From the archives: International students at St George’s

In this blogpost, written by Archivist Juulia Ahvensalmi, we will be looking at the international history of St George’s students.

St George’s Medical School was formally established in 1834, but the hospital, which was opened in 1733, took pupils long before that. There were also several anatomical schools closely associated with the St George’s, including John Hunter’s Great Windmill Street school (established by John’s brother William Hunter in 1745), and Samuel Lane’s School of Anatomy and Medicine adjoining St George’s Hospital; John Hunter was a surgeon at St George’s, and Lane had also studied at St George’s.

There were fees to pay, and students could study for various lengths of time. The early student records show that some students only enrolled for a three-month period, others for six or 12 months. Initially pupils were assigned to a particular surgeon or physician. To become a perpetual pupil, there was an additional fee (which in 1870 was 100 guineas), and allowed the student admission to the practice of the physicians and surgeons of the hospital and all the lectures, allowing them to compete for any prizes and to become clinical clerks and dressers. The high fees then (as now) meant that education was not available for everyone, and the majority of the students were from the upper middle classes; many had gone to public schools and Cambridge or Oxford before attending St George’s.

Photo of 1805 student register.
Student register 1805, showing students enrolled for various lengths of time under different surgeons. Register of Pupils and House Officers 1756-1837, SGHMS/4/1/16, Archives & Special Collections, St George’s, University of London; and Extract from student register, 1945, showing the schools and colleges attended by student prior to their enrolment at St George’s. Register of Pupils 1837-1946, SGHMS/4/1/18, Archives & Special Collections, St George’s, University of London.

International connections

The student records held in the archives reveal a steady trickle of international students, based on their names (which in these early records is often the only information recorded). Names, of course, can only be used as a starting point, but the records also occasionally explicitly refer to visiting students, as in the case of Michal Astrashapovitch and Stephen Koniwetsky, who paid £20 to study under Everard Home and attend the lectures ‘for an uncertain time, to be settled at their leaving England’. There is no more information about them, but they may have been Russian – there are several other Russian names which suggests some regular contact or connection.

Photo of 1808 student register, showing enrolment of Michal Astrashapovitch and Stephen Koniwetsky.
Student register 1808, showing enrolment of Michal Astrashapovitch and Stephen Koniwetsky. SGHMS/4/1/16, Archives & Special Collections, St George’s, University of London.

Another early student was Philip Syng Physick, who had graduated from the University of Pennsylvania, and travelled to England to study under John Hunter in 1785. Known as the ‘father of American surgery’, he is said to have performed the first human blood transfusion, and was particularly interested in using autopsy as a method for observation and discovery – a practice that we can time and again see in our post mortem records.

Swedish names also appear in the registers with some regularity, especially in the 1890s when it appears to have been somewhat of a trend to travel to London to study medicine. These students include Henning Grenander, who later gained fame as a figure skater, winning the world title at the National Skating Palace in London in 1898.

Image of Henning Grenander ice skating.
Henning Grenander. Image: skateguard1.blogspot.com

Henrik Kellgren’s ‘Swedish Institution for the Cure of Diseases by Manual Treatment’in Eton Square, London appears to have further encouraged Swedish students to study in London: Axel Wolter Louis Stackelberg, who was a pupil at Kellgren’s institute, for instance, is enrolled for 6 months as a student of anatomy in 1897, while both Kellgren’s sons Ernst and Jonas also studied at St George’s for a period; Jonas went on to study rheumatism, was a pioneer in the study of physiology of pain, and became a professor of rheumatology in Manchester in 1953.

The adventures of Hajji Baba of Ispahan

Hajee Baba may have been the first Muslim student at St George’s, and one of the first Iranian medical practitioners to study in Europe in this period. He came to England to study medicine alongside another young Iranian, Muhammad Kazim or Mohammed Cassim, in 1811 with the British ambassador to Iran, Sir Harford Jones. Hajee Baba was the son of an officer in the Shah’s army, and the sending of students to study in Britain was seen as a way of strengthening the diplomatic ties and connections between the countries; his brother trained as a mining engineer in Russia. Kazim was to study arts, but died shortly after their arrival in England.

Hajee Baba stayed in England for eight years. Following his studies, he returned to Iran to work as a physician in the court in Teheran, and in 1835 he is described as ‘a respectable elderly looking man’. He also worked as an interpreter for Persian missions abroad. Eventually he became the chief physician to the shah. He died in 1842 or 1843.

Composite image. From left to right: photo of 1817 student register, Cover of ‘The Adventures of Hajji Baba of Ispahan’ (1824-28) by James Justinian Morier; Poster for ‘The Adventures of Hajji Baba’ (1954).
Student register 1817, Register of Pupils and House Officers 1756-1837, SGHMS/4/1/16, Archives & Special Collections, St George’s, University of London; Cover of ‘The Adventures of Hajji Baba of Ispahan’ (1824-28) by James Justinian Morier; Poster for ‘The Adventures of Hajji Baba’ (1954), Wikipedia, ©20th Century Studios.

He may have been the inspiration for a series of best-selling novels, ‘The Adventures of Hajji Baba of Ispahan’ (1824-28) by James Justinian Morier, secretary to Sir Harford Jones; Hajee Baba was reportedly annoyed at Morier’s use of his name for this purpose (and would have been, we can imagine, even more annoyed by the American adventure film of the same name of 1954!).  Nile Green’s book ‘The Love of Strangers: What Six Muslim Students Learned in Jane Austen’s England’ (2016) recounts the story of a group of six students who travelled to Britain in 1815, based on contemporary diaries and letters of the students, in which he also mentions Hajee Baba and his unfortunate companion.

