Gresham College Lectures

A History of Barts, Britain's Oldest Hospital

May 10, 2023 Gresham College
Gresham College Lectures
A History of Barts, Britain's Oldest Hospital
Show Notes Transcript

St Bartholomew’s is the oldest hospital in England still operating on its original site and will celebrate its 900th anniversary in 2023.

This lecture tells its history, from 1123 to today, via its people, buildings and the events that defined this iconic medical institution. Sir Thomas Lauder Brunton's work in vascular pharmacology, Sir James Paget's discovery of bone and breast disease, and Ethel Gordon Fenwick’s campaign for registered state nursing are all important elements of Barts’ history.

A lecture by Charles Knight OBE recorded on 4 May 2023 at Barnard's Inn Hall, London.

The transcript and downloadable versions of the lecture are available from the Gresham College website:

Gresham College has offered free public lectures for over 400 years, thanks to the generosity of our supporters. There are currently over 2,500 lectures free to access. We believe that everyone should have the opportunity to learn from some of the greatest minds. To support Gresham's mission, please consider making a donation:


Support the show

900 years is a scarcely fathomable depth of time.And very few human endeavors or institutions endure that long.And in order to do so, you need skill, perseverance, but also moments of great good fortune.In 1666, the flames of the great fire looked against our walls.And if on the evening of Tuesday, the 4th of September, the wind had not died down, uh, I would not be standing here telling you the history today.So, uh, it's a story of art and architecture, a story of science and politics of heroes and villains, of moments of, uh, uh, rebirth after moments, uh, where the hospital fell into decline.But I hope to show that most of all, it's a celebration of that vision of care, compassion, and service that our founder had nine centuries ago, and results in a hospital that's provided nine centuries of healthcare free at the point of delivery ever since.Uh, to try and cover 900 years in 50 minutes is a tall order.I have approximately three seconds per year, and, um, the journey will need to be rapid with few digressions, uh, but I hope to convey something of the history and spirit of the organization.Uh, so that disclaimer has already cost me about a decade.So, uh, let's press on.It's 1123.Uh, London ha has a population of 15,000, which is about the size of modern penance.Henry, the first, the fourth son of William, the conquerors on the throne has been on the throne for 23 years.Despite her life expectancy of about 30, there will be some people living who remember the Anglo-Saxon rule before the Battle of Hastings.And the Doomsday Book, uh, has just been completed.There won't be Parliament for another century.And Henry's son, William Alene, has just been lost in the white ship disaster two years before plunging England into a succession crisis and subsequently into what became after his death, known as the anarchy.So enter on this stage, our first protagonist sewing pillows.Upon all elbows, he drew to friendship with himself, those whom he had soothed with jokes and flattering, and responded to the goings on of the court with jocular flattery desired to attract himself with ease, the hearts of many.There he made it his business all day long to attend spectacles, banquets, jests, and the rest of the trifold of the court.And with shameless face be taking himself to the suite now of the king, now of the nobles, he assiduously employed a complacent that should please them and obtain with greater ease, anything that it pleased him to speak.So this is Rahi, our founder, and whilst that description sort of drips with class and ecclesiastical snobbery, uh, you do get a glimpse of a rather charming, very manipulative, low born chancellor on the fringes of power.And who on the face of it, is not someone who would, we would be remembering 900 years later or who would have anything to do with a hospital.But that all changed in a life moment when he went on a pilgrimage to Rome, possibly connected with the white ship disaster.And there he fell ill possibly with malaria, and prayed to God that he might be saved, and that if he did, he would do something for the poor of London.He would found a hospital, and he recovered and was saved, and then had a vision of St.Baru.And St.Baru said to him, know me.To have truly, to have chosen a place in the suburbs of London at Smithfield, where in my name thou shall found a church in hospital where I do thou boldly, neither at the cost of the building, doubt, the not direct build and end this work.So there are two things about St.Baru, the apostle first is that he displays an enviable knowledge of the potentials of the London property market for someone that never traveled north of Armenia.Uh, but, and secondly, he describes what might be called a robust management style.Uh, but having been, uh, played alive, as you can see, I think we can forgive a certain briefness of manor.So Rahi did found the hospital.He, the hospital, took about 10 years to build outside the walls of London in Smithfield or Smithfield before its cleansing was very foul and like a marsh or times abounded with filth and muddy water.Where here now lies in his lovely tomb in St.Holies, the great and, uh, the hospital and Pari were run jointly by him nearly to his death in, uh, 1143.Thanks to our amazing records, we can actually identify a patient from the time that Rahi was running the hospital, a carpenter of Dunwich by the sea called Alpha, him professing to himself to be contracted in twisting in all his limbs, had prayed to St Bar.He was brought to London.He gradually