- Email: [email protected]
Dispensary case sheets
December, Hl21]
DI SPEN SARY CASE SH E E TS
., I
.. ..
137
- -' T '
F ~,I
U
I
.-
-
--I
NEW T YPE OF WINDOW AS E R ECTED AT TH E MUN DE BLEY SAN ATORIU M.
LETTERS. DISPENS ARY CASE SHEETS.
To the E duor of " Tubercle," SIR -It would h ave enh a.nced the value of Dr . Heb ert's a rti cle on tbe abo ve su bject in you r last issue. if he had exte nded his statement in conn ection wit h th e "Contiuuatio n Record s " hy ad ding h is own scheme for recordin g t he progress a nd termi nati on of II. cas e. In th ese days when we ar e striv ing after uniformity in all t hi ngs it is as well tha.t we shou ld have .. uni form meth od of record ing not ouly t he condi tion of tho patient as he first a ppea rs before us, but also a uniform method of record ing the progress and termina-
ti on, t ogether wit h th o result s of treatme nt . We are all desirous of im proving our m ethods, an d I am sure the publication of Dr. Hebert's complete scheme would be h elpful to some of us. Personally. I think each cas e sheet sho uld bo so arra nged as to sho w periodically pr ogress repor ts , say, q uarterly for t ho first two yea rs and at longer in tervals thereafter, hut depen dent on the nature of t he case . Th ese repor ts, to be of pra cti cal use, sho uld be devoid of all de tail. As far as t he clini cal side of our work is concern ed, all t ha t is esse ntia.l for us to record is an a nswer to the q uer y , .. Is t he pa tient fit or unfit for work ?" If he is fit for work and contin ues fit, then at loast he is
l3g
[December, 1921
TUBERCLE
holding hiB own. II he is unfit when we firs~ see him. but becomes iH, then be Is going on well, and so on . Working capacity, s.part 1'1. toRether from tbe extent of the pulmonary lesion and other features of the case, should be the basis of theBe reports, and if I remember rightly, such a classification ws.s suggested by Wlngtleld in aD s.rticle published by bim in the B"itish Jou"nal 0/ Tub;)"culo~is, Romethree or four years ago. It is simple, easily curled out, and, on the Whole, more accurate thau the statement II much improved," "quiescent, W
&0. To the record of working ca.pacity I would only add tbe condition of the sputum as to tubercle bacilli and the albumin reaction. Without alluding ~o the diagnostic value of the laUer, I do not tbink tba.t sufficient lmporta.nce ill attached to the albumin reaction as an indication of the activity of the pulmonary lesion. Yet Riviere and others have shown that over OS pcr cent. of "all cases of active pulmonary tuberculosis contain albumin In the sputum , and tba.t a negative axsmination for albumin on three successive occasion. in cases where tubercle bacilli are also absent Is strong evidence against a.ctiv8 tuberculosis." Tbe final entry on the case sheet ~hould contain in addHion to the above, the disposal of the 'C&se a.nd a summa.ry of treatmo~t. especia.lIy of specific treatment, togethcr WIth results. Quarterly nepor~8 would be as follows:-
T.B
.
{Fit
...
Quartor end ing ...... Sputum { Albumin Working capacity
UDti~
Final Etlt"l!.
F it or unfit Discharged on .. ... ... Tubercle hacillil { or - , Died on Left district for on Ceased to attend (for reason stated) Duration of treatment Spccifie trcatment
+
.
. .. . . .. . .
Form A, witb s.1I its redundancy, ma.kes no provision for the discharge of the case, al. though it is true tba.t we have the va.rious progress reports to fall bsck upon. To my mind, however, the complete information should be upon one form, and not spread over eeveral loose forms which are liable to be lost. I am, Sir, Yours faithfully, M. :lbcDON.lLIJ, III.D.. D.P.lI. (httnwich Tubffculoais DisptnJa"lI. NI>Vembe1' 18, 1921.
To the Edit01' 0/" Tub."cle." SIR,-The experimenh of Corper, Simon, and Rensch. quoted in the Ia.st issue of your excellent publication Ip. 72), aro eslremoly Interesting, but I would point out that they kre not In any wa.y derogative to tbe tberapeutio value of the artitlcial pneumothorax trea.tment of phthisis, for it is the prevention of lympha.tic spread tha.t Is aimed at In this treatment, and the closure of cavities, &0., and the prevention of dissemination from and not to the collapsed lung. They do seem. however, to re.empbasise the importance of local foci of tuberculosis elsewhere, aa, for example, in the spleen or the other Iung or in certa.in gla.nds. For If there is So focus, say, in the spleen, tubercle ba.cilli will, by way of the lj mpbatlcs, Iymphatie duct. subclavian vein and r ight hea.rt reach the pulmona.ry artery and so will infect tb. lung even though it is collapsed. In fac~ I should Dot be surprised to find tbat even though one of tbo pulmona.ry arteries were tied, the lung on tbat side would become infected by Intra. venous injections of tubercle bacilli by way of the bronchial arteries. I am , Sir, Yours fa.ithfully,
F. IIa"ley Strut, lV. 1. Not'embff 8, 1921.
a.
