Homo sum; humani nihil a me alienum puto (I am a man and all human calamities come home to me)

Motto of the Royal London Hospital

The Royal London Hospital is located in Whitechapel in the East End of London. It was originally just 'The London Hospital', but was granted the 'Royal' qualifier by Queen Elizabeth II in July 1990, the year of its 250th anniversary. It was first established as a charitable hospital to treat the poor of East London in the eighteenth century, but it has grown from these humble beginnings to being the largest of London's great hospitals. Whilst not as old as some of London's other hospitals, it has seen a lot of history in its short time, including the 'Jack the Ripper' murders, and, for a time, being home to Joseph Merrick (also called 'the Elephant Man').

Origins

The story of the Hospital begins in The Feather's Tavern in Cheapside on the 23rd September 1740. A group of gentlemen had been conspiring to establish an Infirmary in the East End, and their meeting notes for this day confirmed "Mr. Harrison delivered in the lease of the house taken for the intended Infirmary, which was approved." From here on in there was no holding back. Well, actually, that's a lie, there was. The London Infirmary was to be officially opened up for business in the beginning of the November of 1740. However, two weeks before this, the treasurer of the charity funding this endeavour had to admit, I imagine quite sheepishly, that there only be one shilling in the Bank. Not really the best of starts.

It's important to understand the condition of the East End of London when considering the foundation of the Hospital. In simplistic terms, the East End was where London put all the poor people. It was a slum. A ghetto. A war-zone. It has been the traditional settling place for wave after wave of immigrants fleeing political and religious persecution or seeking economic relief, including the Huguenots, Irish and Jews. These immigrants were usually poor, often sick, and never openly welcomed by the London natives. They naturally gravitated toward the East End of the City where housing was available in the form of small, crowded tenements. Men would work at the near-by docks and women could earn their living as members of the oldest profession. By most accounts of the time, it was an area full of misery and human suffering.

It was also full of disease. The East of the City was made up of maze like streets (a feature that was later instrumental in Jack the Ripper being able to get away with his (her?) crimes), and whole families would be confined to living in a single room. Sanitation was beyond minimal, with communal water pumps that would service a whole building or street, and no functional sewage system to speak of. The contents of the chamber pots that collected human waste, or 'night soil' as it was affectionately called, would be thrown into the street each morning. This, in combination with the ignorance that prevailed with regard to transmission of disease, meant that the East End of London was a veritable reservoir for plague. And there had already been many plagues by this time: tuberculosis, measles, typhus, small pox, typhoid, the Black Death. All of these took their annual toll from the population.

The ultimate plague though was that of alcoholism. People who lived in the extreme of the definition of 'poor' needed a crutch to get through their days. For most, that crutch was gin. I'm not talking Bombay Sapphire here; this stuff would have put paint stripper to shame. But it was cheap, and it did the job of making life numb so that you no longer noticed the misery. As the College of Physicians put it in 1726, We have with concern observed for some years past the fatal effects of the frequent use of several sorts of distilled spirituous liquor upon great numbers of both sexes, rendering them diseased, not fit for business, poor, a burden to themselves and neighbours, and too often the cause of weak, feeble, and distempered children, who must be, instead of an advantage and strength, a charge to their country. This state of things doth every year increase. People would forgo food (not least because there wasn't any) for alcohol, and as an estimate, the average person would drink six times more alcohol in a year then than the average person now. William Hogarth brought the situation to the attention of the more genteel folk when he released his famous 'Gin Lane' etching in 1750, which depicted the misery of those poor who lived in the grip of alcohol addiction. This was an effort on his behalf to bring about public attention and support to a Bill that was being put to Parliament to help control the sale of this intoxicating liquor. The Gin Law was subsequently passed in 1751. However, this still did nothing to address the central issue, that of poverty and the poor health that was associated with it due to cold-exposure, malnutrition and semi-starvation.

So, either as an act of philanthropy, or an act of selfishness (who wants to live on the edge of what is essentially a plague pit?) a number of hospitals dedicated to the treatment of the poor sprung up in the eighteenth century. It was this spirit of practical philanthropy that led to the gathering of seven men in the Feather's Tavern whose aim it was to establish a charity for relieving poor Manufacturers, Sailors in the Merchants' Service and their wives and children, with medicine and advice in case of sickness or accident.