The problem of sources…

Often, the spelling of names varies considerably in different sources (this is of course particularly true when the original is in a different script), which can make tracking people difficult (but we do enjoy a bit of detective work!); there is a Wikipedia entry for Hajee Baba, for instance, but in that his name is spelled Hadji Baba Ashfar, whilst the Encyclopaedia Iranica uses the form Ḥājjī Bābā Afšār; in Persian his name is افشار، حاجی بابا.

Many students are also entered in the registers only by their first initial and surname, making identification even more problematic. A ‘foreign-sounding’ name, moreover, is of course not solid evidence either way – the somewhat exotic-sounding Peregrine Fernandez in 1799, for instance, ‘gentleman of Widcombe, Somerset’, may have had family roots elsewhere, but was born and bred in London. Where the student records are simply lists of names, as the earlier ones are, we have to turn to other sources to find out more about the people behind the names.

Image of Assaad Y. Kayat. Source: ‘A Voice from Lebanon with the Life and Travels of Assaad Y. Kayat’ (1847).
Image of Assaad Y. Kayat. Source: ‘A Voice from Lebanon with the Life and Travels of Assaad Y. Kayat’ (1847).

One student we do know more about is Assaad Kayat, who enrolled as a student at St George’s in 1843, studying alongside Henry Gray (of Gray’s Anatomy). His fascinating story is recounted in more detail in an earlier blogpost, and his autobiography tells us a lot about his childhood in Beirut, as well as his and his wife’s experiences as immigrants in London.

The archives also reveal the story of Boghos Baghdasan Tahmisian, who, according to an appeal launched in 1892 by the Turkish Mission’s Aid Society, was a ‘native of Cilicia’, in present-day Turkey; his name may suggest Armenian origins. He is in the appeal described as a diligent student, who had arrived in London in 1889 and enrolled as a medical student at St George’s. He had, however, found himself lacking adequate funds to be able to finish his studies, which is why the society decided to appeal to the public on his behalf.

Composite image. Left-hand side: ‘An appeal on behalf of Mr B.B. Tahmisian’ (1892). Right-hand side: a letter signed by Tahmisian.
‘An appeal on behalf of Mr B.B. Tahmisian’ (1892) and a letter signed by Tahmisian. Archives and Special Collections, St George’s, University of London.

Pictorial propaganda

Following the end of the First World War, the Universities Bureau of the British Empire (now Association of Commonwealth Universities), established in 1913, encouraged British universities to admit students, and the Foreign Office was eager to distribute what they called ‘pictorial propaganda’:

‘The idea is to endeavour to impress the peoples of Russia and of the East with the greatness of the educational system of the British Empire’

Photo of letters to the Medical School, preserved in the minute books of the Medical School Committee XII-XIII.
Letters to the Medical School, preserved in the minute books. Minutes of the Medical School Committee XII-XIII, SGHMS/1/1/1/15. Archives and Special Collections, St George’s, University of London.

‘This medical school is unable to admit any Ceylonese students’

(Medical School minute books, 1920)

The minute books of the medical school from that time contain frequent references to the admission (or not, as it were) of international students; the minutes refer to students by their nationalities: ‘a Pole’, ‘the Siamese doctor’, ‘a native of India’.

At times, certain nationalities were the subject of intense conversations. Following the end of the First World War and demobilisation, many ‘American and colonial’ soldiers found themselves with some time to spare, and willing to use that time to study. A letter from the Royal Society of Medicine in 1918 warns that if plans to offer brief post-graduate courses for such students are not soon put in place, ‘the chances are that the majority of them will go to Paris, where […] post-graduate courses have been arranged for all Allied Officers and are already in full swing!’. The response from St George’s was not enthusiastic due to staff shortages and bureaucratic burden on the school. In the end, however, it was decided that up to 10 American students could be admitted for a three-month course, with a fee of ten guineas.

Appeals from the Egyptian Educational Mission received an even less favourable response: despite admitting two Egyptian students for a clinical course, ‘it was decided that this School cannot bind itself to admit any definite number of Egyptians’, the dean at this time wrote, suggesting that the school is too small to admit ‘foreign students […] although I am doubtful whether they ever really amalgamate or attempt to settle down with their fellow-students’.

At the moment we’re looking forward to delving into our nursing records and learning more about the student nurses at St George’s. Our initial research suggests that in the 1950s-1960s for instance up to 70% of the nursing students were immigrants to the UK; among these are many from the Windrush generation, and students came from all over the world, including the Caribbean, Ireland, India, Nigeria, Sweden and Bermuda.

Photo showing nursing students' nationality in 1970s student records.
Records of nursing students at St George’s in the 1970s. Archives and Special Collections, St George’s, University of London.

Want to know more, or see and study the records for yourself? Just get in touch with us at archives@sgul.ac.uk – we’d be very happy to hear from you!


Decorative banner for St George's archives.

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Mental Health Awareness Week – Reading to support wellbeing

It is Mental Health Awareness Week from 10th to 16th May and this year the Mental Health Foundation has chosen nature as the theme.

This is our second blogpost for Mental Health Awareness Week. To find out about your library team’s thoughts on what nature means to them and their wellbeing in words and pictures, have a look at our previous blogpost. Check out the hashtag #ConnectwithNature on social media. We will be sharing posts around Mental Health Awareness Week all week on TwitterFacebook and Instagram.

Decorative image of person reading in a field.

A great way to support your mental wellbeing is through reading. Especially during busy periods such as exam and essay writing weeks, it is important that you take time away from work to just relax.

Reading a good novel or poetry can certainly help with that which is why the library has developed a whole collection around reading for pleasure. In addition to medical and healthcare textbooks, we also have books you might find in any public library: good novels, poetry and contemporary non-fiction for when you want to take a break from your studies.

Some highlights from our reading for pleasure collection around the theme of nature are listed below.

