Celebrating 900 years of healthcare in the heart of London

Angela Robinson, director of nursing for Barts Health NHS Trust, said anticipation for the anniversary, on 25 March, had been building for some time and staff were “just so excited”.

“We are also hoping that the publicity surrounding our 900^th anniversary will help us raise funds for urgent restoration work,” she added.

Currently, a leading international cardiac and cancer centre, which still serves its local East End community, Barts – as it is universally known – has not had an easy ride over its nine centuries. It survived Henry VIII’s reformation, the Great Fire of London and the bombs of World War II’s Blitz.

However, it then narrowly avoided closure following a proposal in the 1992 Tomlinson report, largely thanks to the Save Barts Campaign, which saw over one million people sign a petition opposing the move.

On warm spring days, as nurses, visitors and recovering patients chat around the Victorian fountain at the heart of Barts’ famous leafy square, it’s easy to forget such troubles.

It is equally easy to forget that close by, in the ancient priory church of St Bartholomew’s the Great, lies the tomb of Rahere, an Anglo-Norman priest and monk who founded the hospital in 1123.

Fountain at St Bartholomew’s Hospital

According to medieval archives, Rahere, one of Henry I’s courtiers – and possibly a jester – contracted life-threatening malaria on a pilgrimage to Rome.

Vowing that if he recovered, he would build a priory hospital for “the sick poor”, he is said to experienced a vision of St Bartholomew instructing him to build the hospital in his name, on London’s Smithfield.

“Although Barts is now an internationally-renowned specialist cardiac and cancer hospital, we still cater for patients living in some of the poorest areas of London’s East End – in keeping with Rahere’s vow to serve the `sick poor’,” noted Ms Robinson.

Care of the new hospital’s sick poor, which included orphans and babies from nearby Newgate prison, would have been basic and carried out by members of the Augustinian religious order. Even so, rest and nourishment probably helped those early patients.

“We still cater for patients living in some of the poorest areas of London’s East End – in keeping with Rahere’s vow”

Angela Robinson

St Bartholomew’s priory was closed in 1539, following the dissolution of the monasteries. But prompted by a petition from the local population, Henry VIII allowed Barts to continue and granted it to the City of London – where it remained until it became part of the NHS in 1948.

From 1546 until 1948, the hospital’s legal, though rarely used and rather clunky name was the House of the Poore in Farringdon in the suburbs of the City of London of Henry VIII’s Foundation.

Early nursing standards in the reformed hospital laid down in 1552 – possibly by Rose Fisher, Bart’s first matron, and her 12 sisters in ‘blue clothe’ – included being “gentle, diligent and obedient to matron; helping all the poor patients in their griefs and diseases; keeping them sweet and clean and giving them meats and drinks”.

The lives of these staff were harsh though. Working alone on their wards, tasks included fetching coal and washing, drying and mending patients’ sheets. Not until 1647 were ‘sister’s helpers’ – or nurses – enlisted to tend soldiers’ wounds during the English Civil War.

By the end of the 18^th century, though undamaged by the great fire of 1666, Barts’ buildings were crumbling and cramped.

As a result, they were mostly replaced by the impressive Portland stone edifice surrounding today’s square. Improvements included the famous staircase mural of the healing of the sick (Christ at the Pool of Bethesda) by hospital governor and artist William Hogarth and the Henry VIII gate, which still forms the hospital’s impressive entrance.

Hogarth staircase at St Bartholomew’s Hospital

Sadly, such architectural elegance was not reflected in the hospital’s nursing standards. Indeed, in 1830, surgeon James Paget described its nurses as “rough, dull, unobservant and untaught”.

Many worked well into their eighties and were apparently “inclined to disorderly behaviour and drunkenness”.

Much-needed training of Barts’ nurses was recognised towards the end of the 19^th century. So-called scrubbers were appointed to relieve them of heavy cleaning chores and the first nursing school was established in 1877.

Initially rudimentary, nurse training was carried out by medical staff and included such skills as bandaging and bed-making.

According to archive notes from an early probationer, nurses still had to scrub floors and “there was generally a row” if they were caught taking a patient’s temperature.

Nurse training was extended from one year to three in 1882, by the famous Barts matron Ethel Gordon Fenwick – also known as Ethel Bedford Fenwick – whose devotion to professional nursing led her to successfully campaign for nurses’ state registration, which was finally granted by parliament in 1919.

Isla Stewart, another famous Barts matron in the progressive nursing movement, next set about weeding out untrained nurses, increasing nurse numbers and reducing daily duty hours from 15 to nine. However, it was not until 1925 that the school of nursing appointed its first nurse tutor.

Nursing discipline during the years before the two world wars was severe. Bart’s long nurse uniforms were formal and starchy, and their wearing closely regulated.

