Conservation Work on the Early Patient Files

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The earlier patient notes from Stannington Sanatorium were bound together in what were known as ‘Discharge Books’.  We had 15 of these large volumes and took the decision to have them unbound and to keep them stored as individual sets of notes instead.  They still remain in their original order but thanks to the work of the conservators at Durham Record Office are now much more accessible and neatly stored in their own custom-made boxes.  The conservators have very kindly given us a step-by-step account of the work they carried out on these records:

 

During their time at the sanatorium each patient had annotated medical notes charting their progress.  These came in a standard format; a bifolio (a sheet of paper folded in half to make two leaves), often with additional sheets or photographs attached. After the patients had been discharged these bifolios were bound together into volumes.    Whilst keeping the notes safe, the bindings were very tight, meaning it was difficult to read text written in the fold or ‘gutter’.  Furthermore, small pieces of paper that were adhered to the notes were often trapped within the gutter, unable to be lifted and thus obscuring text beneath them. (Figure 01)

03 'Trapped' paper obscurring text
Figure 01 – ‘Trapped’ paper obscuring text

 

Whilst normally all care is taken to preserve bindings as part of an object’s historical context, the decision was made that the information that was inaccessible due to the binding structure was more important than the bindings themselves.  As such, I and two Conservators at Durham County Record Office have been dis-binding the volumes.

 

Dis-binding begins with removing the boards and mechanically stripping as much leather from the spine as possible.  The leather was adhered directly to the text-block paper with a thick animal glue.  To remove the glue a poultice of sodium carboxymethyl cellulose was applied which gradually softens the animal glue without wetting the paper beneath.  When the glue was sufficiently softened we gently scraped it away, exposing the sewing and paper beneath.  (Figure 02)

05 Application of sodium carboxymethyl cellulose
Figure 02 – Application of sodium carboxymethyl cellulose

 

We were then able to cut the sewing and separate one bifolio at a time from the rest of the text-block.  In doing so we were able to see the stab sewing the bookbinders had used, which was the reason it was impossible to open the book properly to access the text in the gutter.  When each bifolio was detached, we removed any remaining animal glue from the fold. (Figures 03 & 04)                                                                                    

06 Stab sewing
Figure 03 – Stab sewing
07 Removal of glue from fold
Figure 04 – Removal of glue from fold

 

 

 

 

 

 

 

                                  

Patients who had spent many years in the sanatorium had additional sheets added to their notes.  These were attached to their bifolios with a linen tape.  Over time the adhesive of the tape has failed, becoming dry and grainy.  Whilst this meant the tape carrier was very easy to remove, the adhesive remained on the paper and had to be manually scraped off each sheet. (Figures 05-07) 

Figure 5
Figure 05 – ‘Before’ linen tape
Figure 6
Figure 06 – Removal of adhesive from tape
Figure 7
Figure 07 – ‘After’ tape removal

 

 

 

 

 

 

 

Whilst most of the paper is still in very good condition, the bifolios with many additional sheets were found to have split in the binding process as the paper could not stretch over the bulk of the inserts.  Furthermore, the inserts often protruded further than the rest of the text-block and so had suffered damage along the edges.  Some damaged bifolios had been ‘repaired’ with tape or paper, and often these repairs were failing.  When collections are being digitised, it means the originals will be rarely accessed.  As such conservators carry out minimal intervention, or repairs for ‘once-only’ handling.  This means we only repair a tear or damage if text is obscured or if we think a tear might be caught and worsened in the digitisation process.  We carried out these repairs with a thin but strong Japanese paper and wheat starch paste. (Figures 08 & 09)

12 'After' paper repair
Figure 09 – ‘After’ paper repair

 

11 'Before' repair - with an old repair piece
Figure 08 – ‘Before’ repair – with an old repair piece

 

 

 There were also a number of photographs within the medical notes, adhered with a similar linen tape.  The adhesive was gently removed to prevent scratching the emulsion layer.  Four-flap folders were made out of SilverSafe paper; an unbuffered paper specifically for storing photographs to prevent acidic decay and abrasion. (Figures 10-12)

15 Removal of tape I
Figure 10 – Removal of tape I
16 Removal of tape II
Figure 11 – Removal of tape II
17 'After' page with photographs
Figure 12 – ‘After’ page with photographs

  

 

 

 

 

Bespoke clamshell boxes were made from acid-free archival card to house each volume, which are then ready to be digitised. (Figure 13)

19 Archival clamshell box
Figure 13 – Archival clamshell box

 

Jenny Halling Barnard, Lisa Handke, and Zoe Ross – Conservators at Durham County Record Office

Matron’s Medical Report Book – Part 1

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The Matron’s Medical Report Book is the earliest surviving record we have from Stannington Sanatorium, which contains monthly updates on patient progress and general administration.  The first entry from the Report Book, below, dates from 1908 and lists some of the earliest patients with details of their ages, addresses and condition whilst in the Sanatorium.    

