From servants to soldiers, from agriculture to administration: occupations in St George’s Hospital Post Mortem casebooks, 1841-1918

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 Dr Juulia AhvensalmiProject Archivist.

Post mortems? Surely they’re all about death and misery? In this blog post I hope to show that is not the (only!) truth. I want to examine what else historical post mortems can tell us, and illustrate how they contain a wealth of information about not just the deaths, but also the lives of the patients. The post mortem volumes held in the archives of St George’s, University of London provide a fascinating glimpse to the social structures of 19th and early 20th century central London. So let’s see what the collection can tell us about the patients of St George’s Hospital in the 19th and early 20th centuries. What did they do for living? How did big changes in the society such as the industrial revolution and the First World War show in the lives of Londoners at this time? I’ll use visualisations to give an overall picture, and zoom in to look at the people behind the statistics, so sit back – get your cup of tea ready – let’s go to Hyde Park Corner.

Engraving of St George's Hospital and Constitution Arch
St George’s Hospital and the Constitution Arch, Hyde Park Corner. Engraving. Credit: Wellcome CollectionAttribution 4.0 International (CC BY 4.0)

Most of the post mortem cases record the occupation of the patient, and this is one of the details we have been keeping a track on whilst cataloguing the volumes. The image below shows an overview of occupations from the volumes finished so far, ranging from 1841 to 1918; the data has been visualised using Flourish, and you can explore the graph in more detail by zooming in, and filtering the data by year to take a closer look.

Flourish data visualisation
Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The largest categories are in the building and construction trade (general labourers, painters, carpenters), and in domestic service (servants, cooks, housemaids). Other categories include food and accommodation services (people working in public houses, hotels and restaurants), food industries and sellers of food (grocers, bakers, butchers), people working in occupations relating to agriculture (largely stablemen, grooms as well as gardeners and farm labourers) and industries and manufacture (from smiths to window blind makers) and transport (drivers, railway workers and so on). The classification is a simplified version of ‘The occupational structure of Britain 1379-1911’ by the Cambridge Group for the History of Population and Social Structure.

It’s not always clear what category is most appropriate – unless the record explicitly states that someone works for instance as a servant at a hotel, rather than at a private house, it is impossible to know. ‘Servant’ has therefore been classified as ‘domestic service’, with the caveat that this might not exclusively be the case. The category ‘miscellaneous services and occupations’ include what it says on the tin – a selection of occupations that do not fit neatly the other categories, often because they were rare within the data, or because it is not clear which category they should belong in. The latter category includes things like apprentices (who were they apprenticed to?) and collectors (what exactly were they collecting?). Amongst them there is a wonderful array of occupations: there’s a mosaic worker from 1870, an assistant secretary of the Conservative Club from 1918, a piano forte maker from 1877, a keeper of urinal from 1858, a sword polisher from 1888 and a cats’ meat man from 1858. The latter would have sold meat for cats, probably walking around the streets with a cart (one can only imagine the cats trailing after him!). Rosa Blacker in 1858 is ‘Clergyman’s daughter’, and Louisa Lee in 1887 is just described as ‘gypsey’ (there would also be a lot to say about the use of language in the records, often startling and offensive to the modern reader).

The hospital at this period was located at Hyde Park Corner: the site was not closed until 1980. The building still stands, but instead of a hospital it now houses a luxury hotel. Knightsbridge, Kensington, Chelsea, St James’s, Mayfair, Soho – these days that part of London doesn’t suggest the working class population that the occupational data highlights here. But although Hyde Park Corner, then as now, had an abundance of large, wealthy households, these houses required servants, as well as people working in the local shops and factories. Some of the areas which we may now connect with wealth and opulence were not always like that; the notorious slum around Westminster, for instance, was dubbed the ‘Devil’s Acre’ by Charles Dickens. The so-called poverty map by Charles Booth, a businessman and social reformer, published 1886-1903, shows the area around Hyde Park to be largely wealthy and middle class, but towards Westminster and Chelsea there are areas in which the population is classed from ‘poor’ to ‘very poor, casual. Chronic want’ and ‘lowest class. Vicious, semi-criminal’.

