17th Century St Thomas’
‘That Noble Monument of Charity”
No hospital business was conducted at St Thomas’ between February 1665 and May 1666 due to the onslaught of the Great Plague. The pestilence had been a constant threat since the 14th century, but this final outbreak caused the deaths of up to 100,000 Londoners. According to a long standing policy, St Thomas’s ‘refus[ed] to intermeddle‘ with plague victims.
A few months after the plaque had died down, disaster again struck London in the Great Fire of 1666. St Thomas’ was again affected, as much of the hospital’s leased property in the City was destroyed. More losses followed from fires in Wapping, in 1671, and in Southwark in 1676. The Great Fire of Southwark directly threatened the Hospital. ‘That noble monument of Charity … But through the gracious mercy of God, and the indefatigable industry of the Magistrates [it was] preserved, though not without considerable damage.’ The various fires ensured that, for several years, the hospital was forced to operate with inadequate revenue. Some gains were made in 1670, however, when the City of London purchased hospital landholdings in order to widen the City streets following the Great fire of 1666.
18th Century St Thomas’s
While much of London was being rebuilt after the fires of the late 17th century, the governors of St Thomas’ argued that the present hospital was too costly to keep in repair and too small to accommodate all of the patients. A fund-raising campaign to rebuild St Thomas’ was led by Sir Robert Clayton, the President of the hospital, former Lord Mayor of London and member of the Drapers’ and Scriveners’ Companies. Clayton was supported by the other governors, among whom were Sir Christopher Wren and Thomas Guy (founder of Guy’s Hospital). By the early 18th Century the hospital was transformed into an elegant classical structure of stone and brick, constructed around a series of courtyards. Houses for the ‘resident officers’ of the hospital were also added. The new hospital now provided 272 beds.
The New Hospital Regime
By careful selection of patients to exclude the ‘incurable‘ or insane, the hospital was able to maintain a successful ‘clear-up‘ rate. In 1725, 4537 patients were ‘Cur’d&discharg’d‘ from St Thomas’s, 401 were ‘buried‘ and 662 were ‘under present care‘ . This total number of patients included those with ‘Sores, Broken Bones, Dislocations, &c‘ , who were treated by surgeons, as well as those suffering from ‘inward‘ diseases, who were placed under the care of a hospital physician. Typically, 3 or 4 surgeons served on the hospital staff, each receiving £40 per annum. Surgeons who cut for “the stone” received an additional £15 p.a.
Richard Austin, a surgical assistant in 1725, recorded the care that 59 patients received during his four and a half months of service. Most of these patients, ranging in age from small children to a 68 year old man, suffered from fractures or wounds derived from accidents. A number of others were treated for hernias, burns, tumours, gall stones and venereal disease. In order to gain admission to the hospital, individuals, other than accident victims who were immediately admitted, had to present petitions which stated their disease or disorder. Clients of the many hospital governors gained preferential treatment. Each Thursday, the ‘Takers-in‘ , including one surgeon, one physician and representative hospital governors, gathered to read and decide upon the course of action for each petitioner. Individuals with externally manifest signs of small pox, ‘the itch, scald head‘, or other ‘infectious Diseases‘ , together with those deemed ‘incurable‘ , were denied admission. Those declared as out-patients received, at best, a weeks supply of medicine.
Taken In Upon the Charity of the House
Except for the few petitioners ‘taken in upon the charity of the House‘ , all of those admitted as in-patients were charged. Their fees varied according to their illness: ‘Cleane‘ patients paid 2s 6d (12.5p), while those who the staff claimed to be ‘foule‘ (i.e., venereal diseased) were charged 5s (25p). ‘Cleane‘ and ‘foule‘ patients were also assigned to separate wards, with ‘foule‘ patients prohibited, upon threat of expulsion from the hospital, from entering any ‘cleane‘ ward. Segregation of males and females was also practiced.
Preparing patients for surgical operations required regulation of their internal constitution through particular diet. For example, before ‘cutting for the stone‘ patients were typically fed ‘gruell, salets, [and] pudding‘ for a ‘week or fortnight‘. On the day before their operation, they were given a strong purgative to ‘empty ye Intest[ine]‘ . Surgeons often consulted colleagues to decide whether a particular patient was ‘fitt‘ to withstand an operation. As patients often remained in hospital for several months following surgery, maintaining their diet was seen as an essential part of re-establishing their physical health.
Patients also received many externally and internally administered medicines during hospitalisation. St Thomas’ Dr Mead recommended the following cure for Venereal Disease, published in ‘Pharmacopoeia Pauperum‘ : ‘Take Garden-Snails cleansed and bruised 6 gallons, Earthworms washed and bruised 3 Gallons, of common Wormwood, Ground-Ivy, and Carduus, each one Pound and half, Penniroyal, Juniper berries, Fennel seeds, Aniseeds, each half a Pound, Cloves and Cubebs bruised, each 3 ounces, Spirit of Wine and Springwater, of each 8 Gallons; digest them together for the space of 24 Hours, and then draw it off in a common Alembick.’