And so we return to the problem of but the single shilling in the bank. The saviour of the situation was the aforementioned Mr. Harrison, the gentleman who had previously assured the charity of the tenure of a house in which to place the infirmary. John Harrison was a surgeon, and is nowadays regarded as being the founder of the Royal London. When he was informed of the financal circumstances, he did what anyone of us would do in this situation: thought of someone he knew that was rich, and then badgered them until they gave him some money. This rich gentleman was Charles Lennox, Second Duke of Richmond and grandson of King Charles II. John Harrison managed to convince this gentleman as to the importance of their cause such that he became an annual subscriber, and later in 1742, the first President of the Hospital. Thanks to his intervention, the first incarnation of the Royal London Hospital, then called 'The London Infirmary', was opened in Featherstone Street in Moorfields on the 3rd November, 1740.

The change of name from 'The London Infirmary' to 'The London Hospital' appears to have been a gradual one rather than a decision taken by committee, but by 1748 the transition was completed, with all sources from that point referring to it as 'the Hospital'. However, I am getting a little ahead of myself. Back to Featherstone Street....

The London Infirmary rapidly became a victim of its own success. Within three months of opening, its workload was such that new premises were needed. In May of 1741, the Infirmary moved to a small house secured in Mr. Harrison's name in Prescott Street, in the Goodman's Fields area of East London near Tower Bridge. Soon, not even this was enough, and by September 1744 the Infirmary had leased three more adjoining houses along Prescott Street. The Governors of the hospital knew however that even this would not be enough, and the planning of a purpose-built Hospital began.

The Whitechapel Site

The idea of a purpose-built Hospital was first put forward to the Governors and public at the third Annual Festival held by the London Infirmary Charity in 1744. During the festivities, Isaac Maddox, the Bishop of Worcester, preached eloquently to the gathered gentry about the merits of buying a site for the building of a new Hospital. I imagine that the Bishop had probably earlier that week had an in-depth discussion with Mr. John Harrison about how best to milk the crowd for their money. Their plan was successful, and the Bishop's sermon raised £650 toward the project. Over the course of a few years, this "Benefaction or Building Fund" grew to exceed £5000. The hunt for a suitable site was now begun in earnest.

There were many sites assessed for the suitability of building a hospital, but eventually in 1751 the Governors settled on an area called 'the White Chapel Mount and the Mount Field'. This at first seemed a strange place to site a hospital; it was (in those times) quite far out from the main part of the East End. The Governors had many objections to the site proposed. What good would a hospital be stuck out in the fields outside the City all by itself? How would patients get there? Was it really fair to ask physicians and surgeons to travel along the Whitechapel Road, infested as it was by highwaymen and other riff-raff who frequented the road and robbed those entering and leaving London?

To look at the site now, you wouldn't understand what the Governors were worried about. The Royal London is surrounded by the hustle and bustle of East End London, the centre of a vast, sprawling urban area. The estate purchased was large enough to allow further buildings to be developed as they were needed, and there have been many needed. Though to be fair, they were on the money with regard to one particular objection; physicians and surgeons are still in danger of being robbed by the modern day equivalents of highwaymen and riff-raff that frequent the Whitechapel Road. Some things never change.

'The Mount' of White Chapel Mount and the Mount Field has long ago disappeared. It is hard to believe that two hundred years ago there was a stone hill in Whitechapel that stood higher that the Hospital itself. However, the City of London was growing, and always looking for new places to build. The Hospital's lease over the Mount expired at the end of the eighteenth century, and so the City looked to build on the mount. The egos of those who were running the Hospital at the time (Sir William Blizard being one of these egos) could not allow this; they disliked the idea of there being buildings that would 'look down' on the Hospital, which was and still is a major landmark in the area. The City came to a compromise and the Mount was broken down and carted away. Its passing is marked by the presence of various 'Mount' street names in the area; Mount Place, Mount Street and Mount Terrace.

Architecture

The original building (there have been many losses / additions over the years, not least due to the efforts of the Nazi bombing raids of the Second World War) was designed by Boulton Mainwaring Esq., an architect and a Governor of the London Hospital Charity. His brief was to design a building fit for the reception of two hundred Patients for the present with proper Offices and with a Reserve to increase the Building as circumstances may require. In the end, he submitted several different possibilities for how the Hospital could look. The one that was eventually chosen was of a central block three storeys high that ran east-west parallel to the main road, with two wings (the East Wing and West Wing) extending out south. This plan provided accommodation for 350 patients, and allowed all the wards a southerly aspect which in the Opinion of the Physicians and Surgeons was most desirable for the patients. The Hospital itself was to be plain and undecorated, and built from brick. Building began in the September of 1752, and was completed in 1759. The first patients began to be admitted in the September of 1757 when the central block had been completed.

