WHEN WAS THE HOSPITAL FOUNDED? 

St. Thomas’s was described as ‘ancient’ in 1215. It is named after Thomas Becket who died in 1170. It was probably originally part of the Monastery of St Mary Overie which was founded in 1100. So, it was probably built in the 12th Century. 

IS ST THOMAS’ THE OLDEST HOSPITAL IN LONDON? 

St Bartholomew’s Hospital was founded in 1123. If St Thomas’s Hospital was originally named after Becket it may not have been built until after his death in 1170 – although it would seem strange to call the hospital ‘ancient’ in 1215 if it were only 30 years old. The possibility therefore exists that St Thomas’s Hospital was founded in 1100 at the same time as St. Mary Overie, which would make it the oldest hospital in London (but try telling that to St. Bart’s!). 

DID THE HOSPITAL SURVIVE THE REFORMATION? 

No, the hospital was called ‘the bawdy hospital’ and closed down despite pleas from the City. However it was reopened by Henry VIII’s son, King Edward VI, and renamed St Thomas’s – but this time not after the “troublesome priest,” but Thomas the Apostle. Tudor spin doctoring?

WHY BUILD A HERB GARRET IN THE ROOF OF A CHURCH?

The parish of St Thomas’s Church was restricted to the Hospital and grounds so there was a close relationship between the Church and Hospital. Storage space was normally in basements, attics and garrets. Basements were inappropriate for Herbs because of dampness and rodents. Storing herbs in the oak beamed roof of the church meant excess moisture could be absorbed in the wood and also offered protection against vermin. Experience shows it is a good place to dry herbs. The Apothecary’s offices were also further down St Thomas’s Street.

WHY WAS HERBAL MEDICINE USE?

Before the development of the chemical industry, virtually all medicines were made from natural plants. The use of herbs in St Thomas’ Hospital is first recorded in the Elizabethan period: a time of major advancements in herbal medicine, but also one where earlier superstitious beliefs prevailed. It was recorded that in 1605 that a bath for a woman in Judith ward in the Hospital was prepared with herbs and sheep’s heads.

During the programme of restoring the space in the 1950s, poppy heads were discovered in the rafters. Hooks and ropes in the roof provided further evidence of its former use.

WHAT IS SNAIL WATER?

In 1703, the Hospital appointed royal physician Richard Mead. He regularly published herbal preparations, including Snail Water for venereal disease. Included were ‘Garden Snails cleansed and bruised 6 gallons and Earthworms washed and bruised, 3 gallons’.

Venereal disease was a common ailment at St Thomas’. As well as strict segregation between general male and females, sufferers from venereal diseases would would be further separated from and treated in the ‘foul’ wards.

HOW WERE LEECHES USED IN THE PAST?

Live leeches.

The medicinal leech has been used for thousands of years in the common practice of bloodletting: the loss of blood was more gradual and less of a shock to a patient.

Leeches continued to be used prodigiously in the nineteenth century.

At St Thomas’ Hospital they were very much in favour with both physicians and surgeons. In 1820, 28,850 were used, escalating to over 50,000 in 1822. In 1823, 54,650 leeches were purchased at a cost of £251 9s 6d (over £10,000 today) which was roughly 8% of the hospital’s expenditure on all medical and surgical supplies.

Treatment for a case of gonorrhea in the 1820’s required the daily application of 12 leeches onto the patient’s penis.

Today leeches are used in restoring venous circulation following reconstructive surgery.

WHY BUILD AN OPERATING THEATRE IN THE ROOF OF A CHURCH?

Plan of St Thomas’ Hospital, ca. 1840.

In 1821 operations were known to have been undertaken on Dorcas ward, part of the ward block for female patients, that was adjacent to the Old Operating Theatre. The Hospital Governors at the time reported this as unsatisfactory and half of the church roof space was converted into a purpose-built theatre to maximise light from above, and provide an ideal teaching area for the demonstration of surgical skills. Over 100 students could be attending an operation. To enter the museum today, you have to climb 52 spiral stairs in the church’s tower. Of course patients did not have to do this as the theatre was roughly on the same level as the ward.

DID THE PATIENTS COME UP THE SPIRAL STAIRCASE?

The Old Operating Theatre Museum, 1822.

No, there was a hoist in the stairwell to the Women’s Surgical ward in Frederick Block (now the Post Office). As the Theatre was roughly on the same level as the Ward it was relatively easy to get patients from the ward to the Theatre and back again. There is a possibility that the Garret itself was used as a recovery ward after 1822 when windows appeared to have been inserted in the Garret for the first time.

WHO WERE THE PATIENTS?

