About the Databases
At the heart of the HHARP website lies a suite of databases, based on the admission registers to four children's hospitals: the Hospital for Sick Children at Great Ormond Street (and its convalescent home, Cromwell House), the Evelina Hospital, the Alexandra Hospital for Children with Hip Disease, and the Royal Hospital for Sick Children, Glasgow. The Admission Registers cover a period ranging from February 1852 (when Great Ormond Street's doors first opened) through to 31 December 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 and 1889-1902; Alexandra Hospital for Hip Disease, 1867-1895; and Royal Hospital for Sick Children, Glasgow, 1883 to 1903.
NB The GOSH admissions between 1915 and 1921 are loaded in full, with the exception of patient names which are withheld until each record reaches its 100-year anniversary, at which time an algorithm releases the name information. All records will be complete on 31 December 2021.
The Registers have been carefully transcribed and indexed to enable flexible and accurate searching of this important resource. Users can search either across all hospitals or by individual institution on a range of data types including: name (first and last), age, sex, address and disease on admission. Other searchable fields include dates of admission and discharge, admitting doctor, outcome of treatment and subsequent referrals (if any).
In addition to these fields, which are present in all databases, the Evelina and Glasgow hospitals contain further (non-searchable) information.
Evelina Hospital Additional Data:
- Cause of admission (brief details)
- Treatment (brief details)
- Postmortem report (brief details)
Royal Hospital for Sick Children, Glasgow:
- Parents’ name and Occupation
The Alexander Hospital for Children with Hip Disease was quite different from the other three hospitals, specialising in the treatment of children with diseases of the hip. Its databases have been built from two separate records, a register of applications for admission and the admissions register itself. The structure of the records is also different from the other three hospitals. Name of patient, sex, age and address are all present, but the records also contain information which reflects the nature of the institution, providing descriptions of the deformity of the hip and leg. This information is held in one of three fields:
- Cause of admission which describes how the joint came to be deformed, usually as a result of injury, or as a result of another problem such as infection, or spontaneous (that is, no obvious cause)
- Condition of the joint (slightly abducted, in pain, open sinuses, shortening etc).
- Condition on discharge and cause of discharge - walking well, high boot fitted, no pain, position good etc.
The Application Registers sometimes include information on patients’ parents, whether admitted or not, and sometimes the reason for refusal.
Standardisation and Coding
Several data elements have been added to the databases, by the project team, to make searching simpler or to enable standard searches to be conducted across databases. This information has been included in additional fields. Fields which have been added include, year of birth (for family historians), disease standardisation and classification fields, and additional address fields.
In order to help users locate addresses, additional fields were added to the database to provide standardised spellings of street names. For London and Glasgow-based addresses, Registration Districts and (in the case of London) Registration sub-districts were added. Street names were also standardised. For addresses outside London or Glasgow, the addition of county name provides a similar service. This complicated and painstaking work was undertaken by Juliet Warren. 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.
The disease or condition of a child on admissions was transcribed into the database 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 related field was therefore added to the databases containing a standardised spelling of the diagnosis and two levels of classification were applied to enable analysis of disease-types. The first classification was developed specifically for the project by Dr Andrea Tanner and Dr Sue Hawkins. It is based on nineteenth century understanding of diseases and loosely applies the Registrar General’s Causes of Mortality headings, which, in part, groups diseases by body site affected. The second classification used applies the modern World Health Organisation’s International Classification of Diseases (ICD10) codes to diagnoses in the registers. Work on this was undertaken by Alicja Skowronska, a senior medical coder at Great Ormond Street Hospital for Children. (NB ICD 10 coding was only added to Great Ormond Street admissions between 1852 and 1914)
Standardisation/classification of diseases on admission has enabled cross-database searching.
The HHARP databases are being used in many ways, to study a wide variety of academic questions such as:
- the growing importance of hospitalisation in understanding the health of the urban child
- working class families' use of the children's hospital as a resource
- the suspected change in the role of the hospital, from being a place of refuge from dire domestic circumstance, to a place of scientific advancement offering increasing likelihood of cure for children whose life chances had been disadvantaged by poverty.
- differences and similarities between different parts of London and between the English and Scottish capitals.
The addition of the Alexandra Hospital for Children with Hip Disease provides a unique opportunity to study the treatment of children suffering from the scourge of poor children in the 19th century, tubercular disease of the bones.
For family historians HHARP offers another resource for tracing ancestors, in the inter-census years.
The HHARP databases complement and inform other archival databases, and will fill a gap in information on the lives of Victorian urban children, and on the institutionalisation - and medicalisation - of childhood, that was such a feature of late-nineteenth and early twentieth century Britain.