This is more drawn out than I make the entries, as I abbreviate almost all words used. This takes up but little time and space and helps to report a case or series of cases accurately, also enables you to give Willie or Grandma the same R of last spring, by the bottle being returned with label and R number intact; also it is a good witness in damage suits, or a suit of any kind.

As to ledger, I use double entry, 434 x 6% x 5% inches, flexible leather, with 200 pages and index, and keep it posted to date as near as possible, and carry in pocket; thus am able to tell patron amount of indebtedness any time and place, and thereby collect many accounts that would be neglected should I have to use the common phrase, "I don't know, call at office," which induces neglect.

I also keep a cash and expense account in small double entry book, but have never kept a comparativ statement; also issue bills at regular intervals, and at termination of cases; and where there is no response, I see the debtor personally.

Am an advocate of "deadbeat lists," compiled often and freely exchanged, and am liberal to deserving charities, but draw the liné close. B. FRANK WINDLE, M.D.

Barnes, 1897.

Valley Park, Mo. [The above seems rather crude, but it shows what can be done with an ordinary blank book which can be gotten at any stationer's. -ED.]

Case Records.

Editor MEDICAL WORLD:-In the April number of your journal, one of your subscribers wanted a case record blank. I have devised a system I use in my practise and inclose you I do not have these samples of my cards. blanks for sale, but have them printed here in the city and use a Macey card box on my desk for daily reference.

At the end of the year I file all closed cases in a Macey filing case, and mark the year on the end of the box.

In my desk box I have two sets of alphabet guide cards and two guide cards, one markt An open cases and one markt closed cases. open case is one which I still have under observation. When the case is dismist I note the date and the results or condition of the case when it passed from my care, and transfer it to the closed case side. In making my record of acute cases I have a leather pocket to hold the record blanks and carry it in my coat pocket. The record is made at the bedside with a fountain pen, as it is then permanent.

One who has not tried it does not realize what an advantage such a record is to a physician. It impresses the patient and his friends that you are a very particular person, and it gives them greater confidence. If at any time a dispute should arise as to your conduct of the case, you have your record to refer to, which is a great deal better in law than a memory record. To me it is a pleasure to know I have a record of my cases. I think it just as important to keep a record of cases seen in the home as cases seen in the hospital.

Since I have formed the habit of keeping a record of all of my cases, I know I am a better physician. I am more observant, more careful in my diagnosis, and more careful in my prescribing. I have the case for study at my leisure and, let me say, a library of your own cases, your own successes and failures, is of more real value than the theories of others.

At my first call to an acute case I take down the history of the case prior to my being called. This I write in on the face of the card before making any record of the present condition.

The chronic case, urinalysis, and obstetric record blanks are self explanatory. If more than one card is used in a case I use an envelope to hold all the cards of that case.

CLIFFORD E. HENRY, M.D. Minneapolis, Minn. Jefferson Medical College, 1896. [See accompanying card forms. The card system is now used for many purposes: in libraries for cataloging books, as a system of book-keeping for keeping accounts, etc. This

is our first knowledge of this system being used for case records by physicians, but it is a good suggestion.-ED.]

Editor MEDICAL WORLD:-Was called to a confinement April 13; labor was very slow but normal. Six days later was called to the house again and was told that the baby was passing blood. I askt some questions, then made an examination and found that the baby was passing blood from the vagina. Normal child except for that, with no history to account for the flow of blood. I left some fluid ext. of ergot in child's doses, and have not been called since, but was told that flow lasted three to five days. C. H. HAZEN.

East Corinth, Vt.

Dr. D. W. Hunt, of Glendale, Cal., writes very earnestly concerning proprietaries, his chief objection being that they are usually prescribed in original packages, and then the literature that usually goes with the bottle or package, goes directly into the patient's hands. The next time, the patient goes directly to the druggist for the medicin, leaving the doctor out entirely. Furthermore, the patient shows the literature and recommends the preparation to others, who go directly to the druggist for it, omitting the doctor entirely. He pertinently asks, why should doctors work for pro

prietary medicin manufacturers, and against their own interests in this way?

A further objection is, that patients not being able to determin their needs, frequently injure themselves, and lose valuable time before finally visiting the doctor. Also, the evil could be prevented by directing that an original package be not supplied, or if so, all wrappings and labels be removed, and the doctor's directions be pasted on.

Youth and Age Should Work Together.

