Working on Happiness: robotic rebinding, refurb or leave well alone?

In 1953, while living in Germany, my mother began creating a remarkable book. She called it Happiness. It is a deeply personal, carefully assembled collection of poems, biblical passages, prayers, prose and pictures through which she explored love, faith, beauty, belonging and the life she hoped to lead.

Happiness has remained an intimate family treasure for more than seventy years. Now, as my mother enters her 91st year, we are transcribing and preparing it for publication. We hope to preserve it not only for the generations of her family who will follow, but are mindful that the act of preservation opens up many dilemmas.

Mindful of my recent journey through the NHS, I found myself wondering how a urologist consultant might report on the state of the book and what’s to be done about it. So I asked one, and this is what my friendly consultant came up with.

Patient: Happiness
Date of birth: c. 1953–54
Age: Approximately 72 years
Presenting complaint: Progressive loss of structural control, severe spinal deterioration and increasing difficulty maintaining an upright position.

Clinical history

Happiness is a unique handwritten album created in the patient’s youth while living in Germany. Over seven decades, the volume has developed progressive enlargement caused by the accumulation of poems, pictures, cards and other inserted material. This additional bulk has placed sustained pressure upon the binding apparatus. The condition was initially manageable but has now progressed to significant mechanical obstruction, impaired opening and advanced failure of the supporting structures. There is no history of previous major operative intervention.

Examination

The patient remains cognitively and emotionally intact. The internal contents are exceptionally well preserved in spirit, although structurally vulnerable. External examination reveals:

• marked enlargement and irregularity of the text block;
• severe deterioration of the spinal covering;
• bilateral failure of the joints;
• partial separation of the text block from the boards;
• reduced structural control on opening;
• several loose or inadequately supported leaves;
• localised tears, staining, surface wear and age-related fragility;
• pronounced bulging at the fore-edge caused by inserted material.

The outer boards remain potentially salvageable. There is no photographic evidence of distant spread to neighbouring volumes, although the patient should be examined for active mould or insect activity before admission.

Investigations

Before treatment, I would recommend:

1. High-resolution photographic imaging of the entire volume.
2. Page-by-page mapping of all handwritten and mounted material.
3. Direct examination of the sewing, spine linings and adhesive structures.
4. Assessment of paper strength and adhesive stability.
5. Sampling only where strictly necessary.

Imaging suggests locally advanced binding disease, but definitive staging cannot be undertaken until the damaged spinal covering has been carefully explored.

Diagnosis

Locally advanced structural binding failure, characterised by:

• extensive spinal involvement;
• bilateral joint insufficiency;
• partial extracover extension of the text block;
• significant enlargement due to inserted material;
• possible involvement of the sewing supports;
• no obvious loss of essential content.

The condition is serious but appears organ-confined. There is currently no evidence that radical removal of the contents is indicated.

Multidisciplinary recommendation

The case should ideally be discussed by a multidisciplinary team comprising a specialist book conservator, an experienced hand bookbinder, an archivist and the owner.

The principal treatment options are:

1. Active surveillance

Continued careful storage and minimal handling. This avoids immediate intervention but carries a substantial risk of further spinal failure and eventual loss of individual leaves.

2. Conservative external repair

Local reinforcement of the most vulnerable areas without opening the existing binding. This may provide temporary symptomatic relief but is unlikely to address the underlying structural disease.

3. Robotic-assisted radical rebinding with reconstructive nerve-sparing

This offers the best prospect of restoring structural control while retaining the patient’s original boards, handwriting, images and distinctive personality.

Given the extent of deterioration, I would recommend the third option.

So, what would you do, dear reader?

We’ll be continuing to consult with our consultant about what happens next and will keep you posted!