According to Campbell Thomson, the nucleus of the first medical school library at the Middlesex Hospital was a gift of books from a Dr Leighton and in the late 1830s it was housed in a small room in the original hospital. A thorough review of the teaching facilities in the early 1850s ensured, amongst other improvements, that a new library was provided when the Medical School buildings were enlarged around 1853.

The Dean always held the post of Honorary Librarian, though a succession of other people actually ran the library and were known as the librarians. Their duties seem to have varied and Campbell Thompson noted a reference in the 1855-56 prospectus to the involvement of the librarian at the time, Mr Bing, in teaching French and German to students to improve their general education. The first Library Committee was formed and met in December 1892, apparently in response to concern about the way the library was run. In 1914 The Bland-Sutton Institute building was completed and Saunders tells us that a library was included among the new facilities.