The patients admitted were generally the working poor from all parts of Britain. It was suggested that as the majority of the Hospital’s patients came from outside the local area, its demolition and relocation in 1862 would have little significant effect.

St Thomas’ in Southwark maintained its ancient policy to exclude anyone classed as “incurable” ie anyone with a contagious disease or a mental or terminal illness.

They refused admission on the basis that their condition may pose as a potential threat to others or were beyond ‘cure’. Almost all hospitals in Britain operated an equally restrictiveregime until the mid-eighteenth century.

Guy’s Hospital opened across the road from St Thomas’ in 1725, and admitted those previously excluded from the latter, uniquely allowed “lunatics” access to one ward. The link between the two hospital’s was severed in 1836 following a riot when a number of Guy’s students forced their way into the male operating theatre of St Thomas’. The police were called and the perpetrators fined.

Thomas Wakley, founder-editor of the Lancet medical journal, claimed Guy’s students had been victimised. He had been excluded from St Thomas’ and was full of resentment.

WHAT SORTS OF OPERATIONS WERE CARRIED OUT?

Surgical instruments with a memento mori (reminder of death).

Before the advent of anaesthesia and antiseptic surgery, it was not possible to operate inside the body, with the exception of lithotomy, the extraction of bladder stones. Therefore operations were limited  to those where post-operative infection would hopefully not be fatal: amputations, wounds, fractures, hernia and easily accessible cancers of the skin, etc.

In 1823 surgery for the first artificial nose at the Hospital took place on a 34 year old man: his nose destroyed from the vast amounts of mercury taken to treat syphillis.

During the operation he was obliged to often raise himself from the table to spit out the blood which got into his mouth.

Sawdust was used in theatres to absorb blood. In the 1970s, sawdust collected beneath  the floorboards of the Old Operating Theatre was so congealed with blood, it needed a cement cutter to get through it.

HOW QUICK WAS AN OPERATION?

As quick as possible as this was the only way of restricting pain! An amputation might be over in a minute, although an operation for removing a bladder stone might take up to an hour.

HOW SAFE WAS AN OPERATION?

Operations were potentially lethal mainly because of the risk of infection. Doctors before the 1860s and the work of Lister did not know that bacteria caused infection. So many patients died from infection passed to them by the Surgeon, his instruments, the watching students or even the operating table itself.

Many different estimates of the death rate exist but the Surgical wards at St Thomas’s had about an 11% death rate, although this is an underestimate as not all surgical patients had to be operated on, so a rate of about 20% may be a reasonable approximation.

WERE SURGEONS PROPERLY QUALIFIED?

It depends what you mean by properly! Before the end of the 19th-century, physicians were trained at University, while surgeons and apothecaries were trained by apprenticeship – in the same way that butchers, bakers and candlestick makers were trained. However, apprentices normally attended lectures, dissections and and operations. In the 19th-century laws were passed to regulate medical training.

‘MISERATIONE NON MERCEDE’ – WHAT DOES IT MEAN?

The inscription in the Operating Theatre is in Latin and can be translated as ‘For compassion not for gain.’

IS EVERYTHING IN THE OPERATING THEATRE ORIGINAL?

The shell of the Operating Theatre is original. The standings are reconstructed, while the furniture was acquired from various London hospitals and is of the correct period. The operating table came from University College Hospital and is made of deal

WHY WEREN’T THERE ANAESTHETICS BEFORE THE 19TH CENTURY?

There were. People in the Roman and the Medieval periods had access to substances that could knock patients out. The problem was that before experimental work on gases was done by Priestley, Humphrey and Faraday there was no reliable way of dosing patients safely. In other words anaesthesia was not used because it was unpredictable – often killing the patient or not working reliably. Doctors came to the conclusion that it was safer to do without it.

WERE ANAESTHETICS & ANTISEPTICS USED IN THE HOSPITAL?

Carbolic Spray used at Guy’s Hospital  (1841-1914).

Anaesthetic was first used at the Hospital in January 1847 – 25 years after the first operation in the Old Operating Theatre. It was in the male theatre on a patient with a ‘disease of the hand’. The inhalation caused ‘much coughing, quickened circulation and threatened congestion of the brain and lungs that it was not thought proper to continue the operation’.

The Hospital never benefited from antiseptic (killing or removing germs before they enter a wound) surgery to prevent infection. Hands and surgical equipment were rarely washed before operations and bandages were often reused. 

DID FLORENCE NIGHTINGALE WORK IN THIS OPERATING THEATRE?

Probably not, but her famous Training School for Nurses was set up at the Hospital on this site before it moved to its present site in Lambeth.

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