Historians restore name to pioneering 1779 case report of child amputation at NGH

Researchers into the history of paediatrics and child health have named what is believed to be the first child in England to have an amputation through the hip joint.

Twelve-year-old Sarah Harris from Great Addington, near Kettering, had the operation at Northampton Infirmary (now Northampton General Hospital) in 1779.

Her name was discovered by a team of researchers – including a volunteer archivist and two former consultants at Northampton General Hospital – while researching paediatric patient cases at the Northampton Infirmary between 1744-1804.

Her treatment is believed to be an index case – the first case of its kind with a confirmed name attached to it - and it happened at a local hospital 70 years before the establishment of the first specialist children’s hospitals (such as Great Ormond Street Hospital) in the middle of the 19th century.

The team who worked together to deliver the research were Prof Andrew Williams, (Professor of Child Health and Medical History at the University of Northampton), Mr Fred O’Dell, an archive volunteer at NGH, Mr Rajan Natarajan MS FRCS, a former consultant surgeon at NGH, and Professor Madeleine Mant of the University of Toronto.

Their paper has been published in the Archives of Disease in Childhood- Europe’s most prestigious paediatric medical journal. Prof Williams said: "The publication of the original case report in 1779 was a foundation stone in the history of paediatrics and child health but without a name could not be an index case.

“When tracing the history of medical and surgical procedures the patients themselves are all too often forgotten. By restoring Sarah's name we restore her humanity and acknowledge her contribution, including her suffering to increasing medical knowledge that continues to benefit others to this day.

“Sarah's story shows that specialist child operations were taking place in local infirmaries many decades before we started to see anaesthesia, aseptic surgery and the establishment of specialist children's hospitals."

Sarah’s story

In 1779 Sarah was brought into the Northampton Infirmary suffering from a tumour on the outside of her right thigh along with intermittent fever, cough, night sweats and emaciation.

She had severe pain on moving the hip joint and was probably suffering considerably when she was seen by Dr William Kerr MD, a senior surgeon, who decided to amputate her leg to try and save her.

The operation was performed decades before anaesthesia through ether and antisepsis were introduced. It would have been performed very quickly and she would probably have been held down.

Sadly Sarah died 18 days after the operation after developing breathing problems.

Dr Kerr thought the operation a success and other factors led to Sarah’s death which, judging by the symptoms and post-mortem, are now thought to look like tuberculosis.

The detective work that led to her being identified

While Dr William Kerr’s amputation operation was known about through published accounts his patient was unknown.

And without a patient name the report could not be a historical index case for paediatric amputation.

However Fred O’Dell, an archive volunteer at Northampton General Hospital, set out to make the connection and did detective work in 18th century records to find out.

He said: “I started by looking at the Northampton Infirmary admission records which are kept at the Northampton Records Office in Wootton Hall.

“I found the name Sarah Harris as the only female admitted to Northampton Infirmary (the precursor of Northampton General Hospital) during this time who fitted the facts.

“I couldn’t find her in Kettering Parish Records but widening the search I found that Sarah was baptised at Great Addington church, near Kettering, on 5 November 1766. and died on 13 January, 1779.

“This enabled us to make the connection to Dr Kerr’s operation and document the first recorded index case of a child amputation in England.”

The University Hospitals of Northamptonshire’s Group Medical Director, Hemant Nemade, who works at Northampton General Hospital, said: “This is a fascinating account of an early attempt to save a child’s life through the first case report of a paediatric amputation by a renowned surgeon at Northampton Infirmary.

“I welcome Sarah's name finally being restored to this case and to her moving story. Sarah’s story is a window into the past and a reminder of how fortunate we are that medicine has further advanced. The important work of both pioneers such as Dr Kerr, and patients such as Sarah, have provided the foundations on which modern medicine is built."