Diseases, Outcomes And Discharge Help
Most admission records included an initial diagnosis, sometimes more than one. These were often written in abbreviated form, or used one of several synonyms for a particular disease or condition.
Indexes of standard terms have been added to all the HHARP databases to make searching for diseases easier, and to enable comparative searches across databases to be undertaken. By using the indexes users are not required to anticipate what terms might have been employed in the registers. NB The Alexandra Hip Hospital, as it name suggests, only admitted children with disease of the hip joint, and one or two cases of diseases of the knee. Nevertheless, the disease indexes have been compiled for this hospital to enable cross database searching.
There are three searchable disease fields:
A keyword word search field which uses an index of standard disease terms.
A classification developed specifically for the project. It groups diseases by the body system affected.
Searches can be conducted on either index, and the combination of the two enables searches to be more narrowly targeted.
The third index, ICD10, is a World Health Organisation classification of diseases currently in use in hospitals around the world. It is not advisable to combine a search on the ICD10 index with other disease indexes.
All three fields are also displayed in the Full Record Display and the downloadable results table. A fourth field, Register Disease, is also included in the displays: it contains the information on diagnosis as entered in the registers. Register Disease is not searchable.
The original entries have been standardised using a list of terms developed specifically for this project.
Search this field using individual keywords or phrases, the search will find records containing either, anywhere in the field. For example:
‘Abscess’ – finds all records containing abscess in the disease name field
‘Abscess hip’ – finds only those records containing the term ‘abscess hip’
‘Hip abscess’ – finds no records as the term ‘hip abscess’ is not used as the standard form.
See Hints for an explanation of how the standard disease terms have been constructed.
The terms in this field do not represent an hierarchy of diseases, but introduce a standard form of disease terms used in the registers; Scarlet Fever & Sequela is used for all alternative spellings of Scarlet Fever, such as Sc F, Scarletina, SF etc.
There are over 1,000 unique terms in this field. Many of the terms used reflect specific disease entities, such as scarlet fever or whooping cough, while others are more descriptive, such as ‘abscess of knee’. The Project Team has developed a standard form for both diseases and descriptive symptoms. The following tables list the most frequent diseases and symptoms, together they account for 86% of all records in the database.
Leading Disease Terms in HHARP
For very specific searches use the exact term in a search, or for less specific search use an element of the term.
- Cleft Palate
- Diarrhoea & Vomiting
- Genu Valgum
- Hare Lip
- Infantile paralysis
- Morbus Cordis
- Morbus Coxae
- Scarlet Fever
- Whooping Cough
Diagnoses could be quite vague in the admission registers, and instead of naming a specific illness the registers often record major symptoms instead. For instance, knee disease or abscess of groin were common diagnoses, but these were purely symptoms of an underlying disease – probably tuberculosis in both these cases. However, in compiling the databases we have reflected what is in the register rather than attempting to assign a more complete diagnosis.
A naming system has been devised for these symptoms by assigning the ‘symptom term’ first followed by the anatomical site of the problem.
For instance the diagnosis in the register may be written as ‘knee disease’ or ‘abdominal abscess’ or ‘tumour of femur’ etc. These symptoms or vague disease descriptions have been standardised by identifying first the symptom eg ‘Abscess’ or ‘Tumour’ or ‘Disease’, and adding to that the body part affected. So ‘knee disease’ becomes ‘Disease Knee’, ‘tumour of the femur’, becomes ‘Tumour Femur’ and ‘abdominal abscess’ is ‘Abscess Abdomen’.
The following is a list of the most frequently used symptom-words which can be combined with anatomical sites to narrow searches:
Symptom Terms used in HHARP
These terms can be used either in broad searches, eg to find all abscesss or all diseases involving enlarged organs, or in narrower searches by adding a qualifying site of the symptom: so knee disease would be searched by using the combined term ‘disease knee’; or enlarged glands, by using that very term.
The Disease Names and Symptoms terms listed above account for over 85% of all records in the database.
Disease group is a classification designed specifically for the HHARP database and is intended to reflect medical knowledge in the Victorian and Edwardian periods. It categorises diseases according to the body system affected, with the exception of infectious conditions and fevers, which are broken down into Infectious Fevers, Fevers, Parasitic Disease and Tubercular Diseases. The table below lists the groups in alphabetical order and provides a brief definition for each.
Search by selecting the group you are interested in from the drop down menu.
To narrow your search you can combine ‘Disease Name’ and ‘Disease Group’ together. For instance, if you want to find all children affected by abscesses of the musculoskeletal system:
Disease Name = Abscess
Disease Group = Joints Bones and Muscles.
The resulting records will contain all children admitted with abscesses of this system.
Disease Groups Classification
- Circulatory System
- Includes diseases or symptoms relating to the heart, blood, veins & arteries, lymph system etc
- Congenital Disorder
- All conditions described as being congenital ( or assumed to be congenital) in the registers, excluding congenital syphilis, which is classified under Venereal Disease. If the registers do not state whether a condition is congenital or not, and it could be either, then we have assumed that it is not.
- Digestive System
- Includes diseases of all parts of the digestive tract excluding the mouth (See Diseases of the Mouth). Includes the diseases of the salivary glands, liver, pancreas, bile ducts etc. Also includes diseases of the abdominal cavity such as peritonitis, and conditions such as abscesses in the cavity etc.
- Diseases of the Eye
- All diseases of the eye and eye socket.
- Diseases of the Mouth
- Includes stomatitis, diseases of the gums and dentition.
- Diseases of the Skin
- Includes diseases of the skin and subcutaneous tissue, and as such includes all abscesses and cysts, unless specifically linked to another body system.
