Small and Special (review)

Small and Special is a searchable online database of patient records from the Hospital for Sick Children, London (better known as "Great Ormond Street"). The database, established by the Centre for Local History at Kingston University with funding principally from the Wellcome Trust, contains the records of more than eighty thousand children admitted to the hospital from its opening in 1852 until the end of 1914. It should prove to be an invaluable resource for scholars and students.

The design of the site is uninspired but straightforward. The pages are predominantly text based, with relatively few images, and although this offers the user a rather bland Web site design it does help to ensure that pages load quickly and smoothly. Some sections, such as the "featured patient" on the homepage, change regularly to offer repeat visitors some variation in content.

For each child in the database, records are provided on personal details, admission dates, diagnosis, admitting doctor, and outcome on discharge. These details are presented in a standard format on screen and can be saved or printed. This makes them easy to read and interrogate, but they feel somewhat sterile and out of context. The database also contains detailed case notes for a small proportion of the children: those admitted between 1852 and 1874 who were included in fourteen volumes of case notes kept by Great Ormond Street's founding physician, Dr. Charles West. These records are available in PDF format and for the medical or healthcare historian are probably the most valuable aspect of the database. The use of PDFs gives us the chance to study not only the content of the notes but also their structure and organization. Although they can be difficult to read on screen, they can be downloaded or printed.

Registration, which is quick and free of charge, enables the use of a comprehensive set of search categories: the casual visitor to the site can take advantage of limited search facilities without registering. Individual children can be searched for by name, offering a simple approach for those interested in tracing their family members but carrying with it a small risk that potentially embarrassing information could be misused. Searches can also be made by dates of admission, district of residence, diagnosis, outcome, or any combination of these. The search can also be limited to return only those children with full case notes.

Three diagnostic classifications are used: a standardized set of disease and symptom names and a standardized disease group classification, both developed by the project team, and the International Classification of Diseases (10th Edition) [ICD-10]. This overcomes the problem of searching using only the original diagnoses as these were applied inconsistently in the hospital records.

Records seem to have been transcribed with a high degree of accuracy but it is still likely that some mistakes have occurred, and a response link is available on the site for users to report any transcription errors.

The database is easy to use and already has more than two thousand registered users. Most of these are from the field of family history and the project team is keen to expand into other fields. Readily accessible and with a comprehensive choice of search categories, Small and Special offers an insight into the first sixty years of Great Ormond Street and the children who were treated there. The planned expansion, including the addition of more case notes and of the records from two other London children's hospitals, will enhance its value to scholars. I would also hope to see the inclusion of more information about the staff, such as nurse training programs or recruitment details, and the addition of committee minutes and other administrative materials: these would enable us to better understand the hospital as an institution as well as the children cared for on its wards.