recovered first using his hands in women's work, such as the making of a disc stuff.I didn't write this then when his other limb strengthened Ewing timber with an ax, squaring it with a chopping ax until he was able to resume work as a carpenter.So a cure, rehabilitation, financial independence, a great result.The interesting thing about this is, of course, the town that he came from Dunwich, uh, is now, uh, under the North Sea.It was a prominent port in East Anglia, but has now been entirely reclaimed by the waves.And although, uh, we never like to lose a source of referral of patients, uh, I think, uh, once they're subaquatic, we we have to let them go.So at RA's death, the, there was a split in the leadership.This document is, uh, the charter from Rahi during his life to Hano the Clark to take over the running of the hospital.And Thomas of Ossis was, uh, put in charge of the prairie, but the hospital was under the control of the priority.And there was then centuries of, uh, conflict between the hospital and the priority for control, mainly of money, and the ability to appoint positions.The hospital indulged in repeated bouts of Pope bothering about this.And, uh, eventually in, uh, 1223, the Bishop of London, uh, adjudicated the hospital, gave up its rights to a betar, but obtained crucially, the absence of a prior veto over its appointments.By 1371, the Betar was there, although its bells had to be rung only after the priorities had been rung, a cemetery, a seal, and full self-governance was obtained.And this was confirmed, uh, by the Pope, uh, a century or so later.And from that date, the hospital has a master, not a proctor.We know a lot of this because of this wonderful document by John Cox.The car car is copies of all the important documents of the hospital gathered together.And this is an amazing document that tells us so much about the history at this time.Remember, this is a religious institution.The staff was the master, eight brethren and sisters.And that's why we call nursing sisters, sisters to this day.These are some of the marginal you see in the cartel, reflecting, uh, a lively sense of humor on the part of John Cock as he doodled away, uh, these rather wonderful figures.John Cock incidentally, was a witness to the coronation of Henry the Fifth, the victor of Acor, and reported a day of great reign.Uh, we hope his successor has better luck in two days time, <laugh> Johanna's de Murfield was a chaplain to the hospital and assembled an encyclopedia of contemporary medical knowledge.His advice goes from the sensible.The physician should weigh diligently in his mind.Everything that demands consideration to be confident, it will produce advantageous results for he does amiss in prescribing a medicine of which he's in doubt as to whether it be dangerous or beneficial.We should all live by those rules today.His advice was also laconic has seemed here, grind up hebe with a juice of mint, spread it over the forehead.If the patient doesn't sleep, he'll die.Uh, but sadly, also, frankly, disgusting remedies were in place, uh, particularly odious was, uh, the cure that was to take a whole lot of dead puppies and boil them, and then induce the patient, uh, to take a bath in that, I suppose you call it puppy juice.Um, that's likely to have done nothing for the canine or human, uh, health of Smithfield.John Waker is the next figure.Uh, of note, uh, already when he took over, the hospital was 300 years old.Uh, he increased and better managed the hospital's properties.He was assiduous in financing the hospital.He, uh, managed to get the hundred shillings left by Dick quitting the famous, uh, London there, uh, for, uh, relief of the poor, which he then promptly spent on a new South gatehouse.I guess the, uh, the poor must have been relieved and to have such a nice gate to walk through.He also secured water pipes from the leafy hills and springs of Islington.He opened a school in the hospital precincts and attracted a number of high status, highly educated tenants to live within the hospital grounds, uh, at increasing the income and the reputation of the place.It's probable, but not definite, that it is due to John Wakening that we have inherited our, our celebrated shield.Everything then changed.Henry VII dissolved the monasteries, and this world of prior and hospital was shattered.Uh, then there were only four hospitals in London.Barts St.Thomas is, a few of you may have heard of, uh, St.Catherine and the Sevo, which I suspect you haven't.The Sevo Hospital failed to be rescued, became a brothel, a prisoner barracks, and then burnt down.So that was what we were staring at down the barrel.Uh, in, uh, the 1530s Bartz incidentally, was valued at the third wealthiest at 371 Pans Gresham to the rescue, not Sir Thomas, who's here, but his, uh, and who founded this, uh, wonderful college.But his father, sir Richard Gresham, petitioned Henry VII to, uh, uh, for the city would take over the running of the London hospitals.He was refused.There was more lobbying from the city to try and take over the running of the hospitals.Uh, but by the 1540s after the prairie had been shut, the hospital, although open, had no funds and was in dire straits, they were reported to be running short of bedsheets because so many had been used as shrouds for their patients to be buried in.Just in the nick of time in 1547, they'd managed to get Henry to refund the hospital, uh, and endow it with much of its further property, being enormously grateful to him for returning what he'd just, uh, stolen.And this was just in the nick of time, because Henry died literally a few days afterwards.Okay?The new administration has now moved from the church, the ecclesiastical model to the city.There was a board of 12 