DEAR EDITOR:-Our grand profession has made rapid strides during the last decade. This is shown by the requests in THE MEDICAL WORLD during the last few months for the description of the technique of methods diagnostic and therapeutic familiar to the recent graduate but a terra incognita to many men who graduated years ago.

On page 165 of the April WORLD is the request for method of application of normal saline infusion.

On page 160 of the same number are questions regarding the use of antistreptococcic serum, and in a previous number the technique for the Widal reaction in typhoid was askt.

Requests for other new methods, such as the

diazo urin reaction in typhoid, and the quick analysis of stomach contents, will likely follow.

These questions are signs of the times. They indicate that the younger men have what the older men have not, viz., new methods. But the old men have what we have not: Experience. So let's trade.

Speaking of students with whom I am familiar, I know that junior students in Canada are as familiar with these methods as with percussion, auscultation, etc.

Knowledge is like mercy:

"It is twice blessed; it blesseth him that gives and him that takes."

Friends of the well worn path, take a junior student in with you each summer. Hundreds of them will be glad of the chance. Talk over the new things, tell tales of the past. Neither will be the poorer, both will be the richer, and humanity will be the gainer. You will thus have a little post graduate course at home. He learns his subject best who has a pupil in it. E. BDAICO.

Canada.

P.S. The writer has no axe to grind.

Talk with the Beginners.-Economic Conditions in the South.

Editor MEDICAL WORLD:-The young doctor is apt to have quite a lot of spare time on his hands when he first begins "practise"; in fact, his first task is the practise of patience rather than practise on patients. And it is good for him to improve this leisure period in making himself ready for the first cases he is likely to have.

What are these? They will come under the head of the suddenly arising emergencies, where there is no time to send for the regular practician and the nearest one is called. Usually he must surrender the case to the family advisor as soon as he puts in his appearance; but there is a chance for the younger man if he knows just what to do, and shows it. This thought comes to me from reading your editorial note on poisoning; and the symptoms and treatment of all forms of poisoning, the study of those most liable to occur, such as carbolic acid, concentrated lye and rough on rats, form most valuable subjects for these leisure weeks or months. Extend this to the poisonous plants to be found in the vicinity, and hence apt to cause trouble; such as rhus, stramonium and belladonna. The treatment of snake bites comes as a sort of corollary.

There are other emergencies to follow; the various surgical ones, the hemorrhages, convulsions, fainting, choking, sunstroke, drowning, colics and cramps, hiccup, etc. Indeed, however proficient our young doctor may be, he will find the study of emergencies and the

maladies that lead to sudden calls, most important and interesting reading.

Then there is another group of cases in which our beginner may find himself consulted. The cases that appear too trifling for the attention of the family doctor. Friends ask him why they have headaches, tetter, pruritus, bad breath, the blues, insomnia, bad temper, anorexia, flatulence, vertigo, pimples, or hives. Never make light of any complaint a person may make. A lady askt her doctor what she should do when her nose itcht. He replied: "Blow it." Much fun ensued at her expense-and he lost a $600-a-year patient. Inquire into the case; get at the root of it; and you may find a condition demanding attention or not, but you will surely find a patient who is appreciativ of the interest you have displayed. It is bread cast upon the

waters.

Beale wrote a very suggestiv little book once, entitled "Slight Ailments." If you have Haig on Uric Acid, it will unlock many a door. Still better is it if you have learned to recognize autotoxemia from intestinal putridity as a cause of very many slight or indeterminate ailments. If you have learned to look out for failures in elimination you are prepared for most of these "slight" ailments, and for most of the big ones as well. This will necessitate chemical examinations of the urin sometimes; but never neglect to take this trouble if there is the slightest reason for it. But-here is an important point-do not be in too big a hurry to charge for such cases. Your friends have askt you casually about some little discomfort, and you have gone to some pains to find out that it is really but a trifle; now do not make the mistake of charging heavily. That will give you the name of being on the watch for a chance to "do" them; and that is a disaster. Even tho you have done the work, recollect that they have not seriously consulted you, and charge nothing. This will confirm in them the opinion as to your personal interest in them, and they will come to you again. you again. Next time you will probably find a real ailment, and then tell them so, and that of course you will have to make a charge. They will at once see that you charge when there is a real illness to treat and not otherwise; and people are always willing to pay under these circumstances. In fact, I have found them far more willing to pay ten dollars for a thoro investigation than one dollar for an offhand prescription.

With your first case begin to form the habit of thoro investigation. How often we oldsters wish we were beginning again, so that we could take the time to do our work up in a workmanlike manner. After while, when the calls