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Accessible Hospital Records.
812 synonymous with being a dyer, the professional dyer knew was about, while the histologist with few exceptions did not know, nor does he to the present day." His hope that this could be corrected may have been as exaggerated as his faith in the basis of technological practice, but his beliefs all centred round his impregnable ideal that structure and function must explain each other. The earlier histologists knew this quite well ; to BOWMAN the structure and function of the kidney As the microscope became a were one problem. commonplace and its technique developed, physiologists found, however, that the instrument which they looked to for the solution of their difficulties was raising as many problems as it was answering. Those who believe that the lung is a secretory organ say as little about the structure of the epithelium as they can help, and inflammation and immunity are long since divorced. In despair, we must suppose, of ever making form and function fit, physiology is now in general ready to throw histology overboard, that it may brighten the routine of anatomy. For the moment histology is at a discount among us, but it is not the histology that MANN taught. Some day a bright spirit will reappear, and will carry on MANN’S work, when probably " Physiologcial Histoinspired " logy will go through many editions or form the inspiration for future treatises. The book is, of course, now out of date in many parts ; the physical chemistry of proteids has advanced a long way since 1902. But it still indicates the line along which histology could be pursued with profit; fixers and stainers have not yet absorbed its chief thesis, which is that they ought to know more of the why and wherefore of what they do. became
practically
with this what he
difference, that
Accessible
Records. which a large general
Hospital
ONE of the difficulties with has to deal is the accumulation of patients’ notes. After a few years the mass of material becomes enormous and, as the Hospital Gazette has pointed out, the setting aside of storage room for the purpose is no easy matter. The suggestion is there made that many of the actual notes might be destroyed and concise records of each patient kept in a book under separate headings. Although the drawbacks of present methods are very great from the medical aspect, it is doubtful whether the system advocated would meet all requirements. In most large hospitals there is a registration department in which all the in-patient notes are collected. After a period of a year or so they are bound together to form unwieldy volumes, and in a big institution the number of such books rapidly increases until it becomes almost impossible to find space for them where they can remain easily accessible. The notes are often required for reference when a patient is readmitted or when a member of the staff wishes to investigate a series of cases. It is especially in looking up a large number of cases of a given disease that the present system is found so inadequate, for the notes are bound according to dates, irrespective of the nature of the disease. The notes of every individual case are kept, and space may be taken up by a number of nearly blank sheets and charts of a patient detained for a single night with some trivial ailment. Hence a search may involve the withdrawal from storage of a large number of bulky volumes, each containing one of the required cases. The books are heavy to carry about when the past
hospital
history of a case has to be reinvestigated in the wards. There is also the grave disability that in-patient are separated from notes, and in the out-patient department there is at best a brief abstract of the in-patient
out-patient
findings. These difficulties are overcome to a large extent by the method used in some departments of the London Hospital. On admission the patient has his notes taken by the surgeon or an assistant acting immediately under his supervision. The headings on the first page include only the name, age, and address of the patient, the name of the doctor, the date of admission, and the complete diagnosis on leaving hospital. The notes are kept in boxes in the wards and are not attached to a bed-board where they are apt to become soiled and torn. On leaving hospital the patient is given a dated card for attendance at the " follow-up " department, where his notes are cardindexed under the diagnosis and kept in alphabetical order in a box file. When a patient returns, the secretary of the follow-up department produces the notes for the surgeon to make additions ; there is no break between in-patient and out-patient record. Trivial cases admitted to hospital do not come under the system ; a record of them is kept in a book in the steward’s office, with headings similar to those advocated in the Hospital Gazette. By this means a mass of useless material is abolished, and it is found that a small cupboard in the follow-up department will accommodate the whole of the notes for one surgeon for 15 or 20 years. Such a method of note-keeping combined with
deserves more general the surgeon, enabling him to determine with accuracy the after-results of his treatment. It is of value to the patient who is seen at regular intervals, when any complication is noted early and adequately treated. It is of value in the organisation of the hospital ; wards and out-patient department are not crowded out with old cases. The scheme may appear at first sight to throw extra work upon the staff, as an extra half-day a week has to be given to the examination of these cases. In practice, so great is the relief from interruption by old cases during an afternoon devoted to teaching that time may actually be saved. One half-day a week alone being required by each physician or surgeon, a follow-up secretary is able to control 11 departments. It has been suggested that. since each member of the staff has control of the notes of his own cases. difficulties may arise if an independent investigator wishes to look up a series. The reverse is the fact ; instead of having to consult 50 or more large volumes he sees as many bound notes, which can be consulted with corresponding leisure.
follow-up department adoption. It is of value to a
UNIVERSITY
OF
LEEDS :
A CHAIR
OF
BACTERIO-
LOGY.-Sir
Edward Allen Brotherton, ILP., has given 20,000 to this university for the development of bacteriological study and research, more particularly in the interests This is the largest individual gift ever of public health. received by the University of Leeds. Sir Edward Brotherton, an ex-Lord Mayor of Leeds, who takes an active interest in many branches of public life, has been profoundly impressed by the importance of the study of bacteriology. He is chairman of the University Advisory Committee on the Department of Pathology and Bacteriology. This body includes representatives of the weekly board of the General Infirmary, of the Leeds City Council, and of the County Councils of the North, East, and West Ridings. The Department of the University of Leeds with which this committee is concerned is engaged in research as well as with the instruction of students, and also performs the
bacteriological tests required by the public health department of the city, by the General Infirmary at Leeds, and by other bodies outside the city.
