Notes of cases seen by Fletcher in the Manchester Royal Infirmary that would have formed part of a clinical lecture course during his time as a medical student. The notes often refer to the senior staff who the patients would have been admitted under and who would have been responsible for their care and possibly the clinical teaching. These individuals include Joseph Atkinson Ransome (1805-1867), Robert Thorpe (c.1788-1851), Thomas Turner (1793-1873), Joseph Jordan (1787-1873), Edward Stephens (1804-1863), James Ainsworth (1783-1853), William James Wilson (1792-1855), and Ashton Marler Heath (b.1803).
The patient reports read like case notes and include their name, age, and address alongside their occupation, date of admissions, and the nature of their complaint. There is usually a brief note on their medical history and current bodily condition including a full description of their current complaint and how it came about. Progress throughout each patient's stay in the hospital is recorded and includes any treatment or medication provided, changes in condition, and the end result. Where applicable a description of the post mortem also appears. Both male and female patients are seen ranging in age from approximately 9 to 81 suffering from a wide range of complaints. Of particular note is the great number of industrial accidents.
There is a pencil drawing of a fractured sacrum as seen during a post mortem on f.104v with the page number 124.
In the front of the volume there are a number of patient reports, which follow the same format as the rest of the manuscript, but which have been written on larger sheets of paper that have then been folded in half before being added into the binding. This means that the manuscript has to be turned on its side in order to read the content, the pages are not necessarily in order, and it is not possible to read much of the information which has been lost in the binding. Inscriptions in the front cover indicate that the manuscript was donated to the Manchester Medical Society in 1882 and subsequently allocated the reference GO 5733 viz. their 1890 library catalogue.