Case notes

Queen Square Archives holds 1,500 volumes of case notes, the longest continuous manuscript collection of neurological case histories in Britain. The case notes present a unique opportunity to follow the development of neurology in the second half of the 19th century as for much of this time it was the only specialist neurological hospital.

The quality and detail of the case notes were innovative in themselves, inventing a systematic way of recording medical history and examinations. Of great interest is the development of case taking and examination as it emerges from a study of these case notes.

The format of these records remained basically unchanged from 1860 to1946. At Queen Square, the case notes were bound by the name of the Physician with any surgical notes being bound together . This means that it is necessary to know the active dates for any surgeon as their work, however eminent, will be bound under the Physicians for whom they operated.

The bound volumes are usually indexed at the front by the patient’s name stating the illness against the name. This makes it simple to pick out cases of particular disorders. Where applicable, the case notes are often cross-referenced to the appropriate post mortem volume.

Information covers:

Complaint, Patient history, Family history, Present illness, Appearance on admission, Spine, Sensory, Cranial nerves, Motor, Reflex, Sphincter and Gait; followed, as appropriate, by details of any operation, follow-up notes, daily monitoring charts,diet and medicine, charts, treatment reviews, discharge notes; as well as the result of the patient’s stay (Cured, Improved, In Status Quo, Worse, Death).

Some used printed clinical figure diagrams shaded by the doctor to show the position or extent of any problem. Many contain photographs which can be of the whole patient, closeups of the patient’s skull, or post-operative scars. They sometimes include the post mortem report itself.

A hand written index of case notes by conditions is available up to 1931. The bound volumes are also usually indexed at the front by the patient’s name stating the illness against the name. Volunteers are currently transcribing the index into a spreadsheet to improve searching – and preserve the index. They are also creating an index spreadsheet for cases from 1932 onwards.

Selected bibliography:
*Hunter, R A & Hurwitz, L J. “The case notes of the National Hospital for the Paralysed and Epileptic, Queen Square, London, before 1900”. JNNP, 1961, vol 24, pages 187-194
*Linden SC, Jones E. ‘Shell shock’ Revisited: An Examination of the Case Records of the National Hospital in London. Med Hist. 2014 Oct;58(4):519-45.
*Uff, C. Sir Victor Horsley’s 19th century operations at the National Hospital for Neurology and Neurosurgery, Queen Square. J Neurosurgery, 2011. Vol 114, 534-542
*Vale TC, Lees A, Cardoso F. A biosketch of William Richard Gowers with a new review of his inpatient case history notes. Arq Neuropsiquiatr. 2013 Jun;71(6):411-3. doi: 10.1590/0004-282X20130049.
*Vale TC, Glass PG, Lees A, Cardoso F. Gowers’ Queen Square case notes on chorea: a 21st century re-appraisal. Eur Neurol. 2013;69(1):48-52.