governors established with four alderman and eight common counselors.Uh, the governors appointed a matron, 12 sisters, eight beetles, and three surgeons to care for a hundred patients.This marks the high watermark of our beetle to surgeon ratio, which has substantially diminished in in the subsequent years.This also marks the moment where we move from just nursing care and supportive care to, to medicine and surgery.1547, a surgeon called Martin was paid 10 shillings to remove a bladder stone.That's the first operation recorded in St.Bar use in the 1560s.Uh, the first phy physician is appointed, but due to the excellent management of the city, merchants, Barts flourished.It became wealthier again.Its buildings were repaired, and advanced care was given for the time.This man, we owe a lot to Thomas Vicary, who was the first superintendent of the hospital, seen here receiving the new charter biking Henry viii.He must have been a political player of some, some skill.He survived being Sergeant Surgeon to Henry vii and his three, uh, uh, three children who reigned, uh, a very turbulent time.So one imagines that it was largely due to Thomas Vicary and the support of the city that we survived at all.So this golden age, as we emerge into the Elizabethan era, produced some really, uh, distinguished people.John Keys, who went on to fund, uh, the medical college in Cambridge, Timothy Bright.This is interesting.Wrote, uh, treaties on Melancholy, which is the first psychiatric text to be published in this country.But at the apex of all our alumni stands, of course, William Harvey, who discovered the circulation of the blood, possibly one of the greatest medical, uh, scientific discoveries ever.He managed to do this while being physician to the royal family, and also physician to the hospital for 34 years.So, a consultation with Harvey, this is what outpatients was like in the Great Hall.Once a week, Harvey would sit enthroned in his purple cap and robes, and the arthritic apoplectic, paralyzed poxy and jaundice and syphilitic were brought in, uh, one by one by the sisters.Sometimes on stretchers, their pulse and urine were examined.And then Harvey would decide whether it was a medical case, and he would instruct the atheris or a surgical case, and he would instruct the surgeons.This model of outpatient seems to me to be ripe for reintroduction, <laugh>, particularly the throne element.Uh, but, uh, I, I, I don't think the surgeons will, will really appreciate it.These are Harvey's rules, and again, reflect the real dominance of the physician at this point.So only curable patients, uh, were to be admitted with a limited length of stay.They were out if they were, took them and take their pills.They shouldn't lurk here for relief of only slight causes, that all such as our certified, incurable, scandalous, or infected shall be put out of the house.Surgeons were under tight rain.Some would argue they should still be <laugh>.Uh, they should notit admit patients they don't want to treat, and they must basically ask the physician's permission to do almost anything as per as, as per the apotheker.So about 400 patients a year recovered under this regime, probably despite most of the treatment.This is a, this is an avocation.Always let blood in cases of great distress until the patient faints.Uh, when the inmate was deemed well enough, there was a rigorous discharge process, which is a little different from today.He was presented kneeling to the physician in the Great Hall, in front of the throne, and waited to be pronounced cured.He then gave praise to God and the hospital staff.He was given money, clothes, and a passport and sent on his way.Again, all this was to change.If you imagine Harvey's Hospital, it would be, uh, quite similar to one of the older Oxbridge colleges, uh, slightly ramshackle old buildings with grass squares in the middle, lots of tenements, maybe, uh, people living and trading within the hospital.The governors, as, as the 18th century approached, uh, wished to do away with all that and build a modern hospital.And James Gibbs, the architect, responsible for St.Martin's in the field, and the Radcliffe Camera was appointed to carry out that work.And his hospital is really the hospital we see today.So the North Wing, the administrative block was built first, and then Wards built, uh, in a quad triangle.This nice print here is dedicated to John Tuff, the, the treasurer at the time, and indeed has his coat of arms, as well as those of the hospital.The print is dedicated to him.This was a mistake.John Tuff went bankrupt and absconded to France with 4,064 pounds of the hospital's funds, which was an absolute fortune, probably enough to build one of the wings.Uh, so that caused a scandal and considerably delayed work on the East Wing.Uh, as you know, from the, uh, the Ratcliffe camera, John Gibbs loved Bath Stone, the hu honey colored, uh, effect it gives, but unfortunately, they built that crumbled in the London Air and had to be subsequently replaced.Interestingly, if you visit the one place, you can see the original Bath stone is, as you go through the gateway, you can see the honey colored stone there and the Portland stone that had to replace it.But this was built the Great Hall, which I'm delighted to say.Thanks to the hard work of our charity parts.Heritage is now going to be subject to an 18 month 10 million pound restoration project, starting in a few months time.This magnificent building was a machine to, uh, take money from rich people and then record how much money they'd given on the walls of the hospital, and it was highly effective.Let's look at some of the, uh, figures, uh, of this time.There's a few little vignettes here.Uh, John Hunt was a, uh, business as a night man and rubbish collector, and he was the man that emptied the CS suspects of the hospital.His prices were reasonable around the corner, uh, from the front of the hospital, it was William Salmon king of the quacks, who much to Harvey's, uh, discussed if he'd been alive.Then, uh, was selling me medicines, uh, unapproved to the patients and, and the poor of the area.One can imagine a very, very large market for his elixir of life, and a slightly more restricted market for his other product, which was Nymphomaniac Lemonade.