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Abstract
This thesis presents the results of an investigation into hospital archives in London (England) and Ontario (Canada) which was undertaken by a survey of the records in fifty-seven hospitals and a detailed study of the history of records and record-keeping in eight representative institutions, four selected from each area. Although no hospital has a complete set of records, the survey of many institutions provides comprehensive evidence of the dynamism in the development of records during a period when hospitals experienced significant changes in administration and medical practices. Between c. 1850 and c. 1950 the continued strong representation of traditional types of records is paralleled by important changes in their structure, mode of preparation and in the proportion of administrative and clinical records in the surviving series in hosptials in each area. Records were standardized, technology was introduced to assist in record making and clinical files grew to become the largest single class of records. The impact of outside requirements for record-keeping, the internal demands of business-oriented administration and diversified medical practices combined to encourage similar developments in hospital records in both areas. The timing and impact of change and innovation was focused on the traditional record-offices. They were transformed into hierarchical and functionally differentiated offices in which record-keeping was combined with other administrative tasks and communication functions. Overall, records contributed to hospitals by expressing the terms of admnistrative relationships and by integrating the novel with the routine. They defined new functions, techniques and units within the hospital. Records and record-keeping became generally accepted as a corporate responsibility. Yet, despite their important institutional role, which was discussed in the growing contemporary literature on hospital management, a consistent policy integrating records, record-keeping and planning had not emerged by c. 1950.
