St Bartholomew's Hospital, London

By 1420 the two institutions had become entirely separate. The Priory was closed as part of Henry VIII's dissolution of the monasteries in 1539, and although the Hospital was allowed to continue, its future was very uncertain as it had no income with which to carry out its functions. The citizens of London, concerned about the disappearance of provision for the sick poor, and alarmed at the possibility of plague breaking out, petitioned the king for the grant of four hospitals in the City including St Bartholomew's. Henry finally relented; near the end of his life he issued two documents, one a signed Agreement dated December 1546 granting the Hospital to the City of London, and the other Letter Patent of January 1547 endowing it with properties and income. Along with Bethlem, Bridewell and St Thomas', St Bartholomew's became one of four Royal Hospitals administered by the City. A governing body, or Board of Governors, was now set up to administer the Hospital, and there were paid officials including a Renter-Clerk, a Steward, a Porter and eight Beadles. The nursing staff consisted of a Matron and twelve Sisters, and there were also three Surgeons who had to attend the poor daily. Although a Physician had been provided for in the Agreement of 1546, the first Physician was not appointed until 1562.

The basic constitution of the Hospital remained the same until the establishment of the National Health Service in 1948, although the medical and nursing staff increased greatly during that time. Nurses, or 'Sisters helpers', were first mentioned in 1647. The only medieval building now remaining at St Bartholomew's is the tower of the Church of St Bartholomew the Less. Formerly a chapel of the priory, the church is now a parish whose boundaries coincide with the precinct of the Hospital. All the medieval hospital buildings were demolished during the eighteenth century rebuilding programme, carried out to the designs of architect James Gibbs. The North Wing, which contains the Great Hall, along with the East and West Wings are original Gibbs buildings and Grade I listed. The staircase leading to the Great Hall is decorated with two huge paintings by the artist William Hogarth, depicting the Good Samaritan and Christ at the Pool of Bethesda. The well-known Henry VIII Gate, through which one enters the Hospital from West Smithfield, is also listed and is slightly earlier than the Gibbs buildings, dating from 1702. Other buildings have continued to be added as the need had arisen, including Medical College buildings, nurses' accommodation and new ward blocks. The Fountain in the Square was added in 1859.

Among the many famous physicians and surgeons who have worked at Bart's are William Harvey, discoverer of the circulation of the blood and Physician to Charles I, who was appointed Hospital Physician in 1609, and Percivall Pott, the leading eighteenth century surgeon who gave his name to Pott's fracture and several other conditions. A portrait of him by Sir Joshua Reynolds hangs in the North Wing. A Medical School was gradually established from the end of the eighteenth centrury, but its foundation is generally attributed to the efforts of the surgeon and lecturer John Abernethy, who in 1822 persuaded the Hospital Governors to give the school formal recognition. The first Warden of the School was James Paget, later Serjeant-Surgeon to Queen Victoria, who allowed Elizabeth Blackwell, one of the pioneers of medicine as a career for women, to study at Bart's in 1850. After her departure female students were strenuously opposed and excluded until 1947. The nineteenth century also saw many medical advances which transformed health care. Bart's was one of the first hospitals to encourage the use of anaesthetics, making a great many more kinds of operation possible. Understanding of infection and the importance of antiseptic procedures in surgery were only gradually accepted at Bart's, but once adopted did a great deal to reduce patient mortality. The development of medical science, particularly in pathology and bacteriology, led to an increased knowledge of disease. X-rays were first used in the Hospital in 1896 and by the end of the century the first specialised departments had been created.

Also in the nineteenth century came the beginnings of more skilled nursing and a School of Nursing was founded in 1877. A notable early Matron was Ethel Gordon Manson, better known as Mrs Bedford Fenwick, who encouraged a high standard of training and campaigned for the state registration of nurses. Very soon the entire nursing staff was Bart's trained, and Bart's nurses have continued to enjoy a high reputation world-wide ever since. The Hospital remained open throughout the World Wars, although during World War II many services were evacuated to Hertfordshire and Middlesex. It has maintained its reputation for excellence in medical care, teaching and research; in 1954 it became the first hospital in the country to offer mega-voltage radiotherapy for cancer patients. Cancer services, particularly for children, are still a speciality today. Other notable medical specialities are endocrinology and immunology (particularly HIV/AIDS), while a Day Surgery Unit and state-of-the-art operating theatres were opened in 1991 and 1993.

In 1948 St Bartholomew's became part of the National Health Service, and following re-organisation in 1974 became the teaching hospital for the newly-formed City and Hackney Health District, a grouping including several other hospitals. In the late 1980s, the Government introduced the idea of self-governing hospital trusts within the NHS, and Bart's was planning to set up such a Trust wihen its future was called into question by the publication in 1992 of Sir Bernard Tomlinson's Report of the Inquiry into the London Health Service. This did not see Bart's as a viable hospital and recommended its closure. The Government's response to this report was published in 1993 and laid out three possible options for Bart's: Closure, retention as a small specialist hospital, or merger with the Royal London hospital and the London Chest Hospital. The threat to Bart's sparked an intense public debate and a campaign in which over one million people signed a petition to save the Hospital on its Smithfield site. After public consultation, in April 1994 the Royal Hospital NHS Trust was formed, amalgamating the three hospitals. In addition, Queen Elizabeth Hospital for Children later joined the Trust. The Medical Colleges of St Bartholomew's Hospital and the Royal London Hospital have also merged with Queen Mary and Westfield College. Bart's Hospital is now to remain open providing specialist cardiac and cancer care, whilst general hospital services will be concentrated at the Royal London in Whitechapel.