<laugh>.Barbara, uh, Adam was a Barbara who worked under the direction of the surgeons shaving patients.Sadly, for Barbara in 1671, she was kicked out of her job in her home for, uh, improper conduct on diverse occasions.The details, uh, are not related.Just in the corner.Ran, uh, from the hospital.Marion Ann Hogarth ran a making business.They have a very superior business card because their elder brother William, about whom more later, uh, designed it.And all the Hoar family were baptized and St.Bar used the great.So, going up to the Great Hall, the governors of the hospital wanted something really impressive as you went up the stairs.And they initially, uh, they initially wanted a, an Italian painter called a Coney to produce these great canvases.Unfortunately, a Coney was Catholic, foreign and expensive, and what they wanted was someone Protestant, English, and cheap.And after a certain amount of lobbying, Hogarth got the job, and in fact, did it for nothing, becoming a governor of the hospital instead of payment.And the result is probably still the most spectacular thing we have in the hospital.Never fails to get a gasp from visitors.This is Christ at the Pool of Bethesda and the Good Samaritan Hogarth's Masterworks, which Grace Hill Hospital to this day, and are in good condition, but will be in better condition in about 18 months around this time.We also played a small but important part in the abolition of slavery.Jonathan Strong was an enslaved man who was brought to England by his master, and was so badly beaten and abused that as Jonathan said, I could hardly walk or see my way where I was going.Uh, when I came to Grandville Sharp, and he saw me in that condition, he took me into St.Bar Hospital for four and a half months after he was discharged from hospital, the, uh, Jonathan's master attempted to regain ownership.And the subsequent court cases, which Grandville Sharp fought against that established the legal precedent that slavery was not legal in England.And that was a, a great moment in, in the, uh, in the abolitionist movement.Subsequently.So we now come to some, uh, 18th century, uh, 19th century, uh, uh, stars.Percible pot.A real prince among surgeons has so many eponymous syndromes named after him that I won't recite them.Now, a friend of Dr.Johnson and Garrick, he, uh, is the first person to report an industrial cause for cancer.This, unfortunately, to describe it, was carcinoma of the scrotum in young boys sent up Chi chimneys naked to clean them.That gives a dark side to the world of Hogarth and what we are talking about.Uh, but, uh, part was the first to recognize that the ash and and grit in the, in the chimneys was causing this.And subsequently, legislation was passed to end, uh, this barbaric practice.Next is John Abernethy, who really created medical education at Barts.He was a, a much loved but acerbic man, a workaholic who spent his wedding day on the wards.He was famously, uh, extremely intolerant of the wealthy, worried well, uh, he once told a a well upholster duchess that she didn't need a surgeon.She needed a skipping rope <laugh> a, uh, a Rubicon city worthy.Uh, when asked how he could cure his gout, uh, was told to live on six months a day and earn it.And, uh, hyper conks were, uh, directed to a Dr.Robertson in Inverness, uh, who did not exist.<laugh> John Abernethy also, uh, invented a biscuit.Uh, it's a kind of digestive biscuit with some caraway in it.It's still popular north of the border.If you wish to honor this man and age your digestion, you can get six packets for 13 pounds, 15 on Amazon.I encourage you to do so.Next is James Paget, who was born in relative poverty in Yarmouth.Uh, he identified the cause of, uh, a roundworm infection while still a medical student and really founded medical pathology in this country.He ended up a baronet and, uh, surgeon General to Queen Victoria.And today the Yarmouth Hospital is named James Paget in his honor.So, as I said, medical education begins with Abernethy.This is a certificate that Abernethy would give to students, uh, saying they'd, uh, completed their course.And rapidly Barts became the largest medical school in London.A few, uh, slightly more odd characters.So first we have Michael Farnell, who ended up, I can assure you, as a very distinguished surgeon general in the Indian Medical Service.He was a student at St.Beth Hospital.And the reason he's interesting is that he, he kind of discovered chloroform, uh, his, uh, his, his activities really lies somewhere on the spectrum between drug abuse and scientific inquiry.He says in 1947, I was very much my own master there, and I used to amuse myself by taking sulfuric ether and producing insensibility.The pharmacist became alarmed and gave orders he was not to be allowed anymore.Ether.He explored the pharmacy further and found a way on a back shelf, a neglected dusty bottle labeled Chloric Ether chloroform.I took the cork out and smelt it.It seemed very nice, so I took it upstairs and inhaled it.I found it sweet and very pleasant, and soon produced a certain degree of insensibility.I was much struck with it not producing the suffocation irritation and choking feeling Ethan did.Uh, he then mentioned it to the surgeons, and it actually