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?Archaeological excavations at Shard Place, Southwark, by Museum of London Archaeology (MOLA) revealed evidence of funerary activity associated with old St Thomas’s Hospital. The discovery of 811 inhumations, dating from the 17th to early 18th century exposed the intensive nature of burial activity in an area immediately to the south-east of the hospital buildings. This burial assemblage, together with dumps of hospital waste and evidence of structural remains associated with the 18th-century hospital rebuilding, enhances our knowledge of the early history of this London institution. The study of the skeletal remains of 794 individuals, the majority of whom must have been inmates at St Thomas’s Hospital, provides an insight into the health of the population and the diseases from which they suffered. The demographic structure of the burial sample reveals elevated vulnerability in adolescence and early adulthood, an indication of the health risks inherent within an increasingly crowded urban landscape. The City’s poor endured cramped living conditions and rising levels of pollution. Many migrated to London in search of jobs as labourers, or servants and apprentices. The burial ground revealed early evidence of hospital medical practice in the form of surgical limb amputation. Skeletal evidence of venereal syphilis was also identified, consistent with records of specialist ‘foul wards’ at St Thomas’s Hospital, provided for those suffering from this chronic condition.