About the Project
The Historic Hospital Admission Registers Project (HHARP) is the result of a partnership between Kingston University's Centre for the Historical Record (CHR) and various hospital archives in London and Glasgow. It began life in 2001 as a project to create a database of late 19th and early 20th century admissions to the Hospital for Sick Children, whose extensive archive is still maintained and housed within the Great Ormond Street Hospital for Children NHS Trust. Subsequently, the project was expanded to include three other children's hospitals: the Evelina Hospital (now part of Guy's and St Thomas's NHS Trust), whose records are held at the London Metropolitan Archives; the Alexandra Hospital for Children with Hip Disease (records held at the Museum and Archive Department of St Bartholomew's and The London NHS Trust) and the Royal Hospital for Sick Children, Glasgow, whose records are held by the Greater Glasgow Health Board Archives.
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, the Nuffield Foundation and the History Research Unit at Kingston University.
The initial version of the Great Ormond Street database (covering the years 1852 to 1914) was completed and made available in 2007, the databases for the Evelina and the Alexandra Hospital for Children with Hip Disease were made available in early 2010, while that for Glasgow was completed in late 2010.
Subsequently we have added two series of case notes relating to admissions at Great Ormond Street Hospital: the notes belong to two of the hospital’s pre-eminent doctors, its founder Charles West, whose notes cover a period between1852 to 1874, and Dr Archibald Garrod, whose case notes relate to admissions in the period 1899-1913. In total there are nearly 6000 patient records with associated case notes.
In 2015 the GOSH database was further extended with the addition of admission records for 1915-1921, increasing the number of records by an additional 20,000 plus. The full complement of databases provides access to over 140,000 patient admission records.
The Admission Registers of all four hospitals (plus those for Great Ormond Street's convalescent home, Cromwell House) cover a period ranging from February 1852 (when Great Ormond Street's doors first opened) through to December 31st 1921. While the Great Ormond Street records are continuous for the whole period, the other hospital records cover shorter runs within these dates: Cromwell House, 1869 to 1910; the Evelina, 1874 -1877/1889-1902; Alexandra Hospital for Hip Disease, 1867-1895. The Glasgow database, covers 1883 to 1904. The Registers share a common core of information, which includes the child's name, age (in years and months), sex, and (in most cases) the address. Further columns provide a diagnosis, date of admission into the hospital and date of discharge, and the result of treatment, which is given as 'Cured', 'Relieved', Not Relieved' or 'Died'. Additional information, common to all records, includes the name of the admitting doctor, the child's sponsor and the ward to which they were admitted.
Individual hospitals included more information in their registers. Cromwell House records, for instance, provide information on the child's history of infantile diseases and its vaccination status. In the Evelina records can be found brief details of treatment received and post mortem results. The Alexandra Hip Hospital records are quite different, as all the children are suffering ostensibly from the same disease. Thus the registers focus on the nature of the hip disease suffered, and include information about the condition of child's limbs before, during and after their stay at the hospital, describing the deformities, presence of abscesses etc. They also frequently comment on the duration of illness before admission and likely cause of the problem. Unlike Great Ormond Street records, those at the Evelina and the Alexandra Hip Hospital have provision for recording details of the parents - although this information was not collected as frequently as we would have liked. The Glasgow records contain information on a patient's parents, name and occupation and religion.
The same methodology was applied to each set of hospital records to enable meaningful comparisons between the institutions. Funding from the Wellcome Trust (and the Special Trustees at Great Ormond Street in the case of that hospital) enabled the Registers to be microfilmed 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 databases were built in Microsoft Access, using a template originally designed for the Great Ormond Street records by Peter Tilley (the project's technical advisor), and later adapted by Juliet Warren to incorporate new data elements from subsequent hospitals. Batches were issued to volunteers, who input the data using a data entry programme. Initially, although most volunteers had experience of the Victorian hand, very few had medical knowledge or were familiar with the streets of Victorian London. Crib sheets of common disease terms, terms used in post mortem reports and 19th century therapeutics were provided, and in addition, photocopies from the index to a 1909 London Gazetteer were supplied to help with identifying streets or areas. The A to Z Trust also kindly supplied a copy of the very first London A to Z for reference. The same team of volunteers has worked on the project throughout, and as they gained experience their ability to transcribe the specialised content accurately grew, such that by 2010 they represent a very skilled group of workers.