was apparently used in a few operations at St.Hol.But as ever, if you don't write up your results, you get nowhere in medicine or science.He did not.And of later that year, James Young Simpson, uh, announced the discovery of chloroform anesthesia.Uh, the next is a real Villa William Palmer abouts alumnus, uh, the Prince of Poisoners, described by Dickens as the greatest villain ever to have, uh, uh, been in the, uh, in front of the judge at the old Bailey.He poisoned multiple people, including members of his own family with stricken and other poisons.Uh, the story is as though when he was approaching the gallows and perhaps not quite fully comprehending the process that was about to happen, he glanced down at the track door and asked, are you sure that's safe <laugh>?Uh, the last is, of course, WG Grace, who needs no introduction.His advice to medical students was not to read too many books because it spas your eyesight for cricket.<laugh> nursing, nursing before, uh, this era, uh, was, uh, uh, a poorly regarded untrained, uh, position with involving much manual labor.And St.Baron Use Hospital was, was really at the forefront of trying to change that into the noble profession that it is today.Uh, so the first medical, sorry, student nurses were started in 1877.Ethel Bed, Bedford Fen matron at the hospital was a lifelong campaigner for the state registration of nurses.And, uh, rewarded with state registered nurse number one.Isla Stewart also campaigned for the state registration of nurses.This is a formidable figure, I think, from her photo and a very formidable statement for someone of that era, A nurse's position to the world is that of a woman wishing for independence, willing by her own hands to obtain it and maintain it, and have a profession owing no man anything.She founded the Barts League of Nurses, which flourishes to this day.Uh, and amongst other things, uh, Bartz instigated the International Council of Nurses, which was the first international women's professional body of, of, of all time.So the world was changing radically.Although, as you can see from this watercolor to this photo, uh, 70 years apart, they may appear almost, uh, identical.The world was changing rapidly.So in 1800, the hospital was still slightly in the dark ages.It was getting through 96,300 leeches a year from a huge aquarium in the dispensary at a cost of seven shillings per hundred leeches.And this rather sorry looking object, uh, was, uh, actually for, to allow medical students to tropan practice tropan.But it bears unmistakable signs of his principle use as a football, uh, a slightly lax attitude to medical education at the time.By 1900, the world has utterly changed, uh, nearly two and a half thousand operations occurring at St.Baris with half the mortality due to anesthesia.And as sepsis, we see the beginnings of subspecialty ophthalmology, ear, nose, and throat gynecology.By 1872, we have 676 beds, which is very close to what we have now, and very large amounts of activity going on.Uh, this is worth, uh, as, as we have a large heart center at Barts, it's worth men mentioning.So, William Lauder Brunon physician here, uh, for 33 years, he was the first to describe an effective treatment for angina cardiac pain.And again, he did this very early in his career, uh, as a house physician.

Uh, he says, uh, the pain came on as usual at 3:

00 AM a few drops of nitrate of am were put on a towel and inhaled by the patient.The pain disappeared almost simultaneously with the other symptoms.Uh, it's interesting to note that this was his seventh choice after trying bleeding brandy ether, ammonia, digis, and Lilia.One hopes not sequentially in the same patient at the same time.As we enter the 20th century, we see, uh, senior doctors were still unpaid generalists, largely, uh, who had to maintain their living through private practice or teaching.Uh, but, uh, towards 1930, uh, the South Gibbs' south block was, uh, transformed into the King George, the fifth block with modern operating theaters.And by 1936, Barts was the first hospital in the country to offer mega voltage radiotherapy.It's also worth, uh, recording.Uh, Maisie Holt, as you can see, immensely long-lived, uh, but medical psychologist at Barts in mid, mid of last century, who initiated the first effective treatment for dyslexia, which was then known as word blindness.Uh, so nursing changed radically as well.Uh, nurses still had to leave the profession on marriage in the 1950s.And the rules, uh, are pretty, uh, strict and draconian, all nurses to be quiet, orderly, punctual, obedient, and behave with dignity.By the, uh, late sixties, uh, we had the start of degree courses for nursing, uh, and a real explosion in, in the academic and scientific training.So, uh, as you all know, the NHS started in 1948 and, uh, initially, uh, Barts coped with that change from being a charitable organization to being a state run institution.Uh, very well.There were no obvious problems that all changed in the early nineties with the publication of the Tomlinson Report, uh, which, uh, said unequivocally that Saint Bar's Hospital was not viable and should shut.This led to a huge campaign, uh, and part of that campaign, uh, was to publish this letter from the filmmaker and artist Jerry Jarman, who was then si sadly, dying of AIDS on the hospital walls.Sir, I have been here now for two weeks.I escaped to the 18th century courtyard and read in the Pavilion to the sound of the Pon before retiring to the hospital Church of St.Baru, which itself is cool and filled with the peace of time.Without our past, our future cannot be reflected.The past is our mirror.Every profession has a history, and the medical profession starts here to shut.Barts would be a crime against the