The evolution of the Hospital building is fascinating to look at. By 1840, the south wings were extended out to their present length, and by 1886 two more wings (the Alexandria Wing and Grocers' Wing, later renamed Holland Wing) had appeared on either side of the central building. More storeys had been added and other buildings were springing up elsewhere in the grounds, including the Medical College and nurses' accommodation, and by the beginning of the twentieth century the Hospital had roughly taken on the form that it is in today. A massive, purpose-built Outpatient Department had been built alongside the Hospital and the new wings had been further extended. All buildings have remained true to the principle of 'plain and undecorated', and the Hospital is the epitome of functionality: it was there to treat the sick-poor; it was surrounded by slums and tenements; it was run entirely on charity, both the donation of money from the public and the donation of time from the doctors who considered it an honour to work at the London without being paid, an attitude that was the cornerstone of the British Voluntary Hospital System. Every penny spent had to be accounted for, and there was no leeway to provide for ornamentation. The most distinguishing feature of the Hospital is the face of the central building, with its archway-graced stair entrance and triangular clock tower over looking the street; the rest is just bricks and square windows. But all this functionality does not stop the building from standing out; indeed, it is the first building to greet your eye on exiting Whitechapel tube station, and the sheer bulk of it, with its many structural additions, continues to hold your gaze.

The layout and structure of the Hospital continued to be tweaked and refined for the next thirty or so years. Unfortunately, further progress was then dealt an earth-shattering blow. Literally. Nazi bombing raids in the Blitzkrieg that ran from 1940 until 1942 delivered a total of 137 bombs on Hospital grounds, made up of a combination of high explosives and incendiary devices, and in 1944, a flying bomb scored a direct hit on the East Wing, killing two patients. The Hospital sustained a lot of damage in these attacks, but rebuilt itself over the next twenty years, and indeed, continued to add new buildings that were becoming necessary as medical science progressed. Looking at the buildings while wandering around the Hospital grounds, you can see where the bombs did their damage by the patchwork nature of the brickwork. These scars are worn like medals by the Hospital because, like all scars, there is a story behind them. However, like most scars eventually do, they have faded sufficiently that you will only see them if you know to look.

Recent History

Following the dissolution of the British Voluntary Hospital System and the formation of the National Health Service in 1948, the Royal London at long last began to find itself on a firmer financial footing. It was allowed to keep all previous charitable donations made to it as a 'free fund', and this was used to fund the rebuilding of the hospital following the damage inflicted during the Blitz.

With the Government now subsidising the running of the Hospital, the Royal London has been able to build itself a specialist reputation in the fields of neurosurgery, trauma surgery and renal medicine. In 1990, the Royal London was received the honour of being the host hospital for the London Air Ambulance, a.k.a HEMS; this is a source of pride for those who work at the Hospital, amply demonstrated by the fact that the hospital porter's uniform seems to include the wearing of HEMS-related clothing. The completion and opening in 1993 of Europe's largest A&E department has helped to cement the London's reputation as a traumatic medicine centre. In 1994, the merger of the three main East London hospitals, the Royal London, St Bartholomew's and the London Chest, formed 'The Royal Hospitals Trust'. This was later renamed 'Barts and the London NHS Trust' in 1999.

The Hospital Trust recently announced the redevelopment of the Royal London Hospital, with the old, original pre-war buildings being replaced by a more cohesively structured cluster of inter-connected glass buildings. Two new glass towers will be built, one of which will be equipped with the HEMS helipad. As Britain's biggest new hospital, the new Royal London will have a leading trauma and emergency care centre, Europe's largest renal service and the capital's second biggest paediatric service, provided within a dedicated Women and Children's Unit.

