Case Note Folders

The Retreat Filing System for Case Note Folders:
The Retreat kept patients’ records in case books up to the mid 1930s (see RET 6/5/1 above). These were filed at first by date of admission, but by the early 20th century they were being filed by date of discharge or death (with separate series for males and females). This change in filing procedures echoed what was done at other mental hospitals.
But from the mid 1930s onwards (a process which the Retreat began to introduce in the 1920s), case notes were kept in individual case note folders under name of patient (again, this change echoed what was being done elsewhere). It remained the convention to file notes by date of discharge or death of patient. For a few years in the 1920s and 1930s there was an overlap in systems, with some notes in case books and some in case folders.
However, the Retreat’s system was slightly more complicated than the norm. It seems that while there were separate parallel series for Discharges and Deaths (as one would expect), and separate series for males and females (again, as one would expect), case folders were filed, within these series, in a number of successive alphabetical sequences.
The key to this was probably that the Retreat had a certain amount of ‘current’ storage space available in which to store the recent Discharges and Deaths Folders for Males and Females. Here they were stored alphabetically, in their respective series. But every two or three years the current storage space ran out and so files had to be consigned to ‘semi-current’ storage space a bit further away in the hospital. The files were all cleared away, stored in carefully numbered boxes, and entered onto index cards. In the ‘current’ store, a new alphabetical sequence for each series was then begun.
The folders below, therefore, are now filed in a series of numbered boxes, which represent the final storage order (which incidentally was not always quite coherent: see below) of the separate alphabetical sequences.
There were two consecutive file numbering sequences for the boxes of Case Note Folders between the 1930s and the 1960s.
The first series was numbered from 1 to 107 (although some of these numbers were allocated to boxes of doctor’s correspondence rather than to case notes, and consequently the Box numbers 2, 3, 11, 43, 45, 46A, 53, 66, and 72 have now been removed from this series).
The second series was numbered from MD 1 up to just beyond MD 290. Both Deaths and Discharges and Males and Females appear in these series.
The Borthwick holds all case note boxes in these two series up to and including MD 248. All the case notes of patients admitted, discharged or dying at the Retreat before and up to the year 1960 should therefore be at the Borthwick. The case notes of patients admitted, discharged or dying from 1961 onwards should be at the Retreat. But note that some of the boxes of case note folders transferred to the Borthwick included a few case notes of patients admitted, discharged or dying after 1960 which happened to be filed in the same alphabetical sequence as the pre-1960 notes. And occasionally files of pre-1960 admissions which ought to be in the boxes cannot be located.
The Retreat filing system gives rise to a number of problems.
First, the changes between alphabetical sequences seem haphazard: each alphabetical sequence usually lasted for two to three years, but must sometimes have changed in mid-year. It is also possible to see that some notes found their way to the medical records department late and appeared in the ‘next’ (wrong) alphabetical sequence. A further complication, as can be seen from this index, is that sometimes, as was conventional, older notes for readmitted patients were taken out and re-filed with the later ones at the later discharge or death date - but occasionally the various sets of notes were not married up – and on occasion, the folder was re-filed at the older rather than the more recent date. Another complication is that when a discharged patient was known to have died shortly after discharge, his or her case folder was then filed under ‘Deads’ rather than ‘Discharges’. So one should bear in mind that ‘Deads’ does not necessarily mean death at the Retreat, and if a known discharge cannot be found it is worth checking the ‘Deads’.
But the main problem with the Retreat filing system is that it is harder to capture, physically, a cohort of discharges or deaths by year. Although this could still be done via Discharge/Death Registers, the survival of these is incomplete. The Retreat seems to have dealt with this problem by having some additional index card series which noted discharges and deaths for the years covered by each alphabetical sequence. However, not many of these indexes have survived, and consequently a decision has been made not to keep the very few, unrepresentative, ones which have emerged.
When the case note folders were transferred to the Borthwick, a decision had to be taken whether they should be physically reordered in a more coherent way. But because of the huge number of case note folders, this would be a difficult and time consuming task – all the more difficult because the outsides of the folders are only marked with admission dates, not dates of discharge or death.
It has thus been decided to maintain the original box numbering and ordering, and to use the contemporary index of patients in order to locate the case notes of individuals. It should be possible, through this index, to identify the cohorts of discharges and deaths (and, indeed, admissions). One can also trace, with a bit of work, the way the alphabetical sequences worked and the years they covered and how they were boxed and referenced.
Because the index (see RET 6/5/4/319) contains names of patients who may still be alive, it is not on public access.
The following list gives original filing box number, whether Deads or Discharges, and whether males or females, are covered, alphabetical sequence, and covering dates. Sometimes the apparently wide date range is explained by the presence of files filed in much later than expected, or taken out and re-filed back in their original position after a later admission. A few notes from the 1920s which one would expect to see in the Case Books are also included.
Note that re-boxing has sometimes meant that the contents of an original numbered box now occupy more than one archive box. Where this is the case, the current extent is also noted in the list

Access to the whole of RET 6/5/4 is restricted under data protection laws.

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