past and against the metropolis, which needs its great institutions and would be impoverished without them.Barts is my second home, and my life here is cherished powerful support such as this from the city, from our, within the hospital, from our alumni, managed to save the day.And as with the incoming new labor government in 1997, Frank Dobson of two St.Barts Sainted memory, uh, made the decision to keep the hospital open.He's rumored to have said they treated the arches of Acor here, and I'm damned if it's gonna have a plaque saying, closed by Frank Dobson.We then had another fairly existential threat having been saved in 2006, when the treasury announced on the 23rd of December, a good day to bury bad news, uh, that it was not going to go ahead with the PFI refurbishment of the hospital.That, uh, again, ne led to a huge campaign to make sure that that went through, which again, was successful.And the works at Barts, um, started in 2010.Uh, this is an aerial photo.Uh, for those of you that have been to Barts, you'll recognize, uh, the quadrangle here, Gibbs' quadrangle.But the huge building, uh, is the new, uh, pfi.And I think it is a great building because when you are in the square, you look at it and it really doesn't seem that different in scale and size to Gibbs' blocks.But you can see from the air just how vast it is.And it is a wonderful facility.And, uh, it, I think, fits in with the environment of the city around it incredibly well.It provides a light, spacious, airy, modern hospital, uh, in, in this ancient for this ancient institution.More recently, uh, the Maggie Center has been, uh, completed at Barts a beautiful space again for cancer patients and their families.And, uh, a year ago, the Nuffield Hospital at St.Barts was completed, uh, again, refurbishing, uh, some buildings that were, had got into a terrible state.And it's worth reflecting that after that decision to save bots, there has been around about half a billion pounds worth of investment in the site.A real, I hope, vote of confidence for its long-term future.Uh, a real manifestation of our commitment.Some of those are PFI contracts on 30 years, and we're leasing the building.But if you are been around for 900 years, 30 years is a, a mere bagatelle.Uh, they'll be our buildings very soon.Interestingly, James Gibbs is rebuild cost, as I said, about 5,000 a block.And in today's money, that's about 5 million.So you can see the, although our new hospital is a lot bigger, and James Gibbs didn't have to fit in MRI scanners and CT scanners, you can see there's been a considerable explosion, uh, in the cost of, uh, providing hospital care over those 300 years.So we've changed now from a general to, uh, from a general to a specialist hospital.And one of the reasons for that is simply what kills people these days.You can see that in the UK at the moment, the two big killers are cancer and cardiac disease.And you can see that as life expectancy has increased over the course of the last century, those, uh, those killers predominate over the infectious diseases of the past.And so the modern day Saint Bath Ouse, uh, contains the UK's largest cardiac center, London, second largest cancer center.We have a world renowned endocrinology specialist, endocrinology and respiratory departments.We have around 2,500 staff, 700 doctors, one beetle.So the ratio, uh, is, uh, is very different from before.And we have a similar number of beds, uh, to 1872.Uh, but of course now our focus is on specialized beds and intensive care.Uh, we have a particular, uh, significant mass and expertise in cardiac imaging, and we have the largest, uh, magnetic resonance, uh, service in the world.We have an annual turnover of about 400 million.We're part now bots health NHS Trust.We're rooted in the community of the East of London, like never before in our history.Our, our routine, if you like, population is about 2.3 million residents.And, uh, but some of our specialized services are populations of, uh, of up to 14 million.This is the most diverse and disadvantaged population in the country, and we owe it to them to provide the very best medical care.Uh, we hope, uh, that, uh, as successes of Harvey, uh, we are doing well on the research front.Our cancer teams have particular expertise in breast, lung, hematology and urology cancer.And there are world leading, uh, uh, researchers in key areas of drug and biomarker development and precision therapy.Uh, we are an experimental cancer medicine center, a C I U K, major Cancer Center, and N I H R, biomedical Research Center, and a RadNet Center.And we have an impressive publication record, uh, in all of those areas.On the cardiac front, uh, we're the top UK Clinical Research Network recruiter to trials over the last eight years, and have raised over four 40 million in grants from major charities, uh, hosting up to 20 fellows a year, and a thousand published papers since 2020 with significant impact on national and international guidelines.I'm particularly proud, and I hope Isla Stewart and, uh, Ethel Bedford Finnick would also be of the research efforts of our nursing and allied health professionals.We've invested this and that investment has paid off handsomely.Uh, we've had over 40 research fellowships, uh, with over 150 papers in for nursing and allied health professionals, and again, with significant international and national profile.Uh, the last three years have not been easy for St.Olam.They haven't been easy for the nhs, uh, and they haven't been easy for anyone.I thought it might be good just to reflect on plagues and pandemics, uh, in the last few minutes.So, uh, of the Black Death, there is almost no information in, in the records, the Great Plague of 1665.There's a lot, and a lot of the terms