Only approximately two thirds of the volume has been used, the rest is blank, and there is evidence of folios having been removed from the rear of the volume. A note in the front cover suggests that the volume was donated to the Radford Library by John Hirst of Ladcastle, Dobcross, Saddleworth on 31 May 1886. The rest of Hirst's extensive library was sold at auction by Sotheby's in December 1887. There is a list of names and addresses on the final page, the majority of which appear to be doctors and surgeons.
A case book of gynaecology cases treated by Charles Clay in which the majority of the women are suffering from ovarian cysts or tumours [neoplasms]. There are one or two examples of uterine cysts, which have little detail, and this combined with the wide geographic spread of the patients tends to suggest that some cases were specifically sought out by Clay in order to further investigate the ovariotomy operations he became known for, or that he was sought out by his patients as one of the only surgeons able to assist at that time.
Some cases are reported in more detail than others but in general the information recorded includes the name, age, and residence of the patient in addition to number of children, miscarriages [spontaneous abortion], general appearance, detailed symptoms, diagnosis and account of the treatment which often involved an operation. 82 separate cases are dealt with in total. A letter from one Frederick Turner, surgeon in Buxton, is inserted into one of the cases in which he reports on the patient before recommending her to Clay.