Head and abdominal surgery and amputations took place without anaesthetics or antiseptics.
The Old Operating Theatre Museum and Herb Garret is in the attic of St Thomas' Church, Southwark. It was built in 1703 for St Thomas' Hospital on its old site in St Thomas' Street near London Bridge.
The attic, or garret, was originally intended as a storage space, but the hospital apothecaries saw it as an ideal place to dry and cure medicinal herbs. An operating theatre was later built here, in 1822.
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St Thomas' Church was designed and built, as part of the wider rebuilding of St Thomas' Hospital, by Thomas Cartwright, a mason who worked with Sir Christopher Wren on three churches in the City of London after the Great Fire of 1666 (the only one of the three still standing is St Mary le Bow).
The hospital apothecaries had offices and a workshop a short distance along St Thomas' Street, so could easily get to the garret, accessed at the time via an external staircase. Today the museum is accessed by a 52 step spiral staircase in the church tower.
At the top of the stairs is the museum shop and then a display of a timeline of the hospital's history.
Founded in the 12th century next to St Mary Overie Priory (now Southwark Cathedral), and originally dedicated to St Thomas Becket, the hospital later moved across Borough High Street to St Thomas' Street. Following the Dissolution of The Monasteries and a period of closure under Henry VIII, its dedication was changed to St Thomas the Apostle when it was reopened in 1551. In 1872 the hospital completed a move to Lambeth, where it remains to this day.
The largest part of the attic is a museum dedicated to history and practice of apothecaries. It includes delftware and glass storage jars, cabinets, chests of drawers, a dispensing counter, scales, jugs and even leech jars.
Apothecaries not only dispensed medicines, but also gave medical advice. The use of plants and herbs was a very important element of their practice (see also my blog post on Chelsea Physic Garden).
The apothecary at St Thomas' Hospital, a position dating back to 1566, grew herbs in the hospital's own garden and also bought them from outside (the Old Operating Theatre website refers to a 17th century 'herb woman' selling to the hospital).
The oak beams in the garret absorbed any excess moisture and provided some protection against rats and other pests, offering good conditions for the drying of herbs.
The garret was converted into an operating theatre and post-operative ward for female patients in 1822. This was 67 years after the hospital's first operating theatre, for men, was built in 1755. Before 1822, operations on women had been performed in the ward in front of other patients.
By today's standards, surgery was very brutal in the early to mid 19th century, with no anaesthetics and no antiseptics. It was generally a last resort for life threatening cases, but patients could choose whether or not to undergo an operation. The risks from surgery were high, but the alternative was often certain death.
During the Old Operating Theatre's active years (1822 to 1862), there were only three kinds of surgery that could be performed in the theatre. These were trepanations, lithotomies and amputations.
Trepanations involve boring a hole into a patient's skull to relieve pressure or pieces of fractured bone. Sir Charles Bell, a leading 19th century surgeon and anatomist and a prolific writer and illustrator on these subjects, advised on how to prepare for trepanations, recommending "a stout assistant to hold the patient's head firmly, and let others put their hands on his arms and knees".
Lithotomies are the surgical removal of bladder stones, a result of poor diet, which can become as big as a chicken egg and be life-threatening. William Cheselden, a surgeon at Old St Thomas' Hospital, pioneered new techniques to bring down the time needed for bladder stone removal from 40 minutes to one minute. As a result, survival rates increased to 92%.
Amputations, the removal of all or part of a limb, had a high mortality rate of 30%, but were often performed in situations of disease, trauma and accident. During the operation, shock and loss of blood were significant risks.
During an amputation, blood loss would endanger the patient's life in less than two minutes, so speed was crucial. Knives and saws were the main surgical instruments and, before anaesthetics were introduced in 1846, patients were administered opium, brandy, wine or other alcohol to dull their senses. They would also be held down and often given a leather strap or wooden stick on which to bite.
A major threat after an operation was the possibility of infection, since the washing of surgical equipment was rare, bandages were often reused and surgeons did not routinely wash their hands beforehand.
Linking the herb garret part of the museum with The Old Operating Theatre are a number of interesting displays about the history of the hospital and on medicine, nursing, pathology and surgery, including cabinets of surgical knives and equipment.
On entering the Old Operating Theatre, it is apparent why such rooms are called 'theatres'. There are tiered layers forming galleries from which onlookers could watch operations. The audience would include apprentices, surgeon's dressers and students.
A sign on the wall, dated 1822, spells out some ground rules, under a heading in Latin reading ‘Miseratione Non Mercede’ (‘for compassion not for gain’):
"Apprentices and the Dressers of the Surgeon who operates are to stand round the Table.
The Dressers of the other Surgeon's (sic) are to occupy the three front Rows.
The Surgeon's pupils are to take their Places in the Rows above.
Visitors are admitted by permission of the Surgeon."
These were the pioneering days of modern surgery and it was important that students and other medical professionals should be able to observe and learn from the operations.
Operations generally took place in the middle part of the day, to maximise the natural light available. This was well before electric lighting, when the candles and gas lights of that time would have provided only gloomy illumination by our standards. The Old Operating Theatre is lit from above through a skylight, restored in 2023.
In addition to operations on patients, the dissection of corpses may well have taken place here. This was another vital way for surgeons and students to learn about anatomy and surgical procedures.
At the time that the Old Operating Theatre was opened in 1822, the supply of bodies for dissection did not meet demand. The only legal source was the bodies of executed criminals, but demand was rising rapidly. Knowledge and understanding of the benefits of surgery, and of surgical techniques, had been growing since the mid 18th century, stimulating a thirst for yet more.
One of the grim consequences of this imbalance of supply and demand was the emergence of grave robbers, also known as resurrectionists. This was a lucrative business for criminal gangs across London, with bodies selling for up to £50 in the early 19th century. The notorious London Borough Gang supplied hospitals south of the river, including Old St Thomas' Hospital and the nearby Guy's Hospital.
Perhaps the surgeons justified their purchases by telling themselves that they were advancing medical science and the bodies were dead anyway. However, the purchases became increasingly difficult to excuse when the grave robbers also perpetrated murder to increase the supply further.
The introduction of the 1832 Anatomy Act changed the law so that dissection was permissible on bodies from workhouses, hospitals and prisons that were not claimed within 48 hours of death. It also allowed the next of kin to donate a body for medical study.
The increased legal supply of corpses put the resurrectionists out of business. However, for the first 10 years of the Old Operating Theatre's use, it seems likely that dissections on stolen and even murdered bodies may have been performed here.
The Old Operating Theatre was closed in 1862, when St Thomas' Hospital started its move to Lambeth. Today's museum opened 100 years later, in 1962. St Thomas' Church is the only substantial building remaining from the old hospital's days in Southwark. No longer in use as a church, in recent years it has been an office and is now a gig venue and bar.
The Old Operating Theatre Museum and Herb Garret is a fascinating museum to visit for anyone interested in the history of hospitals, medicine and surgery, or in the Victorian period more broadly.
Information on a visit and tickets to the Old Operating Theatre are available on its website here.
Walks available for booking
For a schedule of forthcoming London On The Ground guided walks, please click here.
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