with which we sadly became familiar were all there.Zoning, uh, social, uh, isolation, social distancing.Uh, this was not the Barts physicians' finest hour.They, they all fled the city.Uh, the surgeons atheris and nurses were left to pick up the pieces.Uh, and these groups that stayed and looked after patients with the plague were specially rewarded by the governors.Her particular hero was the matron.Margaret Blake assisted by 15 nurses to the great peril of her life.Uh, it's wonderful that she survived and continued as matron at Barts, uh, for another 10 years until her death.10 years later in the 19th century, there were repeated influenza, uh, outbreaks, often referred to as the Russian pestilence.In 1891, an observer, uh, found over a thousand patients clamoring for treatment.And it was noted that particularly male patients were so alarmed that they took themselves to the hospital immediately.Uh, probably the first reference to man flu.The influenza epidemic, uh, in 1619, obviously was one of the worst pandemics the world's ever seen and impacted, uh, badly on the hospital in terms of, uh, losing a number of staff and two new distinguished consultants who had memorial, um, uh, funds raised to support their widows and children.Uh, so now we come to March, 2020.This appeared overnight at the steps of our hospital, uh, as Britain was plunged into, uh, lockdown.Uh, this slide, uh, from, uh, March the 20th, uh, shows, uh, that at that point, just taking the graph of the number of patients in hospital meant that by the 3rd of April, London would require, uh, around seven and a half thousand ventilated beds.Uh, we had 800 in the Capitol at that point.And as the next slide, uh, shows there was indeed frantic action to stop London running outta bed in beds in days.And as part of that, uh, uh, part of that approach, Barts Health was asked to run the Nighting Gal Hospital.Uh, and as been mentioned, this was, uh, set up and equipped in just nine days and opened on the 3rd of April.This is a photo of that facility.If any of you have been to the Excel Center, you know, the enormous size of those barns.And for those of us there, seeing these being kitted out with Roe after Rowe, after Rowe of bed spaces was terrifying and awesome, just to think that they might be full of patients.Thankfully, they weren't.Uh, and the tide turned, uh, before it was needed.But we did have 50 patients admitted there.And I, I'm very proud to say that those 50 patients had identical outcomes to the national average for an I T U in a conference center set up in nine days.That's a remarkable testament to the clinical skills of the nurses and doctors working there.So the role of Barts during Covid was to carry on doing what we did as much as we can.We served as the cardiac surgical hub for London.We kept on going with cancer treatments.We also supported the Nightingale, as I've said, and we supported our sister hospitals, particularly the Royal London Hospital, with a massive amount of staff redeployed to the intensive care unit there.It's worth us just recording that in the worst part of the pandemic.In July 21, uh, across Barts Health, there were 835 patients with Covid in our hospitals requiring hospital care.That's one and a half times the whole size of Barts Hospital.And there were 223 in intensive care.More than double the intensive care beds that we had going into this.This was an unprecedented challenge.And thanks to the miracle of vaccines, uh, we don't have those numbers of patients in there today.So Bards Hospital really is a patchwork.It's also the only hospital that has a parish church in its grands.This is St.Barmy is the less.And you can see here the, the amazing difference bits of stone and masonry from the 13th to the 20th century.Uh, I've talked a lot about some of the personalities.I've talked a lot about art and architecture, but I think it's important to focus on compassion and quality of care.These two quotes come from 150 years apart.Charles Ward, a 24 year old gardener in 1886.There were great many brought in as though they had been picked up off the street or come from some very poor home.Indeed and sorry were many, when the time came for them to go back after getting well and the kind treatment received from the doctors, sisters, and nurses, and the good food, they had to say nothing of the clean, comfortable bed they had to rest upon.He noted how some patients said they had never re before received so much kindness.Fast forward to 2021, a patient living with cystic fibrosis who contracted Covid, a very hazardous situation, who received intensive care with us.All the nurses were so compassionate, understanding, and most of all honest, I felt completely safe and knew they would do everything they can to keep me stable because of the nurses and doctors at St.Bar.I didn't become a figure added to your screen under deaths.And, but instead, I became a more important number under recovered.So I've talked a little about, about this, um, remarkable institution, 900 years of healthcare free at the point of delivery.You've heard of periods of greatness and periods of decline.It is astonishing to think that what would be miraculous cures to rahi now occur hundreds of times a day in our hospital.It will be astonishing for Harvey to witness the research that we do today and to see a heart lung machine taking over the circulation that he's so brilliantly described.However, I feel in my role, uh, that I probably have much to learn from Rahi.I don't think the process of caring for the staff and patients and procuring the resources to enable us to do that has changed very much in 900 years.And I suspect that charming, flattering manipulator would, um, cope with the Byzantine bureaucracies of the n h s