Famous Royal London physicians and surgeons

• James Parkinson (1755-1824) – the first to write about 'the shaking palsy' which he first noticed in people whilst walking the streets of Hoxton in East London.
• Sir William Blizard (1772-1838) – an eminent surgeon in his day, Blizard founded England's first clinical medical school, The London Hospital Medical College. In 1791 he founded the Samaritan Society, the first medical social work society, for London Hospital patients. He was among the first surgeons to tie the subclavian artery for axillary aneurism.
• Thomas Davies (1793-1839) – pioneered the use of the stethoscope in medical diagnosis in England, having tutored under Renne Laennec in Paris, the physician who first discovered its advantages in the detection of lung disease. Went on to found the London Chest Hospital.
• Jonathan Pereira (1804-1853) - trained at Bart's, later becoming a chemistry lecturer and physician at the London. Published the first great English work on Pharmacology.
• William John Little (1810-1894) – the father of orthopaedic surgery, in part inspired due to himself having a club foot, the result of polio infection as a child. Established the Royal National Orthopaedic Hospital. Little's disease (spastic diplegia) is named for him.
• John Langdon Down (1828-1896) - trained at The London, and became assistant physician to the Hospital. He and his wife Mary later opened a pioneering facility for the learning disabled at their home in Normansfield, Middlesex. Down's syndrome is named after him.
• John Hughlings-Jackson (1835-1911)- did part of his training at Barts, then came to The London in 1863. Over the next 30 years he organised and laid the foundation of modern neurology, becoming the greatest neurologist of his time. His name will always be associated with the form of epilepsy caused by a localized cortical disorder, Jacksonian epilepsy, but his contributions were both more general and more fundamental. He established a world-renowned tradition of neurology at The London.
• Elizabeth Garrett Anderson (1836-1917) – the first woman to train as a doctor in England she did her training at the London, but was never actually awarded a medical degree due to the misogynistic attitudes of the male doctors and students. Was subjected to prejudice all the way, but was nothing if not determined, and eventually gained her degree from Paris. Then went on to open the New Hospital for Women in London, which was staffed entirely by women, and also formed the London School of Medicine for Women. Her determination and repeated appeals to medical authorities paved the way for other women, and in 1876 an Act was passed in Parliament, which permitted women to enter all of the medical professions. If all this wasn't enough, she then went on to become the first female mayor in England by becoming the Mayor of Aldeburgh. What can I say, you go girlfriend. Respect.
• Thomas Barnardo (1845-1905) – founder of the Dr. Barnardo's Orphanages (now just Barnardo's, a children's charity), he was first alerted to the plight of homeless orphaned children while working at the London. He went on to form 'The Ragged School', which provided these children with a basic education, before opening a series of orphanages to house and care for destitute children.
• Sir James Mackenzie (1853-1925) – the first director of the London's Cardiac Department, which was the first department of its kind in Europe.
• Sir Frederick Treves (1853-1923) – an eminent surgeon at the London, is known for performing a life-saving appendecictomy on Edward VII two days before his coronation, and being the man who cared for Joseph Merrick.
• Sir Henry Head (1861-1940) – an assistant physician at the London, Head achieve worldwide fame for his neurological research, especially in the field of sensation. Also did important work on aphasia and similar speech disorders.
• Sir Henry Souttar (1875-1964) - In 1925 at The London, Souttar became the first surgeon to open a chamber of the heart, the left auricle, in order to stretch the mitral valve. This operation did not become the standard procedure for treatment of severe mitral stenosis, a common complication of rheumatic fever, for another twenty years. Souttar also pioneered the surgical use of radium after meeting with Pierre and Marie Curie in Paris.
• Sir Hugh Cairns (1896-1953) - became the first head of the new neurosurgical unit at The London, after returning from a year in the world leading neurosurgical unit, the Peter Bent Brigham Hospital in Boston, USA. He went on to become one of the pioneers of modern neurosurgery in Britain.

Hospital Museum

The Hospital's Museum is housed in the vaults of St. Philip's Church, along with all its archives, including financial, patient and treatment records. The museum charts the growth of the Hospital from its humble beginnings to the present day, as well as having displays of some of the more interesting points of the London's history, including Joseph Merrick and the work of Thomas Barnardo. It is well worth an hour of your time to explore, my favourite piece being 'the operation bell'. In the bad old days before the development of anaesthesia, this bell was rung in the hospital for a dual purpose: the summoning of the medical students to come and observe the surgery, and the summoning of anyone else with a bit of spare time on their hands to come and hold the patient down. The museum is open from Monday to Friday, 10am till 4pm, and admission is free.

Links of Interest

• Barts and The London NHS Trust - http://www.bartsandthelondon.org.uk
• HEMS website - http://www.hems-london.org.uk
• Hogarth's Gin Lane - http://www.peterwestern.f9.co.uk/hogarth/hogarth48.html

References

• Clark-Kennedy A.E, 1962a, The London: Volume One 1740-1840, 1st edition, Pitman Medical Publishing
• Clark-Kennedy A.E, 1962b, The London: Volume Two 1840-1948, 1st edition, Pitman Medical Publishing
• Collins S.M, 1995, The Royal London Hospital; A Brief History, 1st edition, the Royal London Hospital Archives
• Morris E.W, 1910, A History of the London Hospital, 1st edition, Arnold

Both DylanDog and Vorbis have (I'm sure correctly) pointed out that the latin moto is incorrectly translated - it should be"I am human; I judge nothing human to be alien to me."However, Sir William Blizzard was probably one of those people that no one argued with.Alternitively, my sources are incorrect. Either way, there's the correct translation.