An oil painting of the Gibbs buildings [4]

Bart’s at 900

The world’s oldest hospital celebrates its nonacentennial


This article is taken from the April 2023 issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering five issues for just £10.

This year St Bartholomew’s Hospital celebrates its nonacentennial. At 900 years old, Barts, as it is affectionally known, has no seniors in the world of hospitals, having dispensed care on the same site in the City of London without interruption since the reign of King Henry I. 

Today, Barts (now part of the Barts Health NHS Trust) enjoys a reputation for excellence as a specialist cardiac and cancer hospital. On its creation, however, it was intended not as a place where patients were treated for illness and disease but as a place of restorative care, where the cold, sick and hungry were fed and given sleeping quarters. 

The hospital and its neighbouring priory were founded together in 1123 by Rahere, an enigmatic English priest who had enjoyed favour in Henry I’s court. Shortly after the White Ship disaster, in which the cream of England’s nobility (including the heir to the throne William Adelin) drowned, Rahere [1] embarked on a pilgrimage to Rome. 

Rayer’s Tomb’, (circa 1872). Monument to Rahere, founder and first prior of St. Bartholomew’s Priory and Hospital in 1123, in the church of St Bartholomew-the-Great, City of London. [1]

The shock of this national tragedy appears to have focused Rahere’s mind, and his act of penance is recorded in the thirteenth- century Book of Foundation, together with the story of him falling gravely ill in Rome and vowing to found a hospital should he recover. Then there is a terrifying dream involving an encounter with the winged Beast of the Apocalypse and the intercession of St Bartholomew giving instructions for Rahere to establish a priory, too. 

Rahere was true to his word. St Bartholomew’s Hospital and Priory were founded on waste ground at what was then called Smooth field (Smithfield) on the northern fringes of the City of London.

St Bart’s Gatehouse [2]

The hospital was both distinct from and dependent on the priory, its more powerful neighbour. It was administered on quasi-monastic lines, its proctors elected by the priory and its financial autonomy restricted. Gradually, it was able to assert its independence, but the complete break only happened at the Reformation when Henry VIII dissolved both institutions, selling off the Priory buildings but leaving the hospital intact and handing it to the City of London to run as a fully secular institution. 

This heralded a golden age for the hospital with its physicians and surgeons leading the way in an improved understanding of anatomy and physiology. One of these pioneers was William Harvey (1578—1657) who was the first to produce an accurate description of the circulation of the blood (famously developing his ideas by observing the horrors on the Civil War’s battlefields as Charles I’s “Physician in Ordinary”), but many others followed, and the hospital continues to hold an international reputation for excellence.

By the eighteenth century Barts had outgrown its accommodation. The site had a developed collegiate appearance — a series of courtyards, lined with, and connected by, an array of buildings of different dates. The hospital had started life as a place of shelter rather than medical care and the site reflected this, with private rented houses and lodgings sitting cheek by jowl with wards, laundries and other functional buildings. 

A perspective view by Gibbs [3]

There was now a need, however, to provide more up-to-date facilities both for the care of patients and for medical training. The governors had ambitions for a new hospital that would better reflect the prestige of the institution. They wanted buildings to compete in beauty and grandeur with hospitals in France and Italy — and were energised by recent, native projects at Guy’s and St Thomas’s as well as by Christopher Wren’s magnificent hospitals at Chelsea and Greenwich for the military and navy respectively. 

The first scholarly classical building to be erected at Barts was a new gatehouse [2], which was shoehorned into a row of seventeenth-century houses on the northern side of the hospital, facing Smithfield. Designed by a stonemason, Edward Strong junior, in 1701, the gatehouse features carved recumbent figures representing lameness and disease (based on similar figures which had adorned Bethlehem — or Bedlam — in Moorfields) together with a statue of Henry VIII. 

This modest but elegant structure had given the governors a taste for improvement. Finally, in the 1720s they found their man: James Gibbs (1682-1754) had recently completed two major London church commissions — St Martin-in-the-Fields and St Mary le Strand — both of which demonstrated a mastery of classical design, while incorporating novel ideas (such as placing of the tower centrally behind the portico at St Martin’s).

An oil painting of the Gibbs buildings [4]
North Wing [5]

Gibbs joined St Bartholomew’s Hospital as a governor in 1721 and offered his architectural services gratis [3] [4], no doubt sensing an opportunity to further enhance his reputation. His solution to the Barts problem was to clear away the majority of the existing buildings and replace them with an urbane classical courtyard — The Square — where four independent blocks, or “wings”, would house wards as well as the hospital’s administrative functions.

The medieval church was retained, framing one side of a north-south approach which was to lead from the Gatehouse to the Square, via an archway beneath the North Wing. Work began with the North Wing in 1732. The final block, the East Wing, was completed in 1760, after Gibbs’s death.

Remarkably, despite a number of nineteenth- and twentieth- century redevelopment proposals and the Blitz, three of Gibbs’s wings survive: the East and West Wings house outpatient facilities and the North Wing [5], which never contained wards, has the Great Hall [7], Hogarth Stair [8], the archive stores, and the Hospital Museum. To these treasures we can add the Italianate Library block of 1877 which houses the Pathology Museum [6].

Pathology Museum [6]

In terms of art and architecture, the North Wing is the jewel in the Barts crown. It was designed by Gibbs as the ceremonial heart of the rebuilt hospital, its art a projection of the hospital’s identity and ambitions. It was also a place to ensnare and captivate visitors and attract philanthropy. The walls of the Great Hall bear the names of 3,000 benefactors, painted in gold and framed in sober panels beneath the contrastingly exuberant decorative plasterwork of the ceiling. 

Great Hall [7]

The approach to the Hall is via one of the great staircases of England. The walls are filled by two vast canvases by William Hogarth (1697-1764) depicting biblical scenes and featuring characters seemingly plucked from the streets of eighteenth- century London — real people, with real ailments, seeking a cure. These paintings are powerful retellings of the hospital’s story by an artist who grew up in the surrounding streets and felt a deep connection to it. Like Gibbs, Hogarth refused payment for his services, hoping perhaps this very public display of his genius (and generosity) would encourage future patronage. 

Hogarth Stair [8]

In recent years, the North Wing has languished in institutional limbo. The building has no clinical function and so its maintenance has not been prioritised by the NHS. Grade I-listed, and home to the priceless hospital archives, its poor condition (right) led to the setting up of a Friends group who campaigned for its proper care. This led to the establishment of a new charity, Barts Heritage. 

A 150-year lease has now been agreed with the Hospital Trust and, following the award of a core grant of nearly £5m from the National Lottery Heritage Fund, Barts Heritage is close to raising the required £9.5m to begin a major programme of restoration both to the external fabric and the key interiors. 

The Sharing Historic Barts project will start in the summer of this year and will include a period of open public access to the conservation works. Visitors will be able to follow the progress of works at close hand. 

When finished, the project will make the North Wing widely accessible to the public for the first time in its history. The Hogarths and the Great Hall will be lovingly conserved in a way that will help visitors understand more about the rich history of the building and the hospital itself. This slumbering giant is set to re-awaken in 2025 when it will become a major new attraction in the City of London.

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