Spotlight On… (10): Project to re-order LHSA’s twentieth-century case notes

LHSA holds the second-largest collection of medical case notes in the UK, comprising one million folder-based patient records that date back to the 1900s. These consist of over 100 discrete collections from some of the great general and specialist practitioners in the Lothian area, including Harold Stiles, John Fraser, and Norman Dott.

Inside ear and throat department box.

During a move of the case note collections, a shelving collapse occurred in November 2006. Although the overall damage was minimal, this incident resulted in the disorganisation of 71 of the collections. The time-consuming task of restoring order was carried out by LHSA Archive Assistant Stephen Willis. Taking more than a year and a half to complete, he re-ordered over 208,000 case notes. At the same time, additional information was extracted, for example, regarding medical specialty, date range, and mentioned wards.

Re-ordering of the case note collections.

Occasionally, miscellaneous items were found among the case notes. Some of the more unusual items have included a hair comb, a pair of nail scissors, and the colour supplement from a 1959 edition of Woman magazine!  

This project not only improved access for enquirers, but also made the case notes ready for potential future conservation or digitisation work.  

Since the project's completion, attention shifted to the rest of the case notes, as many of these had not been reviewed before. They were being systematically checked, and similar information was recorded.

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.

Conservation (6): Treatment of the Indexes to the Royal Infirmary of Edinburgh General Register of Patients

In 2004, the National Archives of Scotland awarded £1,100 (10% of the total cost) to conserve 94 Indexes to the Royal Infirmary of Edinburgh General Register of Patients (1869-1960). The Indexes are the first port of call for locating individuals’ entries in the Registers and, apart from the Registers themselves, they are probably the most frequently consulted series of LHSA-held records.

 

Condition

The volumes were in very poor condition, with detachment of the front and back boards and loss of spines frequently noted. Where still present, the half leather bindings showed extensive deterioration. Previous repairs to the spine, primarily with pressure sensitive tape, were observed. This level of degradation posed a significant risk to the long-term preservation of the textblock (the pages), with potential loss of the important informational content of these volumes. Although the textblock was in relatively good condition in general, there was localised, ingrained surface dirt and tearing, along with evidence of water ingress to several volumes.

Index to General Register of Patients, Oct 1928-Sep 1929, after treatment (LHB1/127/63).

 

Treatment

The decision to provide the volumes with a full cloth binding was carefully made, taking into account the limited available funding and perceived value of the original case as compared to the high need for long-term safe and easy access to the informational content of the textblock. As much of the original binding as possible was retained with leather title pieces, labels, and endpapers transferred to the new binding, and a sample case kept for reference purposes. Where necessary, the textblock was cleaned with a chemical sponge, and tears were repaired with wheat starch paste and Japanese paper. Photographic and written documentation of the treatment undertaken was also produced.

Index to General Register of Patients volumes on the shelf.

Conclusion

The project work on the indexes complements similar treatment of the Registers themselves, which was funded from the annual budget over the period 2000-2003. The treatment undertaken on these important volumes has ensured that access continues to be possible without risk of damage.

 

Acknowledgements

LHSA acknowledges the support of the National Archives of Scotland for both this project and an award of £1,850 in 2002, which contributed to the conservation treatment of two volumes of press cuttings from the Royal Edinburgh Hospital.

Spotlight On… (8): The conservation treatment of case notes from Deaconess Hospital

The Deaconess Hospital (148 Pleasance, Edinburgh) opened in 1894, primarily to provide training for missionary Deaconesses. It also provided a much needed medical service to the local community. The hospital closed in 1985 and the building was the headquarters of NHS Lothian until 2010.

LHSA holds the general case notes for the Deaconess Hospital for the period 1894-1954. For 1894-1911, these take the form of 25 bound volumes. During a survey of all bound volumes in the LHSA collection, these were identified as a treatment priority due to their poor condition. Surface dirt, tearing to the textblock, leather deterioration of the cases and loss of spine and/or boards were common. In isolated cases, previous water damage was also evident. This level of degradation made accessing the information in the case notes difficult without causing further damage.

Example of a General Case Notes volume before and after conservation (LHB12/42/4).

The volumes were sympathetically repaired, retaining all aspects of the original. Where boards or spines had been lost, these were replaced with similar materials. This is time consuming, but ultimately effective work so that these important records can be used by future generations.

The Royal Infirmary of Edinburgh’s Royal Charter

On 25 August 1736, Scotland’s first hospital, in the modern sense of the word, was granted a Royal Charter by His Majesty, King George II. Founded in 1729, it was first known as the Infirmary, or Little House, or Physicians’ Hospital. The Charter conferred the more familiar title of The Royal Infirmary of Edinburgh, by which it has been known ever since. LHSA produced three posters about the Royal Infirmary of Edinburgh's Charter.

General information

King George II granted a Royal Charter in 1736, naming Edinburgh's Infirmary, which had been founded in 1729, the Royal Infirmary of Edinburgh.  The charter is in Latin and has the Great Seal of Scotland attached.

As well as extending royal patronage to the hospital, the Charter made it into a corporation. This gave it legal rights to use a common seal, to perpetual succession, to sue and be sued, to own lands and erect properties upon them, to lend money and to make bye-laws, rules and regulations, on condition they were consistent with the laws of the land, and with the institution’s charitable purpose of caring for the sick poor.

Image of the Royal Charter and The Great Seal of Scotland.

The Charter also specified how the Infirmary was to be run. Twenty named managers were nominated in it, drawn from Edinburgh Town Council, the law, the church and the medical profession. They were given the right to elect their successors annually. Charitable contributors who had given five pounds sterling or more were made into a general court, which was empowered to make and amend managers’ regulations.

Originally in English, the text was translated into Latin by the noted Scottish classicist Thomas Ruddiman (1674-1757). It was then inscribed onto parchment and The Great Seal of Scotland was attached by means of intertwined blue and pink silk threads. The wax relief shows King George in military uniform, mounted on a rearing stallion and overlooking the City of Edinburgh. An idealised but still identifiable panorama of the Castle, the church and tenement buildings of the Royal Mile and Salisbury Crags, can be seen behind the horse’s legs.

The Seal was originally kept in a metal tin (not shown) and had broken into several pieces. The subsequent repair and restoration work, carried out by the National Archives of Scotland, can be clearly seen in the illustration, which is approximately life size. The Charter consists of four sheets of parchment folded to make eight pages, four sides of which are blank. As it was kept in its original leather pouch for over 250 years, the parchment had to be relaxed and flattened prior to the Charter, restored Seal and pouch being permanently housed in a specially made box.

 

The Charter text in English

The original English text reproduced in ‘The History and Statutes of The Royal Infirmary of Edinburgh’, 1778, can be seen in the following images.

Images of the Charter and Seal

First and second pages of the Latin text, 1736

Account of expenses associated with the Charter, 1737.

Front and reverse of The Great Seal of Scotland attached to the Charter.

Further resources

Poster 1: General information about the Charter and Seal

Poster 2: The Charter text in English

Poster 3: Images of the Charter and Seal