patient files

We are pleased to announce that the Wellcome Trust have awarded a second grant to Northumberland Archives to continue the amazing work they have done through the Stannington Sanatorium Project.

The ‘Stannington: From Sanatorium to General Hospital: Opening Up Three Decades of Paediatric Care’ Project has been awarded £49,100. This money will allow us to digitise the main series of case files from the Stannington Sanatorium collection covering the period 1944-1966. These files comprise 100 linear feet of records – that’s a whopping 122,000 pieces of paper to be digitised! We will redact the key documents in each file – the patient progress notes, x-ray card and discharge sheet and append the redacted copies to the catalogue entry. The files span the life of Stannington from it being a tuberculosis sanatorium funded by the Poor Children’s Holiday Association (now Children Northeast), including the introduction of the National Health Service, (1947) to its final conversion to a general children’s hospital (1953), which it remained until its closure in 1984, opening up three decades of paediatric care.

The Stannington Sanatorium Project ran from August 2014-July 2015 and allowed the full cataloguing and part-digitisation of the records from Stannington Sanatorium. However, the digitisation element of the project was primarily focussed upon the original and microfiche radiographs that made up a sizeable portion of the collection and only the early case files up to 1943 were digitised at this stage. This grant will fund the digitisation of the remainder of the individual patient files included in the Stannington Collection and will fund full re-packaging of the original files in conservation grade materials.

Through this project we will utilise digitisation as a preservation tool thereby minimising further handling and potential damage to patient files through the creation of a digital surrogate which can be viewed electronically. In turn the project will increase accessibility to the collection via the redaction and web-mounting of the files. It will benefit members of the academic community who have shown a vast interest in the previous project and wish to access the files as a teaching resource or for their own research. This new digital content will be added to Northumberland Archives electronic catalogue where the c.20,000 images created in the first project can now be viewed.

The project will commence in November 2015 and will run for 12 months. Two new members of staff will be employed, one full time the other part time, to undertake this arduous task and they will endeavour to blog about their progress from November onwards so make sure you keep a look out for new postings!

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 06 – Removal of adhesive from tape

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

News from the Archives!

Conservation Work on the Early Patient Files