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From its inception, the priory of St Bartholomew had treated the sick.
The Reformation left it with neither income nor monastic occupants.
After a petition by the City authorities, Henry VIII refounded it in December 1546, as the " House of the Poore in West Smithfield in the suburbs of the City of London of Henry VIII's Foundation ".
Letters patent were presented to the City, granting property and income to the new foundation the following month.
The King's own sergeant-surgeon Thomas Vicary was appointed first superintendent of the hospital The King Henry VIII Gate, constructed in 1702, still forms the principal entrance to the hospital.

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