CHANDLER.
BIBLIOGRAPHY. ORIOIN.lL ARTICLES PCBLISnB:D SEPTEI4BEn-N OVEI4BEB.
(See also l..st Number.) Amel'lean JOQrnal of Medical Sciellces.SEPTE)IBER. The Relativo Va.lue of Laboratory and Clinical Methods of Study in the Diagnosis of Tuberculosis. F. 1.l. POTTENOB:R-p. 35'2. Classification of Rilles: a Plea for Bimpllflca-
tion, J. B. OaTHBn-p. 372. American Journal of Surgery.-SB:pTli:loIBItB. The Treatment of .7oint Tuberculosis. L. W. ELY-p.261.
American Review of Tuberculoal•. SB:PTEMBER.
Tbs Effects of Limiting the Respiratory Ex· curslons of tbe Upper Thorax in Refractory
of Pulmonary Tuberculosis. H. and S. SWItZB:Y-p. 1547. The Spleen as an Approximate Index of Tuberculous Involvemens after Subcutaneous Infection. O. B. RENSCH and fir. 3[oOBll:- p. 655. The Ellects of Carbon Dioxide on the Tubercle Bacillus. II• .7. COB PER, II. OAOSS, and O. B. RENSCH-p. 562. An X.Ray Study of the Progresslve Changos in the Lungs and Aorta. in Tuberculosis and Syphilis. O. FLOYD, If. K. BOOTWJl:LL, and Cases
SB:WALL
R
L. LltON.lRD-p.
588.
Smallpox Vaccination and Tuberculosis. KLO'l:Z
and F. B.
ST.lFl"ORD-p.
W. C.
595.
Purulent Effusions Complioating Artificial Pneumotborax-L. S. PETERS-p. 599.
DI SPEN SARY CASE SH E E TS
., I
.. ..
137
- -' T '
F ~,I
U
I
.-
-
--I
NEW T YPE OF WINDOW AS E R ECTED AT TH E MUN DE BLEY SAN ATORIU M.
LETTERS. DISPENS ARY CASE SHEETS.
To the E duor of " Tubercle," SIR -It would h ave enh a.nced the value of Dr . Heb ert's a rti cle on tbe abo ve su bject in you r last issue. if he had exte nded his statement in conn ection wit h th e "Contiuuatio n Record s " hy ad ding h is own scheme for recordin g t he progress a nd termi nati on of II. cas e. In th ese days when we ar e striv ing after uniformity in all t hi ngs it is as well tha.t we shou ld have .. uni form meth od of record ing not ouly t he condi tion of tho patient as he first a ppea rs before us, but also a uniform method of record ing the progress and termina-
ti on, t ogether wit h th o result s of treatme nt . We are all desirous of im proving our m ethods, an d I am sure the publication of Dr. Hebert's complete scheme would be h elpful to some of us. Personally. I think each cas e sheet sho uld bo so arra nged as to sho w periodically pr ogress repor ts , say, q uarterly for t ho first two yea rs and at longer in tervals thereafter, hut depen dent on the nature of t he case . Th ese repor ts, to be of pra cti cal use, sho uld be devoid of all de tail. As far as t he clini cal side of our work is concern ed, all t ha t is esse ntia.l for us to record is an a nswer to the q uer y , .. Is t he pa tient fit or unfit for work ?" If he is fit for work and contin ues fit, then at loast he is
l3g
[December, 1921
TUBERCLE
holding hiB own. II he is unfit when we firs~ see him. but becomes iH, then be Is going on well, and so on . Working capacity, s.part 1'1. toRether from tbe extent of the pulmonary lesion and other features of the case, should be the basis of theBe reports, and if I remember rightly, such a classification ws.s suggested by Wlngtleld in aD s.rticle published by bim in the B"itish Jou"nal 0/ Tub;)"culo~is, Romethree or four years ago. It is simple, easily curled out, and, on the Whole, more accurate thau the statement II much improved," "quiescent, W
&0. To the record of working ca.pacity I would only add tbe condition of the sputum as to tubercle bacilli and the albumin reaction. Without alluding ~o the diagnostic value of the laUer, I do not tbink tba.t sufficient lmporta.nce ill attached to the albumin reaction as an indication of the activity of the pulmonary lesion. Yet Riviere and others have shown that over OS pcr cent. of "all cases of active pulmonary tuberculosis contain albumin In the sputum , and tba.t a negative axsmination for albumin on three successive occasion. in cases where tubercle bacilli are also absent Is strong evidence against a.ctiv8 tuberculosis." Tbe final entry on the case sheet ~hould contain in addHion to the above, the disposal of the 'C&se a.nd a summa.ry of treatmo~t. especia.lIy of specific treatment, togethcr WIth results. Quarterly nepor~8 would be as follows:-
T.B
.