  • Step by Step: The Life in My Journeys by Simon Reeve. Find out the shelf mark here. The author talks about his own mental health struggles and how he has found wellbeing in walking some of the most remote parts of the world. Perfect for adventurers!
  • Feral: Rewilding the land, the sea and human life by George Monbiot. Find out the shelf mark here. An environmental journalist talks about the importance of rewilding in the UK and across the world, reengaging with nature and discovering a new way of life which is much more in tune with nature.
  • The sun and her flowers by Rupi Kaur. Find the shelf mark here. A beautiful collection of poems in which the natural world plays a big role.
  • Dream Work by Mary Oliver. Find the shelf mark here. One of the finest contemporary poets, Mary Oliver who won a Pulitzer Prize, writes about the natural world with reverence and playfulness. This collection focuses on the work of self-exploration.
Decorative image of person reading on a bench outside.

Reading a good novel or poetry can certainly help with that which is why the library has developed a whole collection around reading for pleasure. In addition to medical and healthcare textbooks, we also have books you might find in any public library: good novels, poetry and contemporary non-fiction for when you want to take a break from your studies.

Specific Wakelets, or lists, we have created, that you might find interesting in this regard are books for Health and Wellbeing , Mood-Boosting books and the Big Read collection.

Resources for nurses at St George’s library

To mark this year’s Nurses Day, we have compiled a brief guide to some of the resources that can help to guide and support the amazing work that nurses do each and every day.

Books

A wide range of print and electronic books are available from the library at St George’s. Below are some lists of available titles on a selection of nursing specialties or nursing-related topics:

To access any of the e-books included in the above lists, you will need an NHS OpenAthens account. If you don’t already have one, you can easily register online. This also provides access to most of the journals, databases and other useful resources noted below.

Websites and online resources

The Royal Marsden Manual of Clinical and Cancer Nursing Procedures, is available online with your OpenAthens account.

A series of training videos on a range of topics including how to carry out different assessments and procedures is available through the ProQuest Hospital Collection.

Clinical guidelines, resources to support professional and career development, and other helpful information can be found on the Royal College of Nursing website, while information relating to registration and nursing standards is available from the Nursing and Midwifery Council.

Journals

NICE provide a searchable A-Z of all journals available through OpenAthens, which can be found here: https://journals.nice.org.uk/

Available journals include: Nursing Standard, Nursing Management, and the British Journal of Nursing.

Login and search to see all available titles.

Databases

In addition to Cinahl and Emcare the larger, and international databases which provide coverage relevant to all nursing specialties and professionals, there are also some smaller UK specific databases with a focus on nursing: the British Nursing Index, and Internurse.

The Cochrane Database of Systematic Reviews, which you can find at the Cochrane Library also includes material relevant to nursing, as do more general medical databases such as Medline (and it’s free equivalent PubMed) and Embase.

Finding information

The library team at St George’s offers training on where and how to find the best quality information to support clinical practice, research, and quality improvement. You can find details on the sessions available here.

We also provide a evidence search service, CARES, which provides aims to provide recent, reliable and relevant evidence on your topic or question. Search requests can be submitted for patient care queries, service development, teaching or research projects, or for any other professional need.

Help

St George’s library has a team dedicated to providing support for all of the nurses (and other NHS staff) at St George’s trust. If you have any questions, need advice on anything related to finding, or managing information, or if there’s anything that we might be able to help with, you can get in touch at: liaison@sgul.ac.uk

Mental Health Awareness Week – what nature means to library staff

From 10th to 16th May 2021 is Mental Health Awareness Week and this year the Mental Health Foundation has chosen nature as the theme.

Check out the hashtag #connectwithnature on social media. We will be sharing posts around Mental Health Awareness Week all week on Twitter, Facebook and Instagram.

In this blogpost, your library team highlights in sentences and images what nature means to them and their mental wellbeing.

Over the last year, many of us have become more aware of our relationship with nature, be that our balcony, garden, local park, forest, the beach or mountains. More than an appreciation of the small things in life, the last year has shown that we are inextricably part of nature and that nature plays a central role in our emotional and physical wellbeing. It has also become clear that access to and time in nature is often still for the privileged few, despite the fact that we all benefit enormously. Nature is not a luxury but must be available to all of us. Perhaps our appreciation for the natural world over the last year in combination with our increasing and continued damage to our planet has given us food for thought. In this sense, access to nature for mental wellbeing is a social justice and environmental issue.

With this blogpost, we want to raise awareness of the importance of mental wellbeing and the role that nature can play in that. We want to normalise conversations around how we are doing and that at times, we might not be doing so well emotionally or mentally.

What does nature mean to us and our mental wellbeing?

Sue – Associate Director of Information Services (Library & Learning Services)

Escape from the rat race
Space to think
Inspiring awe
A step away from the mundane
Tiny miracles
Expanding our horizons

Rocks on the beach in Hastings
at the beach in Hastings

Karen – NHS and Liaison Manager

Accessing local green spaces has helped me and my children digitally detox during intensive times of home-learning and home-working this past year

Emily (Information Assistant)

During the first lock down, when you were only allowed an hour outside a day, I tried to ensure I took my kids out for some sort of walk every day to get a bit of exercise and fresh air.  Being outside helped us to stay feeling connected to the world and I think feel somehow reassured that the sun still came out, the rain still fell, the trees still stood, and the flowers grew. It was a sense of some normality in the chaos that nature still carried on. It made us appreciate every little bit of green space nearby.  We always returned from outside feeling more hopeful.

Anna – Liaison Librarian (FHSCE)

Conversations about nature tend to cheer people up, and are a vehicle for a non-stressful chat with colleagues.

