‘Opening Up the Body’ is a 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 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Juulia Ahvensalmi, Archivist.
We have now catalogued a good chunk of St George’s historical post mortem records, and are preparing to make them available on our catalogue soon. In our blog posts, we’ve been exploring various themes and aspects emerging from the records, from examining cases of leprosy and hysteria, to delving into the social backgrounds and occupations of the patients.
But let’s take a closer look at the records themselves. Do they always contain the same information? How are they structured? What do they actually say? The format doesn’t vary very much: the records we are now cataloguing stretch from 1841 to 1920, and tend to follow the same template, as shown in these images from 1845 and from 1920.
Apart from the two earliest volumes, in which each case occupies only a single page, all the volumes reserve a two-page spread for each individual patient. The labelled boxes across the top of the pages record the patient’s case number, name (sometimes also occupation is noted here), age, date of their admission to the hospital, date of death, the name of the doctor admitting them, the length of time between death and the post mortem examination, references in medical and surgical registers and the ‘Nature of disease’.
This last box details the cause of death, based on the examination. Sometimes the cause is determined to be straightforward, and the box only lists a single ailment (‘Fracture of skull’, ‘Pneumonia’), but more often multiple diseases or other ailments are listed – there is not always a single cause of death, but multiple contributing factors. In the catalogue we are including a transcription of this field, as well as a standardised form of the disease(s), using Medical Subject Headings (MeSH). Treatments (in particular operations) as well as post-mortem changes and features of the body sometimes also appear in this list, and can vary from brief and vague (‘Disease of the heart’) to very long and specific:
‘Renal sarcoma (removed by operation). Accidental inclusion of small gut in abdominal saturation. Volvulus of small gut. Small gut obstruction. Commencing peritonitis’, or
‘Phthisis. Old adhesions of the pleurae. Lymph in pericardium. Atheroma in aorta & mitral valve. Tubercular spots in various parts of the intestines with ulceration of the mucous membrane. Mesenteric glands enlarged’
The left-hand page, labelled ‘Morbid appearances’, is reserved for the details of the post mortem examination in which, following a general description of the appearance of the body (‘Body well-formed and in good condition…’), each examined part of the body is listed. This is sometimes presented as larger wholes (cranium, thorax, abdomen) or simply as list of organs and body parts that were examined (left hip, skull, lungs, heart, uterus and so on). The bottom of the page is usually signed by the doctor who performed the examination; this tended to be a fairly junior doctor. Sometimes there is more than one name.
Any preparations or samples taken are also listed here, with references to the catalogues of the Pathology Museum of St George’s – as a part of the Post Mortem Project, we are listing these references and attempting to locate them in the museum – the referencing systems have, however, been changed multiple times over the years, so the task is not always that easy.
The right-hand page is for details of the medical case before the patient’s death. This, too, is usually signed by the doctor examining the patient, and is similarly formulaic: first, the history of the case is rehearsed, detailing symptoms and other details, followed by a description of the patient on their admission and details of the treatment(s) received prior to their death. If there is no post mortem examination, no medical notes are included either.
There are of course some differences in the way the case notes are presented during this time – we are, after all, talking of a period of 79 years. Some, although by means not all, of the 20th century volumes contain a carbon copy of typewritten medical notes instead of the more usual handwritten ones (a blessing for the cataloguers, who have to decipher the often rushed handwriting – the later volumes also tend to be more difficult to read!). These notes were copied from the medical and surgical registers recording all admissions to the hospital. Unfortunately, however, we no longer have these registers, so it is impossible to tell whether the notes were copied exactly or changed in the transmission.
Perhaps, however, typing your notes rather than writing them down by hand affected the way the cases were recorded: the later volumes certainly tend to be briefer, focusing on the medical facts only, where many of the earlier case notes contain more colourful descriptions and often personal observations by the doctors: the patients are often described in terms which strike the modern reader as distinctly subjective in a medical context, even unprofessional and offensive. Some of the language used in the descriptions can come as quite a shock to the 21st century reader, such as descriptions of patients as ‘idiot’ (which remained as part of the medical vocabulary until the 1970s), ‘stupid’ or ‘half-witted’:
‘[He] was never more than half-witted and could follow no occupation. The [epileptic] fits increased in frequency and the man became more nearly idiotic’ [Alfred Dolman, PM/1891/376]
Racial and ethnic prejudices similarly appear in the medical case notes. John Lusila (PM/1854/384), a waiter who died of tuberculosis, is described as ‘this poor black’. Of Michael Fitzgibbon (PM/1864/127), a cooper who died aged 32, it is simply noted: ‘Of this illness no accurate account could be obtained (the patient was Irish)’; it is unclear whether the reason for the trouble in communication was linguistic (perhaps Michael did not speak English?) or something else. Jane Caldecourt (PM/1887/283), a kitchen maid who died aged only 17, is described as ‘a well-nourished, healthy-looking girl of very dark complexion, mother was a coloured woman’.
One of the doctors, Octavius Sturges (1833-1894), who was a medical registrar at St George’s Hospital in the 1860s, was particularly fond of sketching evocative and occasionally even poetic images of the patients with his words. One patient is described as ‘an anxious, delicate girl with an anxious, sad expression’, another as ‘a dark, spare person of melancholy aspect, a needlewoman’; another as ‘stout and well-built with the countenance of a drunkard’ or ‘a miserable, emaciated old man having the withered and wrinkled face of a mummy’. The reader gets a very immediate sense of the people in front of Sturges (and of Sturges himself in the process): perhaps he had unrealised ambitions as a novelist? A rather disparaging description of Sturges by a colleague after his death describes Sturges as ‘A man of ordinary size with his head rather sunk down between his shoulders. The colour of his face was high and purplish, for he was a victim of nitral stenosis. Not one of our great physicians, he was a thoroughly practical children’s doctor’ – the truthfulness or kindness of the statement can be debated, but it does seem like a description Sturges might have approved of.
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