About the project

The Great Ormond Street Historical Patient Database Project, launched in 2001, is the result of a partnership between Kingston University Centre for Local History Studies and the Museum and Archives Department of Great Ormond Street Hospital for Children NHS Trust. Funding for the project came principally from the Research Resources in Medical History Programme of the Wellcome Trust, with additional financial support from the Friends of Great Ormond Street Hospital and the Nuffield Foundation.

The Records

The Admission Registers of the Hospital for Sick Children, Great Ormond Street, from its opening in February 1852 until December 31st 1914, form the core of the project, complemented by Registers of Cromwell House, the hospital’s convalescent home, from 1869 until December 1904. The Registers are of relatively uniform format in both institutions. In the GOSH registers, each entry gives the hospital number of the child, followed by the child’s name, age (in years and months), sex, and address. Further columns provide diagnosis, which can include as many as four separate conditions, date of admission into the hospital and date of attack. The date of discharge is recorded, along with the result of treatment, which is given as ‘Recovered’, ‘Relieved’, Not Relieved’ and ‘Died’. A column for remarks gives such details as operations performed, drugs issued, brief post-mortem results or an explanation for a premature discharge of the child from the hospital. The final column gives the name of the hospital governor or medical officer who sponsored the patient.  The Cromwell House Registers contain similar information, and for a small number of children include details of the child’s vaccination status (against small pox) and history of childhood diseases. Cromwell House Registers recorded children entering, and moving between, the convalescent wards (used in the main for children who were in need of strengthening before being sent home) and the chronic wards, which were used to house children still in need of nursing care, but who were taking up valuable beds needed for acutely sick children in the main hospital.

Methodology

Funding from the Special Trustees at Great Ormond Street and the Wellcome Trust enabled the Registers to be microfilmed at the National Archives, and digital photocopies made. The photocopies were divided into batches of approximately twenty pages, or four hundred entries, and each batch was tagged and numbered.

The database was built in Microsoft Access, using a template designed by Peter Tilley, the project’s technical advisor. Batches were issued to volunteers, who were given a copy of the data entry programme, and who input the data on their own computers. Where they did not have a computer of their own, suitable machines were provided. The volunteers were mostly based in the Kingston upon Thames area, although several worked remotely, including one based in Canada. Most had cut their teeth on the Kingston Local History Project, and were used to the Victorian hand. Very few had medical knowledge, and even fewer were familiar with the streets of Victorian London. To help them decipher unfamiliar terms volunteers were given an information pack, which included a brief history of the hospital, lists of medical officers, common diseases and London street names. The fields that caused most problems for transcribers were the addresses and diagnoses. The vast majority of the children came from London, and, in the earliest days, lived within half a mile of the hospital. Many of the back courts and alleys that were home to them have long since disappeared in metropolitan slum clearance programmes. After much trial and error, photocopies from the index to a 1909 London Gazetteer were supplied to help with identifying streets or areas. The A to Z Trust kindly supplied a copy of the very first London A to Z for reference. In order to maintain the integrity of the database, the entries were entered into the database exactly as they appear in the Registers, even where it was suspected that a mistake had been made. Additional fields were added to the database to provide standardised spellings of the addresses, Registration Districts and Sub-registrations districts. This complicated and painstaking work was undertaken at Kingston by Juliet Warren. This work has currently been restricted to London addresses, but may be widened to include all addresses at a later date.

The Diseases

Children’s diseases in the nineteenth century were imperfectly understood, and nosology has changed greatly since then. Diseases range from the expected typhoid fever and (w)hooping cough to talipes (club foot) and taenia (tapeworm). Many children were admitted with the diseases of poverty, such as tubercular joints and lungs, rickets and rheumatism. Abscesses, caused by infections, under-nourishment and tubercular conditions, were common, and eczema was remarkably prevalent. Chorea, or St. Vitus’ Dance, is now familiar to all involved in the project, as is the distressing strumous ophthalmia, an eye condition rampant in children’s homes and orphanages. As with the addresses, the volunteers entered the disease or condition exactly as it was written in the Register. This resulted in many different spellings of even common diseases such as diarrhoea and scarlet fever. Disease spelling was later standardised, and two levels of classification applied. The first, developed specifically for the project, grouped diseases by body site, and the second applied the modern World Health Organisation International Classification of Diseases code (ICD10) to the condition.

Checking

Volunteers’ data was transferred to the master database and a print-out of the batch was made. A team of checkers at Kingston dealt with each print-out, checking every entry. The checkers worked in pairs, one person reading the print-out, and the other working from the photocopy. Amendments were made in red ink, and outstanding queries were highlighted. The print–out was sent to Great Ormond Street, where it was checked against the original Registers, and any final changes made in green ink. Once the final checks were completed, all corrections were applied to the master database.

The Casenotes

Fourteen volumes of casenotes for Dr Charles West survive, and it was decided to make them available via the database. Each page was scanned, loaded in the website and linked to the relevant patient’s entry in the main database.

Small and Special Website

The Small and Special website has been developed to make the Database available to as wide an audience as possible, regardless of location or field of interest. Access is unrestricted and is completely free to use. Some restrictions have been applied to the volume of data which can be viewed at any one time, to protect the database from unscrupulous users.

Small and Special also contains a library of articles on subjects connected to the Hospital and the period, including a history of the Hospital for Sick Children at Great Ormond St, pen portraits of some of the medical officers, nurses and patients and articles on the buildings which made up the Victorian and Edwardian institution. Most of the articles have been written by historian, Dr Andrea Tanner, the architect of the Project. Others have been contributed by archivist Nicholas Baldwin.

The articles are complemented by a collection of images of the Hospital from the period.

Project Team

Dr Andrea Tanner – Project Director
Dr Christopher French – Director of the Centre for Local History Studies, Kingston University
Juliet Warren – Researcher and Database Manager, Kingston University
Annie Sullivan – Project Development Consultant and Volunteer Manager, Kingston University
Dr Sue Hawkins – Project Manager and Researcher, Kingston University
Nicholas Baldwin – Archivist, Great Ormond Street Hospital for Children

Technical Consultants

Peter Tilley – Database Design Consultant and technical advisor to the project
Oliver Cope – Freelance Python and Web Programming
Anne Morgan – Amendit Design Services – Web Design
Paula Stephenson – Web Manager, Great Ormond Street Hospital for Children and UCL Institute of Child Health
Alicja Skowronska – Clinical Coding Consultant

The Project team would like to acknowledge the enormous contribution made by the large number of dedicated volunteers and Kingston University students, without whose work on transcribing the registers, checking and correcting the database, this project would have been impossible.

Dr Elizabeth Lomax

The Project team is extremely grateful to Dr Elizabeth Lomax for allowing us to use Small and Special as the name for the website. It is derived from the title of her book, Small and Special: the development of hospitals for children in Victorian Britain.

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