Stephen – Liaison Support Librarian (NHS)

Regarding the question of nature, I suppose the first impulse is to think of the outdoors in some of its grander forms (beaches, mountains, forests, etc.) before then considering those havens of nature which may be nearby to us (parks, commons, woods) which, given that ‘more than one in five households in London has no access to a private or shared garden‘, offer invaluable resources in support of health and wellbeing. 

Even more locally than these, however, is the nature that can (should?) be brought into the home (and work) environment. For the good that plants can do in cleaning indoor air; for the connection that tending plants offers to a larger living world; and for the aesthetic contribution that plants can make to any indoor space, my shout out goes to the humble (or showy) houseplant.

Jennifer – Research Publications Librarian

White blossom; blue sky

Delicate petals fall and

Again, I will sigh.

Photo of tree blossoms
Blossom

Louise – Helpdesk supervisor

I like to be out in nature – in the outside, wandering in the woods – always nicer in the sunshine of course but I love lifting my face to the wind in early Autumn.

The main thing I think is how nature affects your senses;

Smell –  fresh rain – especially in the summer, flowers, freshly cut grass, even those ‘farmyard’ smells just make you think of nature in general.

Sight – new blossom on trees, the changing colours of leaves in the Autumn, freshly laid snow in Winter. Seeing newborns – ducklings/Goslings growing, tadpoles changing into frogs.

Touch – feeling grasses, petals even different textured tree trunks, pebbles, stones, sand beneath your bare feet.

Hearing – the most obvious is the bird call of course. Although noting beats the sea crashing on the shore if you are by the coast, or even the gentler shushing of waves.

Ros – User Experience & Operations Manager

Two children with their backs turned away from the camera, running along a forest path with bluebells on either side.

Dan – Information Assistant

It’s always good to get out of the house whether its just to the park over the road or a car trip to the beach. Its about being out in the fresh air and looking at the trees and green or being by the Sea. I always feel better after I’ve been outside even if its just for an hour or two. It certainly improves my day. The dog loves it too!

Juulia – Archivist

Here is a composite of photos I’ve taken across the year of the trees in a nearby woods. Having access to a green space has definitely been a lifeline, and doing more or less the same walk every day has made me focus on the seasonal changes, and on all the small details you might otherwise miss. And it has made me really appreciate how you can find beauty maybe in some unexpected places – my local cemetery is absolutely brimming with nature & life!

Composite of photos of trees across the seasons

James – Liaison Support Librarian (FHSCE)

When I’m outside in nature my mind becomes quiet and I have the opportunity to become aware of something bigger than myself. When I’m not so focused on me and my story, I can really begin to relax and start to let go of built-up tensions.

Georgie – Information Assistant

I’ve become a member of Kew Gardens in the last year and it’s been wonderful to be able to spend time in such a beautiful place. I had a lovely, quiet, peaceful walk there on Sunday morning.

Picture of bluebells and trees in the sunshine at Kew Gardens.
At Kew Gardens

Alex – Project Archivist

I think to me, nature reminds me that I am part of something bigger, something beautiful. It makes me feel extremely lucky and full of joy but as I have gotten older that joy tends to be tinged with a bit of sadness and frustration at how often we mistreat it and take it for granted. Over the last year I have loved seeing people, myself included, reconnect with nature and take pleasure in simply being outside, but I have also seen how much nature has become a privilege that not everyone has equal access to and that it is very easy to be cut off from in modern cities. Being surrounded by nature, I would say, is extremely good for my mental wellbeing, but it is not always an entirely positive experience and sometimes I do leave it feeling slightly weighed down by my responsibility to do more to protect what I have seen.

Anne – Liaison Support Librarian (IMBE)

A chance to connect with something beyond myself
Miracles of colours, textures, sounds
The abundance of life away from a screen
Sharing the joy of nature with others
A spiritual practice and gratitude
Watching seedlings grow

Careers Week 2021 Reflections and Survey

In March we held the second annual Careers Week at St George’s, University of London. We were delighted with the participation with over 500 views. Complete our survey for a chance to win £50 Amazon vouchers.

Careers Week 2021 – what did we do?

The theme this year was Resilience, Workplace Wellbeing and Planning your Career in a Pandemic. The programme included Q&A sessions in which alumni and students from a range of disciplines and courses shared their own careers and wellbeing insights, providing advice on how to manage your own future and job hunt successfully in these unpredictable times. There were top tips and words of encouragement for current students and those seeking work or direction as well as inspirational career stories, with common themes of perseverance, commitment, and consistent courage to find and take opportunity. The broad spectrum of careers and study routes open to SGUL graduates was showcased by alumni representing the wide range of SGUL programmes, some were most unexpected, demonstrating that studying a vocational course does not mean career choice and progression is a foregone conclusion.

The sessions were recorded and are available to watch on the St George’s YouTube channel.

Decorative image of two healthcare professionals walking and talking.

Win £50 Amazon vouchers – Careers Week Feedback Survey

We would really value your feedback! We are running a competition to win 3 x £50 Amazon vouchers to thank you for your participation. By giving your feedback you will help us improve and make sure we are providing the support you and future students value. You will get the opportunity to give your own ideas and suggestions for Careers Week 2022, comment on the online experience, as well as the Careers Week programme 2021. Complete the survey (5 minutes to complete). Deadline for completion is 21 May 2021.

If you missed the Alumni Q&A sessions then do visit here. See the full list below with key themes covered. It is worth watching a range (i.e. even those outside of your own programme) as the tips and inspiration are often interchangeable between disciplines. Don’t forgot to watch and complete our survey before 21 May 2021 for your chance to win Amazon vouchers.

Careers Week recordings on YouTube Channel

The Careers Week session recordings are on YouTube.

