Conservation (7): Conservation of twentieth-century folder-based clinical case notes

Background

LHSA has a large and important collection of twentieth-century folder-based case notes, with around thirty specialities and over fifty physicians and surgeons represented. They are a scarce local and UK resource with potential international significance.

LHSA was fortunate to be awarded five separate project grants from the Wellcome Trust’s Research Resources in Medical History programme to conserve and re-house this material:

• Preserving twentieth-century hospital case notes of University of Edinburgh clinical professors: Edwin Bramwell and Norman Dott ran from June 2002 to June 2003.
• Preserving twentieth-century hospital case notes of University of Edinburgh clinical professors: James Learmonth and Derrick Dunlop ran from April 2004 to April 2005.
• Preserving twentieth-century case notes of the Royal Edinburgh Hospital ran from July 2005 to January 2007.
• Preserving Edinburgh’s twentieth-century reproductive and sexual health case notes ran from February 2007 to April 2009.
• Preserving Edinburgh's twentieth-century case notes: treating tuberculosis and World War II injuries is a 6-month project that began in May 2009.

The case notes treated in these projects were prioritised because they meet a range of intellectual, conservation and access criteria.

Condition

Heavy usage and inappropriate storage prior to accession meant that the majority of the folder-based case notes were in poor condition and couldn’t be accessed without causing further damage. Surface dirt, folding and tearing were frequently noted. Metal paperclips and staples caused extensive rust damage, and the inferior quality of the folders posed a risk of physical and chemical damage to their contents.

Treatment

A Project Conservator and a Conservation Assistant were employed to treat and re-house the case notes. Because of the large number, remedial treatment is restricted to surface cleaning with a chemical sponge, re-aligning folding and creasing to the paper, and the removal of any paper clips and staples. Black and white photographic prints found within the case notes were given individual folders of photographic storage paper and retained within the original format. Parts of the original folders with informational content were retained and samples of each style of folder were kept for reference. Each case note was placed in a single-creased paper folder constructed of good quality material within an equally high specification drop spine box. The new storage system was labelled appropriately, and handling guidelines were produced to ensure that future access is safe and easy.

X-ray of feet, Royal Infirmary of Edinburgh,1962 (LHSA X-ray Collection).

Some case notes have x-rays and glass plate negatives accompanying the paper-based case note. Cellulose acetate x-rays in good condition were re-housed in cold storage. Cellulose acetate x-rays in very poor condition and cellulose nitrate x-rays were reformatted and subsequently destroyed. Extensive documentation and cross-referencing was undertaken to ensure that the informational content of the case notes was not compromised in any way. Glass plate negatives were housed vertically in good quality four-flap enclosures and boxes with plates of the same size wherever possible.

Extensive photographic and written documentation was produced and a final report submitted to the Wellcome Trust.

Conclusion

To date, c. 300,000 case notes have been treated. This represents c. 30% of LHSA’s total holdings of material of this nature. These projects succeeded in securing the long-term preservation of, and improved access to, these medically and historically important case notes. In addition, a methodology for the preservation of folder-based clinical case notes was developed, which includes the treatment of photographic material (print and glass plate) and x-rays, as well as paper-based notes. This is sufficiently robust to be transferable to other historically significant folder-based collections of papers held by archives, record offices, libraries and other repositories.

Additional information

The projects were supervised by the LHSA Paper Conservator and managed by the LHSA Archivist. The experience gained and methodology developed was disseminated wherever possible via publications, presentations and tours. To get further information or ask advice on producing preservation proposals of this kind, please contact us.

Acknowledgements

LHSA gratefully acknowledges the support of the Wellcome Trust and thanks past project staff: Rosy Marshall, Kate Kidd, Louisa Coles, Toby Gough, Sue Turnbull, Simona Cenci and Katrina Redman.

The Leith Roll of Honour

The Leith Roll of Honour, created by a resolution of the Leith Town Council in 1920, lists the 2,206 officers and men who were killed in the Great War of 1914-1918, as well as the 350 who earned special honours. The first volume contains details on the background of the War and a summary of its events, including the part played by the town and people of Leith. The list of deceased provides the name, age, address, army division and number, and the cause and date of death.

The first volume of the Roll also provides the background to its inclusion as part of a war memorial at Leith Hospital. It had been decided to erect a new wing at the hospital as a memorial to the people of Leith who lost their lives serving in World War I. Contributions were made by people from all walks of life, and the wing was officially opened on 29th January 1927. A managers’ minute of 12th May 1927 tells us that a design for the case to display the Leith Roll of Honour was unanimously approved. The new wing and its contents, including the Roll of Honour, were formally handed to the managers of the hospital on 15th December 1927 by ex-Provost Lindsay on behalf of the War Memorial Committee.

Two pages of the Leith Roll of Honour (LHB6/38).

Leith Hospital became part of the NHS in 1948, and its records were later transferred to LHSA after the hospital closed.  The Roll of Honour is permanently preserved in appropriate archival and environmental conditions.

Spotlight On… (9): Recipes from the Royal Infirmary of Edinburgh Department of Dietetics

The relevance of nutrition in the care of patients was recognised by the Royal Infirmary as far back as 1742 when managers of the hospital were given guidelines in the form of a ‘Bill of Fare for the Infirmary Patients’. By 1843, there was a selection of diets available for patients with particular conditions, such as a low-fat diet, a rice diet and a steak diet with bread.

Diet sheets and recipes, Royal Infirmary of Edinburgh, 1930s-1950s (LHB1/89/4/1).

Continuing this ground-breaking role, the Royal Infirmary became the first hospital in Britain to appoint a dietician in 1924. Miss Pybus, a nursing sister, was given the post with the title Sister-Dietician although she had no formal training in the field. As a reflection of the growing importance of nutrition, in 1928, science graduates were appointed as dietitians. The kitchen work was undertaken by student trainees on a 6-month placement as part of their courses.

Eventually, greater formalisation was required, and in 1936, the British Dietetic Association was founded to help maintain professional standards and develop a code of conduct. Then, in 1944, state registration was introduced.

Baked custard recipe (LHB1/89/4/1).

Fish custard recipe (LHB1/89/4/1).

LHSA holds records relating to the Department of Dietetics. These include student applications and assessments, prospectuses, nutrition leaflets, and photographs. Amongst them are a number of recipes that the department prepared for patients in the hospital's care. They are not dated, but are probably from the 1940s or 1950s. Some of these are very basic – how to make tea and coffee, for example – and some would not be particularly appetising now, such as tripe! But some are also quite tempting. An inviting lunch menu could have consisted of fish soufflé followed by baked custard. The two recipes are pictured above.