Charles Booth's Poverty Map
Charles Booth’s poverty map of the area around Hyde Park Corner. Source: Charles Booth, © 2016 London School of Economics and Political Science. Map data © OpenStreetMap contributors

Accidents and diseases are frequently a direct consequence of people’s occupations, and the post mortems enable the tracking of occupational diseases. Painters often suffered from colic, or lead poisoning, and paper stainers also frequently dealt with toxic substances: John Hyland, 48, is noted as having handled during his working life ‘much lead, arsenic, copper & mercury’ – a paper stainer would have worked with wallpaper, which, due to its vivid colours, was notoriously deadly in the Victorian era. Falling off scaffolding or ladders is a frequent cause of death for builders, and in 1888 we find the case of Aaron Gatheridge, 53, who, as a carpet layer, had ‘swallowed many nails and tacks’ (he died of cancer of the pylorus).

Preconceptions and prejudices about certain occupations as well as classes can also be seen in the post mortems. Those working in the hospitality industry in particular were often assumed to be heavy drinkers, and the doctor treating David Ferguson, 45, in 1888 notes that ‘He was a butler but claimed to be considered temperate’, whilst George Carter’s, 45, medical record in 1860 states that ‘This man was an omnibus driver of drunken habits, like most of his class’. Some positions also came with certain benefits, as we learn from the case of George Courtenay, 38, in 1860: ‘He was a very sober man, though he partook freely of the beer which was allowed in unlimited quantity to the servants’ (sobriety is also a relative concept).

Post Mortem record of Mary Fitzgerald 2 Mar 1905 PM/1905/57
Post Mortem record of Mary Fitzgerald, 2 Mar 1905 PM/1905/57. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

Of Mary Fitzgerald, aged 35 in 1905 it is noted that ‘Her life had always been sedentary – that of a needlewoman’. Another aspect of 19th century life the post mortems reveal is social and geographical mobility. Sarah Black was only 15 years old when she died of tuberculosis. She is described as being a kitchen maid, and her medical case notes tell us that she had come to London from Argyleshire two years previously, presumably to find work in the city. The doctor notes that ‘She was a dark-haired Highland girl with a fair skin’.

Not everyone was, however employed: unemployment was also a problem, and with no social security available apart from poor houses and charity hospitals, unemployment often meant destitution. The case notes of Samuel Brooks, 24, tell us that at the time of his admission to the hospital suffering from tuberculosis, ‘he had been out of work a long time, & starving, that he had recently found employment, and it was supposed he had been unequal to his task. He had been ailing for a fortnight, and had been entirely laid up for a week’. William Chant committed suicide in 1887, aged 57, after a period of unemployment; his notes tell us that ‘in consequence [he] had got very depressed’.

The class divide

The class divisions were stark: if you were wealthy enough, you would pay for a doctor to visit you at home, or attend their private practices. Only those who could not afford it went to the hospitals, which were often filthy and unhygienic.

Post Mortem record of Agneta Le Strange, 3 Oct 1918, PM/1918/207
Post Mortem record of Agneta Le Strange, 3 Oct 1918, PM/1918/207. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

There are occasional exceptions to this rule in the post mortem records: among the occupations of the hospital patients we find some gentlemen, a couple of ladies, an admiral and a naval commander, for instance. But looking further into these cases, they all turn out to be accidents or a sudden disease. The evocatively named Agneta le Strange was brought to the hospital unconscious by the police in 1918 after suffering a sudden brain haemorrhage; not a heroine in a gothic novel or a wizard as her name might suggest, Agneta was presumably visiting the family’s London townhouse in Eaton Square (the family also had a mansion in Norfolk). In the majority cases, the bodies, though recorded in the post mortem volumes, were not autopsied, as that was another marker of social status: the choice to not have a post mortem. H.J. Blagrove, a ‘gentleman’, was ‘flung from his horse near the hospital’ in 1854, but his relatives asked that his body would not be examined, apart from his skull, which had been injured in the accident.

