Digitising the Stannington Sanatorium patient files

As the Stannington Sanatorium Digitisation Assistant I am responsible for digitising over 4,000 patient case files and their contents, redacting personal identifiable information from these and uploading digital copies of the core documents to our publicly accessible, searchable, online catalogue. Before I can do this, my colleague, the Project Assistant has already sorted the forms, charts and various other items contained in each file into core and non-core documents and repackaged them in acid free folders for long term preservation. You can read more about this here.

A file ready to be digitised
The documents of patient file HOSP-STAN 07/01/01/2261 prior to digitisation

Before being digitised the pages in each file are checked to make sure they are in the correct order and any dog eared corners or folds are straightened out. The pages in the folder are then photographed on both the front and reverse sides to make sure that all the information in each folder is captured. The number of images captured varies from file to file and can be from just a few up to around fifty. Most files have around 10 to 15 pages, but the largest digitised to date contains over 140 pages!

We digitise the files using a high specification digital SLR camera connected to a computer. This allows us to take high resolution photographs of each page and is much quicker than digitising each page separately on a flatbed scanner. Using a flatbed would be the normal approach however the time constraints on the project mean we are digitising over 1,500 pages every week so this approach isn’t feasible.

Camera stand and laptop
The camera stand and laptop used to digitise each file.

The images are then processed and saved to nationally recognised standards set by The National Archives. Each file is saved in Tiff and Jpeg formats. The Tiff format creates files of a large size, but ensures that all the original information from the photograph is retained. Because of this and the sensitive nature of information in the un-redacted files they are stored on DVD in the Northumberland Archives strong rooms for security and long term preservation. The smaller Jpeg format allows us to keep these digital files on our own servers and readily accessible to staff and researchers if required.
The core documents from each folder (cover, case notes, x-ray card and discharge report) then have any information which could identify patients or is considered sensitive removed. This process involves using photo editing software on a computer, and reading each page to check for information such as names, addresses and dates of birth, and redacting it. This is a time consuming process not made easier by having to read a lot of hand written doctors’ notes!

Core documents being redacted in Adobe Photoshop
Adobe Photoshop is used to redact sensitive information from the core documents.

The final stage of the process is to upload the images to the relevant records on our online catalogue. Once this has been done a selection of pages from each file are publicly viewable along with each file’s catalogue entry and the digitisation process is complete. Currently over 18,000 pages have been digitised from over 1,400 patient files. Over 6,000 core documents are already viewable online via our catalogue in addition to a large number of radiographs and early patient files which were digitised during the first phase of the project.
A typical set of core documents from the file of a patient suffering from tuberculosis admitted to Stannington Sanatorium in the early 1950s can be seen below.

The front cover of a file
HOSP-STAN 07/01/01/2261/01
Inside the cover of a patient file
HOSP-STAN 07/01/01/2261/02
HOSP-STAN 07/01/01/2261/07 -
HOSP-STAN 07/01/01/2261/03
HOSP-STAN 07/01/01/2261/04
HOSP-STAN 07/01/01/2261/04
HOSP-STAN 07/01/01/2261/05
HOSP-STAN 07/01/01/2261/05
HOSP-STAN 07/01/01/2261/06
HOSP-STAN 07/01/01/2261/06
Pages from a patient file incuding discharge report
HOSP-STAN 07/01/01/2261/07

Working as the Stannington Sanatorium Project Assistant

As the Stannington Sanatorium Project Assistant my responsibility is to ensure the good preservation and access to the Stannington Sanatorium records. Since early November I have been removing boxes of our patient files from the shelves and repackaging them. This follows a set process. First I begin by opening the file and separating out the core documents from the other contents of the file, and securing them to the inside of the file with an archival quality brass paper clip. The core documents include X-ray records, discharge reports, treatment notes and case notes. These contain a wealth of information about each patient’s treatment and health during their time at the Sanatorium. The non-core documents vary greatly in content, usually (but not always) including temperature charts, a history of illness and medical permissions form completed by parents, reports and letters of their transfer. There are often a number of other documents included, and