{Fit
...
Quartor end ing ...... Sputum { Albumin Working capacity
UDti~
Final Etlt"l!.
F it or unfit Discharged on .. ... ... Tubercle hacillil { or - , Died on Left district for on Ceased to attend (for reason stated) Duration of treatment Spccifie trcatment
+
.
. .. . . .. . .
Form A, witb s.1I its redundancy, ma.kes no provision for the discharge of the case, al. though it is true tba.t we have the va.rious progress reports to fall bsck upon. To my mind, however, the complete information should be upon one form, and not spread over eeveral loose forms which are liable to be lost. I am, Sir, Yours faithfully, M. :lbcDON.lLIJ, III.D.. D.P.lI. (httnwich Tubffculoais DisptnJa"lI. NI>Vembe1' 18, 1921.
To the Edit01' 0/" Tub."cle." SIR,-The experimenh of Corper, Simon, and Rensch. quoted in the Ia.st issue of your excellent publication Ip. 72), aro eslremoly Interesting, but I would point out that they kre not In any wa.y derogative to tbe tberapeutio value of the artitlcial pneumothorax trea.tment of phthisis, for it is the prevention of lympha.tic spread tha.t Is aimed at In this treatment, and the closure of cavities, &0., and the prevention of dissemination from and not to the collapsed lung. They do seem. however, to re.empbasise the importance of local foci of tuberculosis elsewhere, aa, for example, in the spleen or the other Iung or in certa.in gla.nds. For If there is So focus, say, in the spleen, tubercle ba.cilli will, by way of the lj mpbatlcs, Iymphatie duct. subclavian vein and r ight hea.rt reach the pulmona.ry artery and so will infect tb. lung even though it is collapsed. In fac~ I should Dot be surprised to find tbat even though one of tbo pulmona.ry arteries were tied, the lung on tbat side would become infected by Intra. venous injections of tubercle bacilli by way of the bronchial arteries. I am , Sir, Yours fa.ithfully,
F. IIa"ley Strut, lV. 1. Not'embff 8, 1921.
a.
CHANDLER.
BIBLIOGRAPHY. ORIOIN.lL ARTICLES PCBLISnB:D SEPTEI4BEn-N OVEI4BEB.
(See also l..st Number.) Amel'lean JOQrnal of Medical Sciellces.SEPTE)IBER. The Relativo Va.lue of Laboratory and Clinical Methods of Study in the Diagnosis of Tuberculosis. F. 1.l. POTTENOB:R-p. 35'2. Classification of Rilles: a Plea for Bimpllflca-
tion, J. B. OaTHBn-p. 372. American Journal of Surgery.-SB:pTli:loIBItB. The Treatment of .7oint Tuberculosis. L. W. ELY-p.261.
American Review of Tuberculoal•. SB:PTEMBER.
Tbs Effects of Limiting the Respiratory Ex· curslons of tbe Upper Thorax in Refractory
of Pulmonary Tuberculosis. H. and S. SWItZB:Y-p. 1547. The Spleen as an Approximate Index of Tuberculous Involvemens after Subcutaneous Infection. O. B. RENSCH and fir. 3[oOBll:- p. 655. The Ellects of Carbon Dioxide on the Tubercle Bacillus. II• .7. COB PER, II. OAOSS, and O. B. RENSCH-p. 562. An X.Ray Study of the Progresslve Changos in the Lungs and Aorta. in Tuberculosis and Syphilis. O. FLOYD, If. K. BOOTWJl:LL, and Cases
SB:WALL
R
L. LltON.lRD-p.
588.
Smallpox Vaccination and Tuberculosis. KLO'l:Z
and F. B.
ST.lFl"ORD-p.
W. C.
595.
Purulent Effusions Complioating Artificial Pneumotborax-L. S. PETERS-p. 599.