just as well as he did.Uh, with the court of Henry the i, we've survived the dissolution of the monasteries, the Great Fire, the First World War, the Blitz.Uh, and we've survived nhs, uh, attempts to close us as we come into the 20th century.After that very dark period, uh, at the, uh, end of the 20th century, we really have gone from dis despair to renewal.We've secured major investment, which will hopefully keep our hospital going for a long time in the future.But I think this history shows that you can never be complacent.There's always some threat that you haven't thought around, around the corner.And whilst we can do everything as a hospital to survive, what's kept us going all these years is the strength of our partnership with patients, with alumni, with the city, with our friends, and with our supporters.And if we're going to endure another 900 years, we need to keep those partnerships alive.Uh, if you are interested just to close, a new, uh, book has just been published two days ago, St.Bar Holies Hospital, 900 years.We'll tell you much more than I could do.And there is also an exhibition.This is an amazingly camp, Tableau von from the 8800th birthday celebrations with the citizens of London, thanking Rahi, uh, but life and death in the archives.An exhibition, uh, uh, from the archives, starts in the Guild Hall yard, then goes to All Gate Square and is in the, in the hospital over the course of the summer.Well worth a look.So huge thanks from me to Kate Jarman, our archivist, and to Elizabeth Raden and Andrew Greasy for their help preparing the talk.Uh, and just before we get too hung up on history and think it's all important, it's worth known that the most searched item on the internet is for an entirely fictional event, which is Sherlock Holmes leaping off our pathology block.I'm afraid the history of Harvey has nothing on the charms of Cumberbatch.Thank you,Charles.Thank you very much.Um, it's very striking when you hear that story told the importance, a, of history being in a place which has both place and collegiality, but also the, the vital influence of individuals at various times in that history who've fought for survival or taught other people leadership in nursing and so on, that you are living through a period of enormous change within healthcare.And how dependent are you on those same forces to sustain St.Bamus now in the next few years?I, I think it's all about people, isn't it?I think the job of everyone in a hospital or in our profession is to try and appoint someone who's slightly better than they are to do your job.When you, when you've gone.I think you, you have to rely upon the spirit of the place in the way that you describe.And if you're running a big institution, I think you also need to get the balance right between people that can consistently do their job and people who are maybe a bit more disruptive.But as you've said, disruption can sometimes be important.And, and as a leader in healthcare, if you can try and balance those two types of individuals, um, you'll be onto to a good thing.The future I think is, is going to be immensely diffi, uh, different and might be quite different quite soon.Uh, just last week, uh, a a a study showed that an AI response to patient's questions was rated as more accurate and more empathetic than physicians.So we might <laugh>, we, we might, uh, we might be on the brink of a real revolution here.A can I open the, uh, floor questions from the floor if anyone would like to ask you, sir,Thank you very much.Most interesting.Can I ask you about the Great Hall, magnificent Great Hall.What is it actually used for?Cuz I, presumably it's not medically.So, um, as I said, its function was always, uh, ready towards entertaining and impressing people to give money to the hospital, which we still hope they will do.Um, it has been used over the years, uh, for conferences for functions within the hospital.The plan once restored is that it is now owned, uh, or on a very long lease by Bart's heritage, which is an independent body.And it's, if you like, business model will be that it allows, uh, the hospital to use it, but also is able to attract, to use it for weddings and a venue, which will give us enough income to keep it from falling into disrepair again.Uh,So I'm struck by the, um, repeated theme of fundraising and the close relationship between the very wealthy, the concept of charity and the treasury having its, um, coffers locked and, and the, it's, you know, whatever political system has been in place throughout those 900 years, the solution seems to have been the same.Take money from rich people and give it to the poor people.Do you feel that's a reasonable analysis or am I being too cynical?No, I, I think that's, that was Bart's business model for at least eight and a half centuries.Um, we still desperately need to fundraise for all sorts of things.Not, maybe not the basics, but to provide, you know, gold standard care instead of ordinary care.We can't do that with the funds we get from the nhs.Uh, and it has been more difficult to fundraise for NHS institutions because people justifiably think, well, you are a public body.Why would we donate to a public body?So, uh, it it, in comparison with the states in comparison with European countries, I think we're behind the curve on exactly that process.As you describe, if you go to an American hospital, is full of the, this wing all named by the donors.Uh, and I think there's still unfortunately a need and a role for that in this country.And, uh, we, I hope with our geography a best place to exploit that.Plenty of rich people around you.Anyone else?Or shall we, um, stop and move for refreshments?And would you like please to thank Professor Charles Knight in the usual way.