In order to maintain the integrity of the Registers, entries were typed into the database exactly as they appeared, even where it was suspected that a mistake had been made by the clerks. Standardised versions of the key data elements enabled such original errors to be corrected while maintaining the integrity of the source material. A rigorous system of proofreading ensured every entry was checked twice, to minimise the introduction of 21st century-typographical errors, and the process was completed by a series of computerised validations.
In order to help users locate addresses, additional fields were added to the database to provide standardised spellings of street names, and for London-based addresses Registration Districts and Registration sub-districts have been added. For addresses outside London, it is planned to add a county name, and this enhancement will be available in the next release of the website. This complicated and painstaking work was undertaken at Kingston by Juliet Warren and more recently for the Great Ormond Street 1915-1921 dataset by Helen Goepel. . A similar approach has been taken with the Glasgow addresses - with the help of local volunteers from the Glasgow and West of Scotland Family History Society.
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 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, 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. A new field was added to the database containing a standardised spelling of the diagnosis and two levels of classification were applied. The first, developed specifically for the project by Dr Andrea Tanner and Dr Sue Hawkins, groups diseases by body site, and the second applies the modern World Health Organisation's International Classification of Diseases (ICD10) to the condition, work which was undertaken by Alicja Skowronska, a senior medical coder at Great Ormond Street Hospital for Children. (This latter was only applied to the initial Great Ormond Street dataset (1852-1904).
The Case Notes
Fourteen volumes of case notes for Great Ormond Street's Dr Charles West survive, and they have been made available via the database. Each page was scanned, loaded in the website and linked to the relevant patient's entry in the main database. A similar exercise has been conducted on the Case Notes of Dr Archibald Garrod, resulting in some 6,000 records now associated with detailed case notes.
The HHARP website has evolved from our original website Small and Special through which the Great Ormond Street database was made available to a world wide audience, free of charge.
Now we are adding two more hospitals, with a third scheduled for later this year, it was no longer appropriate for the website to be so closely associated with one institution, and HHARP was conceived as a portal into the world of Victorian and Edwardian children's hospitals. Although it has a new look (and two additional databases) HHARP maintains the underlying structure of the original site. Its much praised easy-to-use search facility has also been retained. Access remains unrestricted and the new website is completely free to all users. Restrictions applying to volume downloads have been maintained, to protect the database from unscrupulous users.
The original library of articles in Small and Special, on topics relating to the Great Ormond Street Hospital including its history, pen-portraits of some of the medical officers, nurses and patients, have been retained in HHARP. In the new website, the library will be enhanced by the addition of articles on the history of the Evelina, the Alexandra Hip Hospital and Royal Hospital for Sick Children, Glasgow, their staff and patients. The articles have been contributed by the team's medical historians, Dr Andrea Tanner and Dr Sue Hawkins, hospital archivists and others involved in the Project.
The gallery of images portraying the hospitals and their inhabitants in the period will be similarly enhanced, moving images under the individual hospital sections and also providing images of the original registers.
A new section has been added to Historical Background, 'General', where articles contributed by leading historians on health provision and issues of the late 19th century will be discussed.
Dr Andrea Tanner - Original Project Director
Dr Christopher French - Director of the Centre for Local History Studies, Kingston University (now retired)
Dr John Stewart - Director of the Centre for the Historical Record, Kingston University (current)
Juliet Warren - Researcher and Database Manager, Kingston University
Annie Sullivan - Volunteer Manager, Kingston University
Dr Sue Hawkins - Project Manager and Researcher, Centre for the Historical Record, Kingston University
Nicholas Baldwin - Archivist, Great Ormond Street Hospital for Children
Katie Ormerod - Deputy Archivist, St. Bartholomew's Hospital Archives & Museum
Alma Topen - Archivist, Royal Hospital for Sick Children, Glasgow
Prof Dan Young - Honorary Archivist of the Royal Hospital for Sick Children and Emeritus Professor of Surgical Paediatrics, University of Glasgow.
The Kingston University Team of Volunteers
Peter Tilley - Database Design Consultant and technical advisor to the project
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.
We are also indebted to Anne Morgan (Amendit Design Services) who designed both the original site and its new incarnation in HHARP and who sadly died in late 2009.
Dr Elizabeth Lomax
The Project team was extremely grateful to Dr Elizabeth Lomax for allowing us to borrow <em>Small and Special</em> as the name for the original website; and hope she will forgive us for the move to a new name. Her book, Small and Special: the development of hospitals for children in Victorian Britain, remains an inspiration to our work on children's hospitals.