FIG. 228.-DAY-BOOK AND LEDGER. SIZE 4x 7.

The other side is similar, except that the columns are marked from July to December.

THE KEEPING OF RECORDS OF CASES

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for the account of each patient, is intended for the use of physicians among their patients where no trained nurse is employed, and where he himself is taking the temperature, pulse, and respiration and is doing all the nursing outside of the ordinary care of the patient. The so called card system is employed, and there is provided a card for the recording of the history of the case, both as to the condition of health and as to the diseases in the past and the symptoms of the present illness. The card is ruled on both sides, so that the history may be carried over on to the back (Fig. 226).

Another card, "the bedside notes," is provided, which is so ruled as to make it possible to jot down upon each visit the date, hour, temperature, pulse, and respiration, the medication ordered, the condition of the patient, and any other notes that may be of value (Fig. 227). This card may be carried in the pocket or in the physician's bag and referred to when the visit is made, or it may be left in the patient's room and taken away at the last visit. These two cards are all that are necessary to keep a full record of each case, and if the notes are written down at the bedside, they are thereby rendered authentic and make a valuable history of the case. A tin box of a proper size to fit the cards is necessary for the filing of the completed records and for their easy reference. This box should contain a set of alphabetical index guide cards, and each history with its set of bedside. notes should be placed behind the guide card bearing the initial letter of the patient's name. Subsequent histories and notes of patients with the same initial letter are placed behind this. This makes a complete, compact arrangement, and if the tin box is japanned or is made of quartered oak, it makes a very acceptable bit of office furniture.

To this system may easily be added the keeping of the account of each patient, thereby doing away entirely with the bulky day book and ledger at present used. A card is provided similar to the one shown in Fig. 228. Both sides of the card are used, the one side for the accounts of the first six months, and the other for the last six months of the year. It is so ruled that the fee for each visit may be written down. At the end of each month the amount is summed up at the bottom. On the right half of the card are ruled spaces for the credit side of the account. The first space is for the noting of the date upon which the bill is sent out, the amount of the bill up to that date being placed in the second column. When the bill is paid, the date is placed in the first column and the amount paid in the third column. If any balance remains due, this is placed in the last column on the same line with the amount paid. When the next bill is sent out, this balance is added to any new account and placed in the second, or "Due," column. If the account is entirely paid up, no figure will appear in the balance column. The card will contain the account of each patient for one year, and is placed in the box directly in front of the history card.

This system makes the keeping of accounts concise and complete, for it not only places every item in plain view on one page, but it does away with all books. The small book now used for the recording of each visit or prescription, which record is later copied into a day book, is made unnecessary by this system, for the bedside note card is the index for each visit made, the day and hour being written there. The fee for the visit is placed in the column corresponding to the day and month, and at the end of the month

these are summed up. When payments are made, they are placed on the credit side of the card. This card, therefore, becomes a combined day book and ledger, and one card serves the purpose of three books.

Therefore, the history of the disease, the record of its symptoms, course, and treatment, and the patient's account are brought compactly under one head, and, if arranged alphabetically in a tin or oak box, make a perfect system, accurate and easily available for examination.