Occupations in SGUL post mortem examination books, 1858. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The earliest of the post mortems from the 1840s only record patients’ occupations sporadically, often when it has some bearing to their disease. As we proceed further in time, the registrars start recording the occupations more methodically. Decades before cars filled the streets of London, horses were an important feature in everyday life, as the presence of grooms and stablemen shows; cab drivers, carmen and coachmen were employed in driving the horse-driven carts or cars around the capital. A gardener might have worked somewhere like the Vauxhall Pleasure Gardens, Chiswick Garden or Hyde Park, for instance, or in any number of plant nurseries providing plants to aspiring gardeners in the capital – there are even occasional farm labourers among the patients. Many people are employed in the building and construction: London was rapidly growing and these skills were in demand. There are fruiterers, bakers, butchers, distillers; people work in hotels, restaurants,  coffee houses, pubs (‘potman’ collected and washed dirty pots and glasses in a public house); they cook and serve; sew dresses, make cabinets and wigs and saddles; the charwomen and street sweepers clean and take care of public places as well as private houses.

The gender divide

Women’s occupations in SGUL post mortem examination books, 1841-1918. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

Women did not have many occupations open to them on their own right. When in employment, they were, by and large, working with textiles as dressmakers, needlewomen and milliners, and in domestic service, as servants, housemaids, cooks, laundresses and cleaners. Towards the late 19th century industrialisation means some other occupations become available for women, such as working in factories, and in particular during the First World War we start seeing clerks, secretaries and typists among the women. Lilly Grundy, 19, is recorded as having been a ‘machinist’, probably in a shoe factory. For unmarried women with children, the options were even fewer, and for most of the 19th century limited to dressmaking and cleaning. The post mortem records usually note the occupation of the father for the children; recording the occupation of the mother instead signals to the reader that the mother was unmarried. The mother of Edwin Cannon, aged 4 in 1887, was a charwoman (or cleaner), and the mother of Pat Gurney, aged 5 in 1917, was a flower seller, indicated in the post mortem records by ‘M’ for ‘mother’.

Index to the post mortem volume 1887, showing the entry for Edwin Cannon, PM/1887/120, and index to the post mortem volume 1917, showing the entry for Pat Gurney, PM/1917/266. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

This was also the time when St George’s Medical School allowed its first female students, several of whom went on to work at the hospitals, including on the post mortems. Mostly, however, women’s status was defined by that of their husband or father; they are designated as ‘wife of labourer’, ‘wife of coachman’, or simply ‘married’, ‘wife’ or ‘widow’. And looking more closely into the cases it is soon obvious why this would be. Lack of (knowledge of) contraception as well as the social unacceptability of it meant that many women spent much of their lives pregnant, breastfeeding and caring for their children – they simply did not have the chance to even consider working outside the home. Emma Rickets, 50, is recorded as having had 22 children in 1888 – and having been one of 22 herself. That is of course an extreme example – but 10 children is not uncommon, and surely much fewer would have been stressful enough. Maria Cooper was 27 when she died in 1860; she is noted to have been married at 15 and borne nine children before her untimely death.

War and bureaucracy

Soldiers and sailors make occasional appearances in the records, often in the form of men who had perhaps gone ‘to sea’, often in East India Company’s employ, and latterly returned to Britain from the colonies. James Scott, for instance, died aged 44 in 1881. His occupation is listed as a confectioner, but his medical case notes tell us that he had gone to sea aged 17 in East India Company’s service, and had suffered from dysentery whilst in India. Life at sea is laid bare in the description of Scott as ‘a very heavy drinker of spirits, especially 1858-1870 when he had much morning vomiting & depression’. Far fewer are references to people who made the journey in the other direction: John Lusila was only 23 when he died in 1854 of tuberculosis. His medical record notes that ‘This poor black, who was a native of Angola, and had been in the West Indies, had been 10 years in England, & was a waiter in an eating house’.

