The original notes were bound in large volumes by consultant, some of which had become fragile. Only medical case notes survive until 1896. During 2006 the Archivist applied for a grant from The Wellcome Trust scheme for Research Resources in Medical History to carry out conservation work on the oldest patient case books dating from 1876 to 1905. This work was undertaken by Preservation Solutions during 2007-9.

Not all case notes have survived therefore the numbers within each case book are not consecutive. The notes are catalogued by page number with the patients name in the title and disease, abode and occupation, if known in the description field. If a number was not written on the case notes a number was added at the time of conservation, these numbers are added in pencil with a circle around the number.