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Patient case records of the Royal Free Hospital

December 15, 2010

By Lynsey Cullen

The original Royal Free Hospital building on Gray's Inn Road, London, 1898. Wellcome Library

The literature on the health of the London population, and on hospital medicine and surgery, during the early 20th century, is minimal. More research is needed to widen our understanding of hospital practice and development by addressing the specific medical treatments and surgical procedures practised at a central London hospital. Hospital patient case records, moreover, are a neglected historical source, yet their contents can provide a unique and valuable contribution to our understanding of health, hospital medicine and patient identity.

Engaging with these historiographical issues, my doctoral project centres on a sample of 480 case records of the Royal Free Hospital, a central London voluntary hospital of the early 20th century. These records will be examined in order to identify the patients, the ailments from which they suffered, the treatments they received and their overall experience and use of the Hospital in the wider medical market. Records have been sampled from two surgeons and two physicians, from the years 1902, 1907 and 1912, the months of July and December, and of equal numbers of male and female patients. No previous study has made use of a sample of such records that is as statistically significant in size and scope.

My project has three main aims. It will contribute to the current historiography on the history of British hospitals, hospital doctoring and hospital patients. It will consider the time period between the late 19th century and World War I, for which we know comparatively little about hospitals’ treatment regimes, the professional approaches of practitioners or the health of the population. It will also reconstruct the patient’s experience and use of the Royal Free in order to understand the role of the Hospital in the wider medical market, and to help fill a significant gap in the literature on patient experiences of medicine and treatment.

The Royal Free and its staff will be examined and a relevant institutional history produced as a backdrop to the study. While administrative, economic, socio-cultural and regional hospital histories are common, institutional histories for the largest urban areas, particularly London, remain surprisingly few in number. The Royal Free was an important and pioneering voluntary hospital of London, yet has never been the subject of an academic study in its own right.

The patient information contained on the cover pages of the case records will be analysed, including name, age, sex, marital status, occupation and address, in order to establish the patient base of the Royal Free during the early 20th century. This will allow a detailed analysis of the patient ‘typology’ of a medical institution to be presented for the first time, and compared with those of other institutions through the use of census records.

My project will also provide a much-needed insight into the changing health of the population during the early 20th century. It will chart the current and previous ill health suffered by the sample patients and their families, and will compare the ailments suffered by the Hospital’s patients with the ill health and mortality of the wider London population. The nature of the medical and surgical treatment techniques and procedures conducted at the hospital will be examined from the daily notes contained in the case records. This examination is both unique and essential to our understanding of how disease was conceptualised in the early 20th century, as very little is currently known of the health of the London population during this period, or of how hospital patients were treated.

Another important aspect of this project is to ask how and why patients came to make use of the Royal Free as a representation of patient consumer behaviour within the medical market. We know little about how and why patients made use of medical provisions throughout their lives. Patient histories detail the previous means of medical assistance the patients and their families had sought in their lifetimes, including other institutions, dispensaries or general practitioners. Such information allows for the Royal Free to be placed in the wider medical community of London during this time, and provide a rare and valuable insight into how people made use of the available medical provision.

To this end, my project will also strive to reconstruct the personal experience of the patients at the Royal Free. The contents of the patient records recall the length of each patient’s stay at the hospital, and the contact they had with medical staff during that time. This information will be used in conjunction with other sources, included the ‘Rules and Regulations’ reports for the period, annual reports and almoners’ records, in order to gain an insight into life as a patient at a central London voluntary hospital, and to gain a better understanding of the relationship between the patient and their doctor.

Lynsey Cullen is a doctoral candidate at Oxford Brookes University.

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