Post mortem record of John Lusila, 17 Dec 1854, PM/1854/384. Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London

From the Napoleonic wars in the early 19th century to the First World War, the post mortems record soldiers, their wives and their children. In the visualisation of the occupations in 1918, the armed forces has become the largest category: there are soldiers, privates, riflemen, sergeants, a captain, a naval commander and an admiral – and in particular their wives and children, who of course were the ones remaining in London.

Occupations in SGUL post mortem examination books, 1917. Source: Post Mortem Casebooks, Archives and Special Collections, St George’s, University of London. By Juulia Ahvensalmi

The visualisation also shows a huge increase in the types of occupations, compared to the earlier chart of 1858. In addition to the categories seen earlier – domestic service, occupations relating to the food industries and hospitality, building and construction – the industrial revolution, as well as the war, is apparent in all the jobs in factories: machinists, munition workers, aeroplane makers, electric fitters. There are also more white-collar type jobs in administration (clerks, secretaries, typists); there are engineers, a barrister, an architect, a bank manager and so on. The biggest change, however, is in the ‘other’ category, which earlier was filled with married women; in 1918, this category only includes two widows and one housewife.

Hélène Crosmond-Turner in Various musical celebrities by and after Elliott & Fry bromide print, 1890s. NPG Ax139913 © National Portrait Gallery, London

One of the interesting categories are those working in arts and entertainment. There are not many, but they include Percy Vaughan, a comedian, who died of tuberculosis aged 29 in 1887. His medical case records laconically that ‘he had been a pantomimic actor & had lived hard and fast’. Another tragic story is that of an opera singer, Hélène Crosmond-Turner. Born Rosa Levison or Leverson, she shot herself in a cab on Piccadilly in 1888 after failing to renew her contract as a lead in Aïda. She had for some time been worried about her financial situation and her career, and had tried some days previously to overdose on painkillers. The papers made much of this dramatic suicide, including describing her dress in detail – red and brown stripes, with a black and brown checked ulster, trimmed with imitation beaver (‘not one of her best outfits, as her landlady Mrs Godbold later observed’). Part of the attention lavished at poor Hélène following her death was due to her famous mother, Madame Rachel, whose tagline was ‘beautiful forever’. From selling rabbit skins and used clothes in London’s East End, Rachel proceeded to be the owner of a very profitable beauty salon in Mayfair. Her famous cosmetics, however, contained a multitude of toxic chemicals, including prussic acid, lead and arsenic. This, alongside with allegations of blackmailing her clients, led her to being prosecuted for fraud. She died in Woking jail in 1880, aged 60, eight years before her daughter.

What other stories would you like to hear from the post mortem project? We’re lucky in that we have all the volumes digitised, so we’re able to continue cataloguing the cases, and are eager to hear your views!

Libraries Week 2019: Celebrating Archives

Libraries Week takes place between 7th – 12th October 2019. This year’s campaign is focused on celebrating the role of libraries in the digital world. Over the course of the week we’ll be introducing you to different teams within the Library and explore how they use technology to support our community.


Today’s post comes from our Archives team, who have been involved in a large-scale digitisation project – so this year’s Libraries Week theme offered a perfect opportunity to provide an update! Click here for previous posts from our Archives.

Opening Up the Body: Digitising, cataloguing and visualising post mortem case books

Opening Up the Body is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946, and to catalogue and digitise those dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The catalogue data and digitised images will be made available on the St George’s, University of London website.

Post mortem of Caroline Parker, 42, from 1865.

The volumes contain manuscript case notes and detailed reports of the patients’ medical history, including details of treatments and medicines administered to patients. They also contain comprehensive reports of the pathological findings made during the detailed examination of the body after death. These rich and detailed post mortem records are a unique resource, which will contribute to our understanding of medical education, death practices, and the history of London’s hospitals and infectious diseases, amongst other things. Moreover, the volumes feature notable physicians and surgeons, including Henry Gray, who compiled his influential ‘Gray’s Anatomy’ whilst performing post mortems at St George’s.

Meet the team

Two Project Archivists have now started to catalogue the post mortem volumes and the project team consists of the University Archivist, Carly Manson, and two Project Archivists, Juulia Ahvensalmi and Natasha Shillingford.