’
practically
with this what he
difference, that
Accessible
Records. which a large general
Hospital
ONE of the difficulties with has to deal is the accumulation of patients’ notes. After a few years the mass of material becomes enormous and, as the Hospital Gazette has pointed out, the setting aside of storage room for the purpose is no easy matter. The suggestion is there made that many of the actual notes might be destroyed and concise records of each patient kept in a book under separate headings. Although the drawbacks of present methods are very great from the medical aspect, it is doubtful whether the system advocated would meet all requirements. In most large hospitals there is a registration department in which all the in-patient notes are collected. After a period of a year or so they are bound together to form unwieldy volumes, and in a big institution the number of such books rapidly increases until it becomes almost impossible to find space for them where they can remain easily accessible. The notes are often required for reference when a patient is readmitted or when a member of the staff wishes to investigate a series of cases. It is especially in looking up a large number of cases of a given disease that the present system is found so inadequate, for the notes are bound according to dates, irrespective of the nature of the disease. The notes of every individual case are kept, and space may be taken up by a number of nearly blank sheets and charts of a patient detained for a single night with some trivial ailment. Hence a search may involve the withdrawal from storage of a large number of bulky volumes, each containing one of the required cases. The books are heavy to carry about when the past
hospital
history of a case has to be reinvestigated in the wards. There is also the grave disability that in-patient are separated from notes, and in the out-patient department there is at best a brief abstract of the in-patient
out-patient
findings. These difficulties are overcome to a large extent by the method used in some departments of the London Hospital. On admission the patient has his notes taken by the surgeon or an assistant acting immediately under his supervision. The headings on the first page include only the name, age, and address of the patient, the name of the doctor, the date of admission, and the complete diagnosis on leaving hospital. The notes are kept in boxes in the wards and are not attached to a bed-board where they are apt to become soiled and torn. On leaving hospital the patient is given a dated card for attendance at the " follow-up " department, where his notes are cardindexed under the diagnosis and kept in alphabetical order in a box file. When a patient returns, the secretary of the follow-up department produces the notes for the surgeon to make additions ; there is no break between in-patient and out-patient record. Trivial cases admitted to hospital do not come under the system ; a record of them is kept in a book in the steward’s office, with headings similar to those advocated in the Hospital Gazette. By this means a mass of useless material is abolished, and it is found that a small cupboard in the follow-up department will accommodate the whole of the notes for one surgeon for 15 or 20 years. Such a method of note-keeping combined with
deserves more general the surgeon, enabling him to determine with accuracy the after-results of his treatment. It is of value to the patient who is seen at regular intervals, when any complication is noted early and adequately treated. It is of value in the organisation of the hospital ; wards and out-patient department are not crowded out with old cases. The scheme may appear at first sight to throw extra work upon the staff, as an extra half-day a week has to be given to the examination of these cases. In practice, so great is the relief from interruption by old cases during an afternoon devoted to teaching that time may actually be saved. One half-day a week alone being required by each physician or surgeon, a follow-up secretary is able to control 11 departments. It has been suggested that. since each member of the staff has control of the notes of his own cases. difficulties may arise if an independent investigator wishes to look up a series. The reverse is the fact ; instead of having to consult 50 or more large volumes he sees as many bound notes, which can be consulted with corresponding leisure.
follow-up department adoption. It is of value to a
UNIVERSITY
OF
LEEDS :
A CHAIR
OF
BACTERIO-
LOGY.-Sir
Edward Allen Brotherton, ILP., has given 20,000 to this university for the development of bacteriological study and research, more particularly in the interests This is the largest individual gift ever of public health. received by the University of Leeds. Sir Edward Brotherton, an ex-Lord Mayor of Leeds, who takes an active interest in many branches of public life, has been profoundly impressed by the importance of the study of bacteriology. He is chairman of the University Advisory Committee on the Department of Pathology and Bacteriology. This body includes representatives of the weekly board of the General Infirmary, of the Leeds City Council, and of the County Councils of the North, East, and West Ridings. The Department of the University of Leeds with which this committee is concerned is engaged in research as well as with the instruction of students, and also performs the
bacteriological tests required by the public health department of the city, by the General Infirmary at Leeds, and by other bodies outside the city.
’