Programme contributors

Resilience and Adjusting to Channel Nicoletta Fossati, MBBS Alumna  

Adapting to change and looking after your wellbeing Cathy Wield, MBBS Alumna 

Work-life balance and managing stress Chris Redmond, Healthcare Science Alumnus

Looking after your wellbeing in a pandemic– Nirja Joshi, MBBS Alumna

Making a move into teaching, and taking a career break – Matthew Owen, Physiotherapy Alumnus

Non-traditional career pathways Francesca Humfrey, Biomedical Science Alumna

Changing career paths and moving into management– Jessica Brett, Healthcare Practice Alumna

Non-traditional routes into healthcare – Adrien Dansette, Paramedic Science Alumnus

Changing direction in your career, and working towards your goals – Shirley Forson, Physiotherapy Alumna

Postgraduate study and studying abroad – Rosie Dutt, Biomedical Science Alumna

Adapting to new ways of working and balancing work and family – Saira Alam, Therapeutic Radiography (contact careers@sgul.ac.uk should you wish to view this interview).

Making a difference through research – tips for those considering a PhD – Jacob Wildfire, PhD

Outpatients at St George’s Hospital, 1733-1948

This blogpost was written by Alexandra Foulds, Project Archivist at St George’s, University of London.

How did you become an outpatient at St George’s Hospital before the creation of the NHS? What was it like to be an outpatient at St George’s Hospital at this time? Well, from its establishment in 1733 until the creation of the NHS in 1948, St George’s Hospital was what was called a voluntary hospital, which meant that it was reliant on receiving donations from ‘subscribers’ for funding. The board of governors at St George’s Hospital was made up of those who made large financial contributions to the hospital and medical staff who, unlike at most voluntary hospitals, were eligible to make subscriptions to the hospital.

In order to support themselves, voluntary hospitals ‘ran continuous appeals and publicity campaigns’, and voluntary hospitals competed with each other for funding. They would organise dinners and fundraisers which played an important part in the social calendar for donors. The expanding middle class would donate to the hospitals out of philanthropy and because of the social status it brought them. Becoming a subscriber to a voluntary hospital also meant that you could refer people to the hospital to become an outpatient or inpatient, and the amount donated equated to a certain number of referrals that were allowed per year.

Voluntary hospitals were created in the eighteenth century to give free medical treatment to the ‘sick poor’, or those who could not afford to be treated by private physicians. A distinction was made between the ‘poor’ who were considered to be self-reliant and therefore believed to be deserving of charity and the ‘destitute’ who were not. As Henry Burdett, the hospital administrator who helped to establish the British Hospitals Association in 1884, stated:

‘The people who are entitled to free relief are those who are able to maintain themselves independently of all extraneous assistant until the hour of sickness, when the breadwinner, for instance, is  struck down, or the added expense of sickness in the home renders it necessary that the hospital of dispensary should step in’.

This meant that initially to be treated as an outpatient or an inpatient at a voluntary hospital like St George’s, patients needed a letter from one of the hospital governors or a hospital subscriber that said that they were ‘proper objects of charity’, and even once patients had been accepted they were subject to suspicion that they may be abusing the system.

The outpatient department functioned alongside dispensaries to provide out of hospital medical care to poor patients on a charitable basis, and it was where the majority of what we now refer to as primary care was conducted.

Patients at St George’s mostly came from Westminster and Pimlico, both of which were largely poor, working class areas and some parts of which were slums. In 1910 St George’s Hospital reported that the majority of patients came from Westminster (Pimlico), Chelsea, Fulham and Battersea, with a few coming from further South in Clapham, and Lavender Hill (King Edward). 6% of these patients were trained servants, however, only 2 1/4% were currently employed as servants, and their average annual wage was between £21 and £22.

Photo of a newspaper clipping showing a photo of people attending the unveiling of the bust of John Hunter at the St George's Hospital Medical School, Hyde Park Corner. Not Dated.

After receiving a letter from a subscriber to the hospital, outpatients would visit St George’s Hospital. They would first be seen by a Medical Officer who would decide whether a patient was an acceptable hospital case, should be an outpatient or an inpatient, or should be treated as a casualty in which case they would be seen by a doctor immediately. The term casualty could apply to anything from ‘a small cut’ to a ‘bad toothache’, as well as those who had been in an accident. Once a patient had been accepted as an outpatient an Inquiry Officer would ask for their name, age, occupation, address, their marital status, their wages, and if they were married then their number of children that were dependent on them. In the case of patients who were children they would also be asked for information about the father, and in the case of married women they would be asked for information about their husbands.

Upon their second attendance at the hospital they would be seen by a Casualty Officer and an Almoner. The almoner could then investigate to advise on whether free treatment should be ceased and patients should be referred to workhouse infirmaries, private practitioners, dispensaries, or other hospitals. In 1910, of the 48,583 outpatients 6,768 cases were investigated, with 432 considered not suitable for treatment. The almoner could also decide along with the doctor whether home visits from volunteer ‘lady health visitors’ should be organised, or whether instruments (such as trusses for hernias) or meals should be provided, generally paid for out of the Hospital’s Samaritan Fund which was principally made up of subscriptions from hospital governors. The almoner was also responsible for coordinating with charitable societies to ensure that patients would continue to receive the care they needed outside of the hospital.

At the beginning of the nineteenth century, outpatient treatment numbers were small, however, from 1835 they began to rise and continued to rise until the beginning of the twentieth century. In the years 1833-1842, St George’s Hospital treated 70,000 cases of which 44,000 were outpatients. By 1910, St George’s treated 48,583 outpatients in that year alone, of which 67% were casualties.