 

April 11th 1908

“There are now six patients here.  Five have been here for nearly four weeks (since March 18th) & one for three weeks.  They are:-

1. Maggie Smith, aged 17.  Address 73 Leopold St (sent from the Gateshead Workhouse)

2. John Edward Kenney, aged 15 ¾; Address 72 William St, Hebburn Quay (working at Hebburn Colliery)

3. James Robson, aged 13. Address 16 Bottle Bank, South Shields

4. Thomas Hill, aged 12 ½. Address 76 Belvedere St, Heaton

5. John Nicholson, aged 10.  Address 10 Hyiamais Court, Gateshead

6. Thomas Burns, aged 16 ¾. Admitted March 21st. Address 40 Stanley St, Jarrow

 

The general condition of all the patients has considerably improved.  They have all gained in weight during the last 18 days: Maggie Smith 5 ¼ lb, John Kennedy 4lb, James Robson 2 ¾ lb, T. Hill 3lb, J. Nicholson 3 ¾ lb, T. Burns 3 ¼ lb (all given to the nearest ¼ lb).  Only one patient, Maggie Smith, has any marked degree of fever.  There is a slight improvement in her temperature.  One patient, J. Hill, does not cough at all.  All the others are coughing less and bringing up less sputum.

Examination of the sputum for tubercle bacilli has not yet been possible.

The local condition in three patients, T. Burns, T. Hill & J. Nicholson is quite satisfactory, shewing improvement. In two patients, Maggie Smith & J. Robson it has remained about the same.

In one, J. Kennedy, there has been some extension of the diseased area, but improvement again during the last four days after strict rest.”

[HOSP/STAN/2/1/1]

 

The close association of tuberculosis with poor living conditions is further highlighted here by the first two patients who have come from Gateshead Workhouse and Hebburn Colliery respectively.  At this stage there were only 6 patients but the sanatorium had opened not long before this with provision for 40 children and soon saw the beds fill up.  In the following years the sanatorium’s capacity began to expand rapidly with an extension providing an additional 50 beds opening in 1911 and several new wards opening in the 1920s so that by 1926 there were 312 beds available.

HOSP-STAN-9-1-1 aerial view

Aerial view of the sanatorium c.1936

[HOSP/STAN/9/1/1]

We will post some more entries from the Matron’s Report Book in future blog posts to track the progress of the early days of the Sanatorium.

Patient Files

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As part of the Stannington collection we have patient case files spanning the years 1939-1966 containing a wealth of medical and social information to support that found in the radiographs.  The earlier files have a different format to the later ones owing to a change in the administration of patient records at Stannington which occurred in 1946.  Up to 1946 the patient records take a much larger format and the patients were all allocated their own unique patient number based on their date of discharge, whereas from 1946 onwards standard sized paper files come into use with patient numbers being based on date of admission.

[HOSP/STAN/7/1/1/1587]

The above file is an example of one of the later files with the patient’s name redacted for confidentiality purposes.  Three different colour files were used, each one indicating the type of tuberculosis the patient was suffering from.  Blue files were used for sufferers of pulmonary TB, pink files for non-pulmonary TB, and finally green files for TB of the bones and joints.  This image gives a good indication of the sort of information that can be found on the files, which is also indicative of the information we will be recording in our catalogue.  The information featured in the catalogue for each patient will be as follows: patient number, date of admission, date of discharge, sex, age on admission, home town, diagnosis, result of treatment, where admitted from, the local authority sending them, and where applicable any re-admission numbers and dates.

 

To clarify some of the information given on the file, the date of immunisation refers to immunisation against diphtheria, not tuberculosis, as widespread vaccination against TB was not yet in place.  As a contagious disease and a major concern for public health, all diagnosed cases of tuberculosis had to be made known to the local public health authorities, which is what the notification date refers to.

 

Each case of tuberculosis had to be classified according to centrally issued guidelines and this is often noted on the patient’s file under diagnosis. The first distinction made when classifying the disease is between pulmonary and non-pulmonary tuberculosis, with pulmonary including TB of the pleura and intrathoracic glands and any patient suffering from a combination of pulmonary and non-pulmonary TB would be classified as pulmonary.  Cases of pulmonary TB could then be subdivided between TB minus and TB plus.  Cases in which tubercle bacilli have never been found in the sputum or other pathology samples are classed as TB minus, as the above patient is.  TB plus on the other hand applies to cases in which tubercle bacilli have at some point been found and is subdivided further into 3 groups; group 1 applying to cases with slight constitutional disturbances if any and limited physical signs, group 3 for cases showing profound constitutional disturbance or deterioration and with little or no prospect of recovery, and finally group 2 for all cases which cannot be placed within groups 1 or 3.  Patients suffering from non-pulmonary tuberculosis would be classified according to the site of the lesion, for example, tuberculosis of the bones and joints, abdominal tuberculosis, tuberculosis of other organs, and tuberculosis of the peripheral glands.

 

There is also a space on each patient file to enter the result of treatment and there were also central guidelines covering this.  Most patients leaving Stannington are deemed to be ‘quiescent’, meaning that they have no signs or symptoms of tuberculous disease and any sputum is free of tubercle bacilli.  A patient’s condition could also be classed as ‘arrested’ by which it is meant that in pulmonary cases the disease has been quiescent for at least two years and in non-pulmonary cases it is quiescent and there is no reason to believe it will recur.  And finally, a patient could be considered to be ‘recovered’ if the disease had been arrested for at least three years.

 

The information that you can expect to find within the patient records does vary from patient to patient but generally includes data on other family members, living conditions, medical history, temperature charts, x-ray reports, pathology reports, details of progress, and any correspondence with family members or local authorities.  The correspondence contained within the files can give a fascinating insight into social problems and the impact tuberculosis could have on families at the time adding an extra dimension to the medical information that we expect to find.  The image below is an example of the x-ray reports that can be found in the back of some of the files; it is quite common for files dating from the mid-1940s to find small diagrams of what was seen in the x-rays also.

 

x-ray reports

[HOSP/STAN/7/1/1/1587]

 

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