- Ear Nose & Throat
- Includes all diseases of the ear, the nose and throat (upper respiratory tract), such as tonsillitis, otitis media, adenoiditis etc.
- All non specific fevers or pyrexia, where an infection is not identified as the cause.
- Growth Nutrition & Decay
- Relates mainly to symptoms of malnutrition (eg rickets, marasmus and wasting). Also includes diseases of the thyroid.
- Infectious Fever
- All infectious diseases, except syphilis (see Venereal Disease), tuberculosis (see Tubercular Diseases) and parasitic infestation (see Parasitic Disease). Particularly the infectious diseases of childhood eg Measles, Scarlet Fever, Whooping Cough etc.
- Joints Bones & Muscles
- Includes all diseases where there is major involvement of the bones, muscles or joints. Also includes diseases of connective tissue, eg tendonitis.
- Nervous System
- All disease of the brain, the spinal cord and other nervous tissue. Also includes behavioural diseases and mental impairment etc
- Organs of Generation
- Includes diseases of male sex organs, female pelvic organs and genital tract.
- Parasitic Disease
- Various worm and lice/tick infestations
- Respiratory System
- Diseases of the lower respiratory tract – ie the trachea, lungs and bronchi. (See Ear Nose and Throat for diseases of the upper respiratory tract). Also includes diseases of the chest cavity such as mediastinitis.
- Tubercular Disease
- Tubercular disease was the underlying cause of much of the disease seen in 19th and early 20th century patients. It manifested itself in different ways, which were recognised by the c1870s as all being linked to tuberculosis. Hence any disease described as: tubercular/tubercule, struma/strumous, scrofula/scrofulous, phthisis/phthisical are included in this class. Consumption (a term now commonly associated with tuberculosis) was rarely encountered in the HHARP records.
- Urinary System
- Includes diseases of the kidney, bladder and urinary tract. Diabetes was considered a disease of the kidneys in this period, so is included here. NB In males, disease of penile urinary tract is classified in ‘Organs of Generation’.
- Venereal Disease
- Mainly syphilis (including congenital syphilis) and gonorrhoea
- Violence is used here to mean any unnaturally occurring damage to a Body System, not just violent attack. Thus all injuries, poisonings or burns (intentional or accidental) and swallowing of foreign bodies etc are included in this category.
- Not classified
- Used mainly when the information on diagnosis is so vague as to preclude further classification, or where no diagnosis is given.
The International Classification of Diseases (10th Edition – ICD10) is an ‘international standard in diagnostic classification’ compiled by the World Health Organisation and used by health administrators and epidemiologists around the world. For more information on the classification system see http://www.who.int/classifications/icd/.
ICD10 coding has been applied to the HHARP patient admission records by an experienced Medical Coder from the hospital, who has coded the diagnoses as closely as possible according to current medical knowledge.
The classification is complex and it is recommended that only those familiar with its structure should use this field for searching the database. Our coder has used, where appropriate, a combination of codes to represent diseases and affected sites.
It is advised that the ICD10 index should not be used in combination with other disease indexes to search the database as the two systems derive from different views of medical knowledge. It is very likely that such a search would result in zero hits.
Following ICD10 convention, Uppercase D following a code indicates this is the main disease (indicated by ‘+’ in the ICD10 classification), uppercase A (* in the ICD10 classification) indicates a site of disease.
For instance ‘caries of the spine’ is coded:
A18.0D for tuberculosis of bones and joints, followed by M49.09A indicating site of disease is the vertebral column.
Searching for ICD10 = A18.0D M49.09A produces all records where spinal caries has been diagnosed. (NB When searching for combined codes such as this it is important to type them as shown above, with no spaces between the code and the A or D, but with a space between the two parts of the code.
Treatment (Evelina Only)
Admission records for the Evelina Hospital sometimes included brief details of the treatment received by the patient. For surgical patients this might indicate the type of operation performed, and whether under chloroform or not, while details for medical patients could list the drugs given, sometimes including the dosage. Treatment information has not been standardised and is therefore not searchable, but is displayed in the Disease, Outcome and Discharge box (and included in the download format) if it was provide in the register.
In ‘Outcomes’ you can search for the result of a child’s stay in hospital. The following terms are sued: ‘Cured’, ‘Relieved’ ‘ Not relieved’ and ‘Died’. Select the outcome from the drop down menu to include in the search. NB The Alexandra Hip Hospital records did not categorise outcomes this neatly, and therefore it is not possible to search on outcomes at this hospital using this field. An indication of the child’s progress can be found in ‘Reasons for Discharge’ and ‘Follow-up’ which are included in the Display and Download formats.
Post Mortem (Evelina Only)
About 500 Evelina records for children who died contained a brief summary of post mortem findings. This information has not been standardised and is therefore not searchable, but where it was given it is reproduced in the Disease Outcome and Discharge box in the Record Display and included in the download format. Some records state ‘See PM Notes’. This refers to separate detailed registers of post mortem results which no longer exist.
On discharge some children were sent to other institutions rather than home, usually for a period of convalescence. Great Ormond Street had its own convalescent home, Cromwell House, but it used other homes as well – particularly seaside institutions. The Evelina did not have its own home in the late 19th century, but sent children to many different institutions. As a specialist hospital providing long-term care to children who had often been referred from other hospitals, the Alexandra Hospital was less likely to send children on to other institutions. All hospitals in HHARP had rules prohibiting patients with infectious fevers, and patients who developed such illnesses as in-patients were often dispatched to specialist fever hospitals. Some children were removed from the hospitals, by friends or relatives, against the advice of the doctor. This group can be retrieved by using the term ‘Removed against advice’.
Use the drop down list to search on this item.