A repackaged file with supplies - unfolded card folder, archival tape, Brass paper clips and a bone folder for folding the flaps of the folders.
A repackaged file with supplies – unfolded card folder, archival tape, Brass paper clips and a bone folder for folding the flaps of the folders.

we will look more closely at the contents of the files in a future blog. I also ensure the file itself is in good order for its conservation, that there is no yellowing sticky tape, old paper clips or pins that may corrode.

It is then folded with an archival-grade four-flapped envelope, which we were able to purchase thanks to our Wellcome Trust grant. These are high-quality, acid-free card envelopes; an excellent way to protect the documents from damage and dust ingress. This is then given a printed label with the file’s reference number, and tied together in acid-free archival tape tied with a quick-release knot. Due to the thickness of the files after their repackaging additional boxes are required, and I estimate repackaging will at least double the number of boxes the collection occupies.

Files yet to be repackaged on their temporary shelving
Files yet to be repackaged on their temporary shelving

This all has to be given extra space within the Northumberland Archives strongrooms. I have moved the boxes yet to be repackaged to a new temporary location, and am refilling the shelves as the boxes are completed, updating their location references as I go. I have just passed the halfway mark, but there is a lot still to be done!

Once completed however, the records don’t just sit unused. We often have Subject Access Enquiries, usually made by former Stannington patients wishing to see their records, and these are dealt with by our research team. We require authentication and permission to do this, which can take some time. The documents are not only useful for finding out more about individual lives, but for research into tuberculosis in children and the history of its treatment. A number of research institutions have looked at redacted images of the files and radiographs, to learn more about Tuberculosis.

Repackaged boxes of files at their new permanent location
Repackaged boxes of files at their new permanent location

This has to be done with the strictest patient confidentiality, and we will discuss more about the redaction process in future blogs. A former colleague at the Northumberland Archives, Becky Cessford, is looking at the uses of the Stannington Sanatorium collection in the wider fields of archaeology of human remains, history of medicine and archival outreach in her PhD. She will discuss her fascinating project in a blog post for us sometime soon. It is fantastic that the records are being used by former patients and researchers as such a valuable collection should be appreciated. The team last year started to raise the collection’s profile through these blogs, talks, an online exhibition and a touring exhibition, and I hope to be able to carry on some of this in phase two. You can see the online exhibition here, and the touring exhibition will soon be moving from libraries across Northumberland to HM Prison Acklington until late March.

The new Stannington Project assistants

Our new Project Assistant

As highlighted in our previous blog posts the second phase of the Stannington Sanatorium project is now underway. Using a second tranche of funding from the Wellcome Trust this phase will make digitised copies of the patient files covering the period 1946-1966 and re-package them in conservation grade materials. Our new Project Assistant began in early November. Her part-time role will involve determining which are the most important or ‘core’ documents, separating them from the rest by means of an archival standard brass paper clip. They are then enveloped in a four-flapped folder, made from acid-free card, tied and labelled with its own reference number. This way we can help to preserve the original documents for years to come.

Our new Project Digitisation Assistant
Our new Project Digitisation Assistant

The Project Digitisation Assistant, will then make Jpeg and Tiff image files of each document. Digital copies of the core documents will be redacted, removing the names and personal information of the patients and attached to our online catalogue. This will mean that although they will be accessible from anywhere in the world, that patient confidentiality will still be maintained. They will provide an excellent resource for those studying the treatment of Tuberculosis, and the lives of children in hospitals in the mid-twentieth century. We will be posting in the coming months about our progress, so please look out for how we are getting on. We will also be creating a Flickr set of a typical case file including all contents. This too will be redacted to protect patient confidentiality. Please remember to look at our new online exhibition about Stannington Sanatorium, available here.