As a result, doctors had to treat patients incredibly quickly, with Dr Robert Bridges, a casualty physician at St Bartholomew’s Hospital and later the Poet Laureate, writing in 1878 that he had to treat over 30,000 outpatients a year at a rate of 88 seconds per patient. By 1900, St George’s Hospital introduced a limit on how many new outpatients would be treated each day with the rest being turned away. In 1910 average outpatient attendances were approximately 160 a day, with new cases limited to 15 per hospital department per day, with all patients being seen first by a superintendent who imposed the limit when they arrived at the hospital. If a patient was not one of the 15 but was considered to require treatment he was brought back the next day.

Photo of the outpatient department at St George's Hospital at Hyde Park Corner.

As outpatient departments provided free access to health care, they were viewed as being in competition with private physicians and were therefore seen as a threat to the physician’s income. This meant that in medical journals outpatient departments, and voluntary hospitals more generally, were frequently described as locations in which patients abused the medical system by getting free care when they could afford to be treated by a private doctor.

By the end of the nineteenth century several voluntary hospitals, St George’s among them, was choosing not to require a letter from a hospital subscriber for outpatients (Louden), and so physicians tried to introduce the requirement for patients to be referred to the hospital by private practitioners in order to prevent this perceived abuse of the system. A letter to the British Medical Journal in 1894 stated that:

‘The abuse of the hospitals’ outpatient departments is an evil so gigantic that the tendency is to regard it […] as necessary in the sense of being unavoidable […] The remedy lies in the hands of those who suffer most from the unfair competition of the hospitals, and it is idle to appeal to the public or to the hospital authorities. […] The remedy I would suggest (though I claim no originality) would be to admit to the outpatient department only patients whose cases are certified by some medical authority or medical man to require special consideration’.

In 1910, however, only 3-6% of outpatients at St George’s Hospital were referred by physicians.

These perceived abuses led in 1910 to an investigation into the admission of outpatients in hospitals in London by the King Edward’s Hospital Fund for London, who from 1897 gave funding to voluntary hospitals. They called on people from various medical charities and representatives from each of the voluntary hospitals to testify, asking about the suitability of the letter system, hospital procedures for dealing with outpatients, the numbers of outpatients and the kinds of cases hospitals treated, and whether they believed the system was being abused by patients. William West, the treasurer at St George’s at the time, testified, arguing that he did not believe that the system was abused at St George’s, but that there were times it was misused by patients who had paid to be treated by a physician and upon seeing no improvement wanted a second opinion and so visited the hospital.

In 1948 the NHS Acts brought voluntary hospitals under public ownership, however, researchers have argued that it is these nineteenth and early twentieth century arguments about the relationship between hospitals and private physicians that led to our current NHS health system in which patients are required to be referred to specialists in hospitals by their GP.


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Information Skills Training: April to June

In the upcoming months we will again be offering a variety of library skills training sessions. There are different sessions suitable for your level of expertise or year of study, for students, academics and NHS staff.

Below you can find out more about the different training sessions we offer and the dates for these sessions. To book, please visit LibCal and register for the session you would like to attend. These sessions are all held online, via Microsoft Teams.

Don’t forget, we also continue to run our Library Research online drop-ins, Monday to Friday 12-1pm. At our drop-ins we can help you with getting started with finding information for your assignment, doing in-depth literature searching projects and referencing enquiries.

Visit our website to find out more or email liaison@sgul.ac.uk.

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Training sessions on offer

My Learning Essentials: Hunter & Harvard

Wednesday 26th May, 1-2pm
Tuesday 22nd June, 1-2pm

This session is suitable for SGUL or FHSCE undergraduate or postgraduate students who have specific referencing or literature searching enquiries relating to their assignments.  You will be able to discuss your query with the librarian, and receive guidance on how to effectively use Hunter to find academic books and articles and how to use CiteThemRight to ensure your referencing complies with SGUL’s specific Harvard Referencing Style.

Book here.

Literature searching for your dissertation

Tuesday 18th May, 11.00-12.30pm
Tuesday 15th June, 11-12.30pm

We know databases, like Medline (aka PubMed) and CINAHL, can be daunting, but with a little help and guidance, we are short you will get to grips with them in no time. If you have a longer research project, like a dissertation, or you just want to impress in your assignments, this session is for you. You will learn how to effectively run a literature search in a database relevant to your subject. The sessions are suitable for St George’s and FHSCE staff and students.

Sign up here.

RefWorks

Thursday 13 May 1-2pm
Wednesday 16 June 12-1pm

In this session, we will introduce you to the reference management software RefWorks. We will show you up to set up an account, add references, manage them and how to use RefWorks Citation Manager (RCM), a Microsoft Word Add-in.

Book here.

Training sessions for NHS staff

NHS Library induction

Thursday 20th May, 12.30-1pm
Tuesday 15th June, 11-11.30am

Library induction for NHS staff, introducing you to the range of services and resources on offer to those working for St George’s Hospital, Queen Mary’s Hospital and other community-based sites.

Sign up here.

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Finding the Evidence

Thursday 29th April, 1-2.30pm


Monday 10th May, 12-1.30pm
Wednesday 26th May, 12.30-2pm


Friday 11th June, 11-12.30
Monday 21st June, 1-2.30pm

Finding top-quality evidence is a priority for health care practitioners. This session will introduce the high-quality resources available to you, as well as provide training in how to use them effectively to support evidence-based clinical practice or decision-making.

The session will cover: The range of evidence-based healthcare resources available, including: NICE Evidence, the Cochrane Library and BMJ Best Practice.

How to use the NHS databases effectively and identify the most appropriate database for your need. This includes how to create and plan a search strategy using subject headings and keywords and how to combine searches and apply limits to focus your results; how to access full-text articles where available or locate articles through St George’s journals page; and how to save your searches and set up alerts.

You can book your slot here.

