The Case Notes of the National Hospital for the Paralysed and Epileptic, Queen Square, London, Before 1900

Thecasenotes oftheNational Hospital present a unique opportunity offollowing thedevelopment ofclinical neurology inthesecondhalfofthe nineteenth century since formuchofthis timeitwas theonlyhospital specializing inneurological diseases. Itisowingtotheforesight ofthehospital's early physicians andadministrators thatfrom1863three years after itsopening-the in-patient records arepreserved complete andtheygive avivid picture ofclinical neurology asitwaspractised anddeveloped during those early years. Theearliest casebookcovering theperiod 1863-67 consists simply ofthepatient's history, a noteof obviousphysical signs, medicines given, and diagnosis. Figures 1(a) and(b)showsthenotesof a patient withaphasia andleft hemiplegia written in1865.Dr.Hughlings Jackson's interest inthis combination isapparent fromhispencilled request toseethepatient. From1867thenotesbecamemoresubstantial andconsisted ofanout-patient sheet boundwith thein-patient notes.Thein-patients' noteswere nowmadeupofafront sheet giving personal details, dates ofadmission anddischarge, duration ofillness, result oftreatment, diagnosis, andthenameofthe physician underwhosecarethepatient was;later thenamesofthehousephysician andclinical clerk werealsorecorded. Therefollow continuation sheets, treatment card, fitcharts inepileptic cases, infebrile cases temperature charts whichincluded recordings ofpulse, respiration, weight, andanalysis ofurine; notinfrequently sensory andperimetry charts, clinical andpost-mortem drawings andphotographswerealsoincluded. Occasionally, correspondence fromreferring doctors orother consultants waspreserved. t Figure 2showsaphotograph inthecasenotesof apatient ofDr.ThomasBuzzard in1875diagnosed ashysterical ptosis. Notetheabsence ofcompensatory contraction ofthefrontalis muscleonthe affected side, whichhelps todistinguish thecondition fromthis cranial nerve palsy. Incidentally, there is alsoaphotograph ofhernormalappearance after treatment. Attheendofayeareachphysician's notes were boundinavolumeinalphabetical ordertowhich wasprefixed anindex ofpatients' namesanddiagnoses.In1880, a separate diagnostic cardindex wasestablished, andasthenumberofpatients in thehospital increased, thenotes ofmenandwomen wereboundseparately. Thesevolumes arenow arranged onshelves around thewalls oftheregistrat 's roomintheOut-patient Department, whichisin