How do we use technology to support our users?

AtoM (Access to Memory)

AtoM (Access to Memory) is a web-based, open source, standards-based application for archival description and access. AtoM was originally built with support from the International Council on Archives to encourage broader adoption of international standards for archival description across institutions. AtoM is a dynamic open source application with a broad user base who work together to continually improve and enhance the software to the benefit of the whole community.

Our catalogue is made available via the St George’s Archives & Special Collections website: https://archives.sgul.ac.uk/. AtoM allows users to type keywords into the search box located at the top of the banner, or they can explore the collections by browsing via collection, people and organisations, archival institutions, functions, subjects, places or digital objects. The catalogue homepage also displays the most popular items that have been searched for that week, which provides a glimpse into the interests of our researchers.

Each individual post mortem is being catalogued according to international standards and a summary of each will be produced, providing searchable keyword access. The information being captured in the catalogue includes the name of the patient, occupation, gender, date of admission, date of death, the physicians and surgeons who attended the case, a transcription of the diseases affecting the patient, and notes from the medical and post mortem examinations.

Example post mortem catalogue record

The catalogue data from the Opening Up the Body project will be imported from spreadsheets into AtoM.  The digitised images will be linked to the individual catalogue entry, allowing researchers to access the collection remotely and therefore increase access to the collection and also preserve the physical volumes.

Subject access points are being identified using the Medical Subject Headings (MeSH) database (https://meshb.nlm.nih.gov/search), which will allow researchers to search and identify cases by disease and anatomy group. For example, at the click of a button a researcher will be able to identify post mortems that were related to diseases of the respiratory system, or patients that were admitted to the hospital following an injury.

Name access points are also being created for every surgeon and physician of St George’s Hospital who treated the patients or undertook the post mortem examinations, and will be linked to their authority record in the catalogue. The authority record will list information such as dates of existence and a biographical history of the key figures in the history of St George’s.

Visualising the post-mortems

Word cloud of commonly found words in a post-mortem volume from 1887 using Wordclouds.com (https://www.wordclouds.com/)

As we catalogue the material, we are collecting a large amount of data. In order to be able to get the most out of this incredibly rich source, we’ve modified our cataloguing templates to structure the data so that we can both export it into AtoM in the required and easily readable format, and to make it easier to properly explore that data and gain new insights into the material.

This also requires standardising the data, especially when it comes to the names of diseases. These can change over time: tuberculosis, for instance, may be called tuberculosis or phthisis, and we want to make sure we can track these conditions, regardless of what they’re called (this of course is not always that simple, but that may be a subject for another blog post!).

Packed circles showing groups of diseases in 1864, using Flourish (https://app.flourish.studio/templates)

There are plenty of free, open-source tools available, many developed specifically for digital humanities. Visualisation tools are great for immediate visual effect, for telling stories and for drawing attention to details that might otherwise be missed, or might be worth more in-depth exploration – why does the word ‘India’ appear so frequently in the word cloud above, for instance? Why did so many people die of cardiovascular and respiratory diseases? Visualisations are nothing new, of course – John Snow (who at one time worked at St George’s) managed to figure out the cause of the 1854 cholera outbreak by mapping the cases.

Line graph showing instances of death from cholera during the 1854 cholera epidemic in London, using Flourish
Sankey diagram illustrating distribution of diseases by gender in 1864, using Flourish

As we continue cataloguing and collecting more data, we can begin to explore changes over time and ask more questions – did people live longer? How do their occupations change? How do medical advances affect the kind of diseases featured in the post mortems? How do the post mortems themselves change? Presenting the material like this not only allows our readers insights into the contents of the post mortem records, but it also gives us a chance to reflect on the details of our work, and on the ways in which we are dealing with the data as we go along. More importantly, though, we can use these visualisations to bring the material to life – so to say!

We are only just starting, so look out for more exciting visualisations as we delve deeper into the post mortems! And feel free to get in touch with us at archives@sgul.ac.uk – we’ll be happy to answer any questions you may have about the project and accessing the material.


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