Systematic Reviews: finding and managing the evidence

Wednesday 28th April, 1-3pm

Tuesday 25th May, 11am-1pm

Thursday 24th June, 11am-1pm

This course will focus on in-depth literature searching for systematic reviewers and how to manage your results. It will provide you with an overview of the systematic review process, the know-how of creating effective search strategies, systematic searching of the literature, managing your results and documenting the search process.

You can book this session here.

At the end of this session you will be able to:

  • plan robust search strategies for literature searches in support of systematic reviews
  • carry out systematic, advanced searches on the Ovid platform
  • save searches strategies and create alerts
  • plan how you will manage your search results and report on your search methodology.

If you have any questions about these training sessions, don’t hesitate to get in touch by emailing liaison@sgul.ac.uk.

The library working environment: study break passes and texting service

Maintaining a pleasant working environment for everyone who uses the library is one of our main concerns. To ensure that it continues to be a great place to study, we have introduced, or rather reintroduced for those of you  who have used the library for a few years, two new schemes.

Study break scheme

We are still operating at reduced capacity and we’d like to make sure everyone has access to the study space they need. A study break pass allows you to take a break of up to 30 minutes during which time you can leave your belongings unattended. While we don’t take any responsibility for unattended personal stuff, with our study break scheme you can make sure that we don’t move your things to make space for other library users during the 30 minutes. After that time or if you choose not to use a study break card and you are away from the desk, other library users or staff are able to move your belongings to the side to make space. Find out more here or email library@sgul.ac.uk with any comments you might have.

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Noise in the library

We have also introduced a texting service, so you are easily able to alert us to noise in the library or other issues affecting your study space. Text us, with your location, on 07562901543 and we will ensure you can study in peace and quiet. This service is available between 9am and 9pm Monday through to Sunday. Again, if you have any comments about this, please email library@sgul.ac.uk.

Poster for texting service.

We hope that these schemes allow us to continue keeping the library a pleasant working environment for all library users.

Tips and tricks for longer research projects

The focus of this blogpost is literature searching, specifically for longer research projects such as dissertations, and it is aimed at St George’s students.

Your expert Liaison Librarians are able to support you with every step of the way so don’t hesitate to get in touch by emailing liaison@sgul.ac.uk. We are able to advise on how to plan and carry out a complex literature search in a variety of databases. We can also recommend which databases are most suitable for your topic.

You can email us for an individual appointment or come to one of our online drop-ins. Monday to Friday between 12-1pm you can chat to a Liaison Librarian directly. Click on the relevant link on the day you want to drop by.

Here we provide tips and tricks, no matter which stage of the process you are currently at.

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If you are…

…just getting started

Do a scoping search in Hunter. Even if you already use Hunter to locate books and journal articles in our collection, our Hunter video might teach you another thing or two about how to really make the most of its search functions.

If you aren’t familiar with the planning stage of literature searching or you usually skip this bit to get stuck in straight away, now is a good time to change that. When it comes to dissertations and research projects, you need to be much more systematic in your work, including when you formulate your research question. Have a look at our Canvas unit on this topic. It gives you more information and by the end, you will have a research question ready to start searching with.

If you are worried about how to structure your dissertation or academic writing, you can make an appointment with the Academic Success Centre team. Their details are found on the Study+ section in Canvas. We also have a number of books in our collection which can help with academic writing, including how to approach a literature review, dissertation or research paper. They are listed on our Writing for Assessment Wakelet.

If you need specific software to do your research, such as SPSS, have a look at what is available to you through St George’s University and request it here.

And finally, a little tip on how to get started. If you know of a paper which covers the area you are interested in already, have a look at which articles they reference and perhaps you find some relevant papers in their reference list for your project. While this is not a systematic method, it can help you get started and add to your search strategy (e.g. which alternative terms to use).

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…ready for an in-depth literature search

If you are a little overwhelmed by the prospect of doing a complex search in multiple databases (and who can blame you), you need to start by familiarising yourself with how to build a complex search, what alternative terms are and how to include them and how to use advanced search strategies. We have a libguide that takes you through the whole literature searching process. For those of you who are working on a systematic literature review, have a look at our relevant libguide, which highlights what you need to consider to turn your literature review into a systematic literature review. Watch the following videos to find out more about identifying keywords and alternative terms.

We have introductory videos on Ovid (Medline), Ebsco (Cinahl) and Internurse to get you started. Once you have familiarised yourself with the basics, watch our detailed video tutorial on how to search in Ovid/Medline using advanced search techniques.

Have a look at our Databases A-Z list to see which databases are available to you. Your subject guide will tell you which databases are most relevant to your course.

Don’t forget – you can also ask a Liaison Librarian for help by emailing us at liaison@sgul.ac.uk or coming to one of our daily online drop-ins. We can recommend which databases are most suitable for your topic.

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…finishing up and sorting out your references

To cite correctly at St George’s, most of you need to use Harvard Cite Them Right. While we have a number of physical copies of this in the library, you will probably be using the Cite Them Right website (login required). In case you need a refresher on how to navigate Cite Them Right, we also have a detailed walkthrough video on our YouTube channel and in our Referencing Essentials unit in Canvas.

We strongly recommend you don’t use reference generators such as Cite This for Me as we find that generally the references produced by such tools are wrong. You end up spending longer correcting and double-checking your references than you would have done writing them from scratch. If you find the resource in Hunter, you will notice a “citation” option for each record. This has been formatted to match the requirements of Harvard Cite Them Right but it is not always correct. Make sure you compare it to Cite Them Right and correct it if necessary.

For a longer project, we encourage you to use reference management software as it helps you to deduplicate your search results, manage your references and create in-text citations and references. At St George’s, we support RefWorks, which is a web-based software. You need your St George’s login to access it and create an account. To get started, have a look at our RefWorks libguide. Additionally, our detailed video tutorial covers everything from how to get started to how to create references and in-text citations from within Microsoft Word.

