led to Bethlem's being admitted as a medical school of the University of London. Bfidewell Royal Hospital at the start of the 18th century comprised two establishments on its original city site: a school for apprentices snd a house of correction. It was not long before a separation became imperative; but controversy arose because, with the increase in charity schools, the number of apprentices at Bridewell was falling, an-d while one side urged education the other side advocated its conversion into

Fig. 8. Bethlem Royal Hospital, St. George's Fields, Southwark, 19th century. (By courtesy of the Wellcome Institute.) a model prison. A parliamentary enquiry ensued and, as a result of its report, the school. was closed and the buildings administered as a common prison. However, in 1830 a house of occupation was opened at St. George's Fields to provide general an-d industrial educa-tion for boys an-d girls from 8 ito 18 years of age. This was a success, soon calling for extension to accommodate 200 children -and, with the closure of the prison, the whole income of the Bridewell Royal Hospital was devoted to education. S?~rtly afterwards, with the obvious intention of dissociating the school from -the repultation in the past of Bridewell having been a house of correction, the name was changed to King Edward's School, which it still bears. By 1860 a new scheme was adopted to purchase 40 acres at Witley, in Surrey, for the erection of a school for 150 boys, which was opened in 1867 and by 1886 had 237 pupils, while the girls' school remaining at Lambeth also numbered 237. 97 SIR LIONEL DENNY

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Christ's Hospital, the boys at Newgate Street and the girls at Hertford, was flourishing in spite of reports by the Charity Commissioners and a body with the unusual name of 'The Select Committee on Education of

iB..-3,=!i_gz, E. .:-' 5-!||- :...!: :: .- li .!l ..'sL, ,--- Fig. 10. Christ's Hospital, Horsham, 1972. In the centre of the quadrangle is the statue of King Edward VI. (By courtesy of Mr. N. T. Fryer.) 98 THE ROYAL HOSPITALS OF THE CITY OF LONDON the Lower Orders'. Finally a Royal Commission in 1877 recommended removal from London; but it was not until 1897 that H.R.H. the Duke of Cambridge, son of Queen Victorila, a most keen president of Christ's Hospital for 50 years, laid the foundation stone of the new boys' school at Horsham in Sussex on a 1,200-acre site. Meanwhile the school at Hertford, which had formerly been housing the juniors and the girls, had been given over exclusively to the girls' school. Since 1891 Christ's Hospital has been governed under schemes of the Charity Commissioners and the Board of Education, which have provided for the inclusion of representatives of the Court of Aldermen and the Court of Common Council on the governing body, as a result of which a close association still exists with the City. Each year the Lord Mayor attends speech days at Hertford and Horsham in state and scholars return the visit, on St. Matthew's day, after a service close to to the original site at Newgate, marching to the Mansion House to re- ceive the customary largesse from the Lord Mayor, following by refreshments. The population of the schools today is 805 boys and 288 girls. As to the Royal Bridewell Hospital's school, King Edward's at Wit- ley, coeducation was introduced in 1952 with great success and the girls' school in London was closed. Thus the royal foundations of King Edward VI for deprived children still meet a social need after four centuries. Towards the end of the 19th century, in spite of the removal of the criminal insane to Broadmoor, more space was required by Bethlem and a convalescent branch was opened at Witley in 1870. Nevertheless, by the 20th century advances in psychiatric treatment called for a change in environment and in 1928 Bethlem left Lambeth for the spacious Monks Orchard estate at Beckenham, opened by Queen Mary in 1930. In 1946 came the National Health Service Act and on the 'appointed day' all voluntary hospitals were transferred to the State. The association of the Court of Aldermen with St. Bartholomew's, St. Thomas's, and Bethlem, which had subsisted for more than four centuries by virtue of the appointment of the aldermen of the City to their respective governing bodies, was terminated. The aldermen recorded their pro- found regret at this severance, recalling with pride their deep sense of responsibility to the royal foundations in the discharge of which they had sought to preserve and promote the welfare and prosperity of these hospitals. As teaching hospitals, Bart's, St. Thomas's, and Bethlem were permitted to retain their endowments, which were freed for the promotion of research and the provision of amenities for patients and staff not then supported out of public funds; further, they were permitted *to be administered by boards of governors, the chairmen of which were 99 SIR LIONEL DENNY

Fig. 11. Rebuilding of St. Thomas's Hospital, 1972. The building in the foreground is the new Nightingale School of Nursing. (By courtesy of the Secretary.)

Fig. 12. St. Bartholomew's Hospital today. (By courtesy of the Clerk to the Governors.) 100 THE ROYAL HOSPITALS OF THE CITY OF LONDON appointed by the Minister, while the remaining members were appointed in accordance with Part III of the Third Schedule of the Act. Contact with the boards of governors of St. Thomas's and Bethlem and the Corporation of the City has now become lost, which is to be regretted; but Bart's, one might be permitted to say with commendable loyalty, has maintained touch by the choosing of some aldermen for its board, and since 1948 four past Lord Mayors of London have served thereon. The Act provided that the hospital seal, the application of which still legalizes documents relating to transactions covering the endowments of iall five royal hospitals, remains in the custody of the City Chamberlain and the procedure is that, when docquets are submitted for the seal, it is applied publicly at the next meeting of the Court of Common Council at Guildhall. Christ's Hospital and the Bridewell Royal Hospital, that is to sav the two schools, were in no way affected by the nationalization of the hospitals and continue to be governed in accordance with schemes laid down by the Board of Education and its successors. In both cases the courts of governors include aldermen and members of the Court of Common Council and the Lord Mayor attends the annual speech day at King Edward's School, Witley, just as he attends at the Christ's Hospital schools at Hertford and Horsham. So, of the five royal hospitals, three are nationalized and the other two are independent schools of standing. Only one, Bart's, still stands within the City boundaries, and each of the five serves no longer the City of London, or even Greater London, alone, but the whole nation, each outstanding in its own class. The City of London has every reason to be proud of its royal hospitals; King Henry and King Edward too would be proud of their foundations, which the city nourished, and so would be Thomas Vicary! ACKNOWLEDGEMENTS I wish to acknowledge my warm appreciation to the Council for thc honour of my being appointed this year's Vicary lecturer and to thank the archivists and others at the respective five royal hospitals for their willing aid, particularly the Deputy Keeper of the Records at Guildhall, Miss Masters, who was un- tiring in producing not only the original sources but, what was vastly time-saving, the transcriptions thereof. I am also indebted to the Wellcome Institute for many of the illustrations.

SOURCES Records of the Corporation of London. Memoranda etc. relating to the Royal Hospitals printed under the directions of the Court of Common Council, 1836. Supplement to same, 1867.

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