St Bartholomew's Hospital was founded, with the Priory of St Bartholomew, in 1123 by Rahere, a former courtier of Henry I. A vow made while sick on a pilgrimage to Rome, and a vision of St Bartholomew, inspired Rahere to found a priory and a hospital for the sick poor at Smithfield in London. Rahere was the first Prior of the Priory of Austin Canons in Smithfield and supervised the Hospital House. In 1170 a layman Adam the Mercer was given charge of the Hospital as the first Proctor and a certain amount of independence from the Priory was achieved. After 1170 grants were received by the Hospital, which attracted valuable endowments of property.
However, relations with the Priory remained problematic throughout the medieval period. There were conflicts over several issues, including the admittance of brethren, lay-brethren and sisters who cared for the sick in the early medieval period. Gradually the Hospital became independent, and was using a distinctive seal from about 1200. By 1300 the title of Proctor used for the head of the Hospital was dropped in favour of Master. By 1420 the two institutions had become entirely separate. As well as caring for patients from the City of London and the country the brethren looked after small children and babies from Newgate Prison, and orphans. By the 15th century a school had been formed with a latin master, and a night shelter for pilgrims and travellers was provided.
The Priory of St Bartholomew was closed during Henry VIII's dissolution of the monasteries in 1539, and although the Hospital was allowed to continue, its future was uncertain as it had no income. The citizens of London, concerned about the disappearance of provision for the sick poor and the possibility of plague, petitioned the King in 1538 for the grant of four hospitals in the City including St Bartholomew's. In 1546-1547 St Bartholomew's Hospital was refounded as a secular institution and a Master and Vice-Master, Curate, Hospitaller and Visitor of Newgate Prison were appointed. Henry issued a signed agreement dated December 1546 granting the Hospital to the City of London, and Letters Patent of January 1547 endowing it with properties and income, comprising most of its medieval property. Along with Bethlem, Bridewell and St Thomas', St Bartholomew's became one of four Royal Hospitals administered by the City.
In 1546 four Aldermen and eight Common Councillors of the City of London became the first Governors of the Hospital. They administered the Hospital and appointed paid officials, including a Renter-Clerk, Steward, Porter and eight Beadles. The Board of Governors also divided work amongst themselves. Four were Almoners with responsibility for admitting and discharging patients, ordering stock and checking bills. They worked closely with the Treasurer, responsible for Hospital finances. The weekly meetings of the Treasurer and Almoners developed into an executive committee in the 19th century, reporting to General Courts of the Governors, and became the Executive and Finance Committee in 1948. Other Governors were Surveyors of the Hospital buildings and property. The first professional Surveyor was appointed in 1748. Some Governors had responsibility for inspecting financial statements, and worked closely with the Treasurer and Almoners. Their meetings developed into the House Committee in the 18th century, dealing with leases, appointments and reports of the Hospital Surveyor. The House Committee met frequently and eventually came to manage the routine running of the Hospital. The General Courts of Governors were held two or three times a year. The basic constitution of the Hospital remained the same until the establishment of the National Health Service in 1948. The Medical Council was formed in 1842 to give expert advice to the Governors, and comprised all physicians and surgeons serving the Hospital.
The nursing staff on the Hospital's re-foundation consisted of a Matron and twelve Sisters, and there were also three Surgeons who had to attend the poor daily. Nurses, or "Sisters' helpers", were first recorded in 1647. Although a Physician had been provided for in the Agreement of 1546, the first Physician was not appointed until 1562. A Medical School was gradually established from the end of the 18th century, but its foundation is generally attributed to the efforts of the surgeon and lecturer John Abernethy, who in 1822 persuaded the Hospital Governors to pass a resolution giving formal recognition to the School. Bart's was one of the first hospitals in the 19th century 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 established. A School of Nursing at St Bartholomew's 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.
All the medieval hospital buildings were demolished during the 18th century rebuilding programme, carried out to the designs of architect James Gibbs. The staircase leading to the Great Hall in the North Wing is decorated with two huge paintings by the artist William Hogarth. Other buildings have continued to be added as the need has arisen, including Medical College buildings, nurses' accommodation and new ward blocks.
The Hospital remained open throughout the World Wars, although during World War Two many services were evacuated to Hertfordshire and Middlesex. In 1954 it became the first hospital in the country to offer mega-voltage radiotherapy for cancer patients. Cancer services remain 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, which included several other hospitals. In the late 1980s, Bart's was planning to set up a self-governing hospital trust when its future was called into question by the publication in 1992 of the Tomlinson Report of the Inquiry into the London Health Service. Bart's was not regarded as a viable hospital and its closure was recommended. The Government's response to this report (Making London Better, 1993), 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. This produced an intense public debate and a campaign to save the Hospital on its Smithfield site. The result was St Bartholomew's remained open, and joined with the Royal London and the London Chest to form the Royal Hospitals NHS Trust in 1994, which became Barts and The London NHS Trust in 1999. St Bartholomew's Hospital now provides specialist cardiac and cancer care. The Medical Colleges of St Bartholomew's Hospital and the Royal London Hospital merged with Queen Mary, University of London in 1989, to form the Central and East London Confederation (CELC). Following the recommendations of the Tomlinson Report (1992) and the governmental response to it (Making London Better, 1993), the colleges united with Queen Mary and Westfield College in December 1995, to become known as Barts and The London School of Medicine and Dentistry.