We can also help you with your references, so if you are unsure about anything please email liaison@sgul.ac.uk or come to our drop-ins.

A Railway Mystery

Opening Up the Body’ is a Wellcome-funded project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1921. This post was written by Project Archivist Natasha Shillingford.

Following on from the discovery of a post mortem case of a monkey on the railway we decided to explore other cases of railway mysteries in the post mortem collection of St George’s Hospital. We soon came across a case worthy of the great Hercule Poirot.

On 23rd September 1886 Moritz Fischer was admitted to St George’s Hospital with a compound depressed fracture of the skull, with laceration of the dura mater and brain with meningitis.

PM/1886/292. Archives and Special Collections, St George’s, University of London

The case notes said that ‘The man was found in a 1st class compartment of the Metrop[olitan] Railway with a fractured skull.’ He was conscious but did not speak. There was a scalp wound about eight inches in length which extended from the centre of the forehead. The external table of the skull was fractured and the internal table was driven through the dura mater into the brain, with the brain substance protruding. The fragments of the bone were picked out with forceps and the scalp was brought together with sutures. He went on well without any special symptoms for nine days when he passed his urine into the bed and became drowsy. His temperature slowly rose from 99 degrees to 106 degrees on the evening of the 3rd October and he died on the 4th.

The post mortem examination states that there was a wound 3 ¼ inches long over the frontal region. It started from a point 1 inch to the right of the middle line and passed obliquely forwards and to the left. The angles of the wound were infiltrated. Beneath it, part of the temporal bone was absent. Some soft greyish substance protruded which was examined microscopically and found to consist almost entirely of nerve fibres, blood and granular matter.

PM/1886/292. Archives and Special Collections, St George’s, University of London

What happened to Mr Fischer in the first-class compartment to cause such brutal and deadly injuries?

Lloyds Weekly London Newspaper reported on September 26th 1886 that on the arrival of the train at Bayswater, ‘the attention of the newspaper boy attached to the bookstall on the platform was attracted to the last compartment by one of the first-class carriage fourth from the engine, there being a stream of blood on the outside of the carriage door, the window of which was open. On looking through into the compartment the lad observed a gentleman lying prostate on the floor, alone, and with his feet towards the door, there being a small quantity of blood on the carpet, and a much larger quantity on the cushion of the seat nearest the engine.’ The acting-inspector on duty opened the door and ‘saw that the unfortunate man was quite insensible, and that blood was flowing from a terrible wound on the forehead.’ The gentleman was ‘attired in a grey overcoat, the coat underneath being of black diagonal cloth, and his trousers were light-striped. His gold watch and chain were safe, as were also his rings, but not much money was found in his possession. A few papers were discovered, and they were all in German. A visiting card was found bearing the inscription, “Mr. Moritz Fischer,” and the police, as the result of subsequent inquiries, ascertained on Friday that the injured gentleman was Mr. Moritz Fischer, head of the firm of Mr. A. Fischer and Co., general foreign agents of 35 Carter-lane, and having residence in Westbourne-terrace.’ Thus it appears that none of Mr Fischer’s belongings were stolen so theft was unlikely to be a motive for an attack. However, ‘It was reported that despite the carriage being empty, they could not be quite certain on the point, owing to the confusion which prevailed.’ Therefore it is entirely possible that another individual was in the carriage with Mr Fischer and escaped during the turmoil.

The police, however, were of the opinion that Mr Fischer sustained his injuries by accident, and the following anecdote appeared to confirm this hypothesis:

‘A friend of the injured man says that about twelve months ago Mr. Fischer met with a curiously similar but by no means so serious an accident while travelling on the railway. He had put his head out of the carriage window when he was struck by some projection in the tunnel. He was severely cut, and had to wear a bandage for some time. The injury then sustained was just over the forehead, as now, but the skull was not fractured. The old accident subsequently formed a standing joke among his friends, and he was often rallied about putting his head out of carriage window and advised not to be of so inquisitive a turn of mind. Only a few nights ago the old joke was repeated to him, along with the question whether he had lately been putting his head out of the window. This may be an explanation of the mystery, or it may be only a striking coincidence; but it is a singular fact that most of the known facts appear to lend themselves to such an explanation of what at first appeared to be a very tragic crime.’

The newspaper paper continues by saying that ‘It is conjectured that Mr. Fischer had a propensity for watching the people who occupied the adjoining compartments, and while indulging in this habit he must have placed his feet on the carriage seat, and in his endeavour to place his body as far outside the window as possible, his head must have come in contact with the projection in the spring of the arch.’

However, at the inquest into the death of Moritz Fischer (reported in the London Evening Standard 08 October 1886), a friend of the deceased, Fritz Mercier, said that despite being aware of Mr Fischer previously having injured his head during a journey from Manchester, he refuted the claim that he was well known to have put his head out a carriage window. Despite this, the inquest further confirmed that there was no sign of a struggle, there was no derangement of the carriage and ‘On the night of the accident when the traffic had ceased, Witness went in a carriage and found at the very spot where it was supposed the gentleman met with his injury, that it was quite possible by leaning about 18 to 20 inches out of the window, to meet with a similar accident. At the same spot there was a continuous trail of blood on the wall.’ Furthermore, a witness spoke to picking up a pair of spectacles about twenty yards from where the blood was found on the wall, and another witness testified that Mr Fischer had never been known to be without his spectacles.

Based on the evidence, and despite conflicting testimonies from the friends of Mr Fischer, the jury returned a verdict of Accidental Death. Foul play or a case of curiosity killed the cat, either way please refrain from putting your head outside a carriage window on a moving train.


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If you are interested receiving updates from the Library and the St George’s Archives project, you can subscribe to the Library Blog using the Follow button or click here for further posts from the Archives.