A nurse could be expelled for not maintaining the correct measurement between her frilly cap and stiff white collar.

In addition, most sisters ruled their ward domains obsessively. Cleaning and tidying routines – still largely carried out by nurses – centred around the big moment when an important doctor and his retinue of medical students conducted ward rounds.

Next came Barts’ near miraculous avoidance of destruction during the WWII bombing raids on London, known as the Blitz, and recounted by nurses such as Betty Levack, who was there in 1941.

She said: “The square was white with ash, with bits of flame blowing about. Fifteen or more incendiary bombs fell on the hospital roof and were dealt with. If the wind had changed direction, Barts would have burnt to the ground.”

The late Winifred Hector, renowned nursing textbook author, former Barts tutor and principle nursing lecturer at London University, was a ward sister during those nights.

“Sometimes at night we nursed by the light of the burning city. During bombing raids, we told patients to put their heads under their pillows for safety. In the morning there were big holes and craters round the hospital,” she wrote.

St Bartholomew’s Hospital old fascia

In the post-war years, Barts’ traditions continued. At Christmas, carol-singing nurses traversed the wards in red capes.

A list of poor, lonely, older people would be invited to spend Christmas as in-patients to enjoy a bath, some excellent meals and unpack a Christmas stocking. On View Day – still held each May – a patient would be asked by a hospital governor if they were being well-cared for.

Meanwhile, on St Luke’s Day, the Lord Mayor of London and senior staff would proceed to St Bartholomew’s the Great church, where the hospital’s most junior nurse would lay a rose on Rahere’s tomb. There was even reputed to be a benign ward ghost in a brown tunic.

“It’s quite an honour to be working somewhere that fuses ancient history with developing modern medicine”

Edgardo Reyes

However, the 1960s and 1970s brought changes to Barts. The Salmon report’s new nursing career structure abolished the old post of matron; the first nursing degree course began at City University; male and overseas nurses were welcomed and senior nursing posts at the hospital were no longer held exclusively by Barts-trained nurses.

The organisation maintains a strong link with its history and its former nursing staff via the Barts League of Nurses. Elizabeth Wood-Dow is president of the league, which was founded by Isla Stewart in 1899.

Today, it boasts a rising membership of 2,000 and runs benevolent and scholarship funds and memorial services for Barts’ nurses.

Ms Wood-Dow said: “I’m proud and excited to be the league’s president during Bart’s 900^th anniversary year. And we feel that both our league and Barts as a centre of excellence have exciting futures.”

But she noted: “Some of our older nurse members inevitably get a bit nostalgic. For example, remembering their pretty uniforms, now replaced by tunics and trousers.”

Ms Robinson believes its former matrons, Ethel Gordon Fenwick and Isla Stewart, would approve of the professional standards displayed by today’s Barts nurses.

Ethel Bedford Fenwick

“Since converting to a specialist cardiac and cancer hospital in 2015, Barts has been offering nurses some excellent post-graduate training opportunities,” she said.

“For example, surgical care practitioners work closely with our cardiac surgeons, advanced care practitioners admit and discharge day patients. And we have a nursing research strategy, promoting clinical research to doctorate level.”

Ms Robinson also cited the recent launch of the annual Pam Hibbs Memorial Nursing Lecture, in memory of the hospital’s former chief nurse, Pam Hibbs, who devoted her career to good nursing care and pressure ulcer prevention.

“Pam established a weekly patient pressure sore audit across the trust, assessing why they had occurred and how best treated. Her legacy is that good basic patient care is the essence of effective nursing. Sadly, she passed away during the Covid pandemic.”

During the Covid-19 pandemic, Barts, like most hospital trusts, allocated its 53-bed intensive care unto to patients affected by the virus, noted Ms Robinson, who reflected further on its impact on nursing staff.

“Our historic Barts Square and fountain have always formed the heart of the hospital. So, during the pandemic, it was touching to see tired nurses removing their masks to relax under the trees after long shifts, or trying some aerobics with our physiotherapists.

“Unfortunately, some nurses are still exhausted,” she said. “But, as nurses must have done during London’s Great Plague of 1665, Barts’ staff rose to the completely-unexpected challenge of the pandemic admirably.”

So how does the latest generation of Barts nurses feel about the hospital’s 900^th anniversary?

Edgardo Reyes, a staff nurse from the Philippines, recently began working in Bart’s 22-bed thoracic centre, specialising in cystic fibrosis, and is keen to continue learning.

He said: “Nurses around me seem very excited about Barts’ 900^th anniversary, so it’s quite an honour to be working somewhere that fuses ancient history with developing modern medicine.”

Outside St Bartholomew’s Hospital