Horace R. Givens
UNIVERSITY OF MAINE AT ORONO

A TOTAL INFORMATION SYSTEM FOR PHYSICIANS: c. 1897

Abstract: This note describes an account book designed for the use of physicians, from the late 19th century. In addition to financial records, the book provides space for recording details of the medical problem, prescribed treatment, patient condition, and other matters of concern to the doctor. Records were to be kept for each patient, with supplemental entries by type of case. The book represents an early attempt to provide a total information system for the user; a system in which all necessary information would be available without reference to other material.

Accountants are today being asked to provide information on a variety of business matters, of a non-financial nature. This growing tendency has led accountants away from the traditional approach to their work, which centered upon pure financial reporting, and has produced the concept of the total information system designed to furnish a broad spectrum of data. Extensive systems are now common, involving data banks, computer models and so forth, which are intended to give management different types of informa¬tion for decision-making purposes. It is interesting to observe, therefore, an attempt to accomplish something similar, in a small way, many years before the advent of the computer with all of its attendant paraphernalia.

in 1897, O. E. Williams of Marietta, Ohio published The Physi¬cian’s Memorandum and Account Book, Combined and Complete. (Williams had earlier published a similar volume entitled The Den¬tist’s Memorandum and Account book, Combined and Complete as well as supplemental Pocket Editions. None of these items has been located.)

In the Preface to the Physician’s volume, Williams notes that the medical practitioner must hold himself in readiness: “.. . at all hours to go at the call of a fellow-being who may need his services.”1 Because of these demands on his time and the uncertainty of his schedule, Williams says: “. . . he has little time to make such memoranda of each case as is really necessary for the patient’s welfare, as well as to prevent mistakes on his own part, and which would, without doubt, prove to be of real value for reference in future months and years.”

Williams points out further that every physician has various rec¬ords in his office. However, “. . . for the reason named, his records are not kept with the accuracy he would like; and again, when nec¬essary to trace a case or account through these different books, the time required is an important consideration.”

The author offered his book to the attention of the medical pro-fession, stating: “No other books are necessary, for between its covers is space for memoranda contained in the ‘Visiting List,’ ‘Case Book,’ ‘Day Book,’ and ‘Ledger,’ besides much other of a valuable nature.”

The book itself is quite large, after the fashion of most 19th cen¬tury account books. It measures 15% inches high by 21 inches wide per double page. It is 2/4 inches thick, bound in heavy boards with a ribbed back of leather. The title is embossed in gold on the cover. There are 300 pages available for entries, with both lefthand and righthand pages bearing the same number. Each page is headed with the title of the volume and page rulings are in blue and red.

The bulk of the volume, some 276 pages, is divided into sections for each letter of the alphabet. Each of the double pages carries the following column headings:

Name and Address
Age
Name of Disease
Record of Visits – Patient’s Home – Condition
Record of Visits – Patient to Office – Condition
Record of Surgical Operations – Nature
Record of Obstetric Cases – Nature
Record of Prescriptions – Filled at Drug Store – Ingredients
Record of Prescriptions – Given by Self – Ingredients
Record of Accounts – Debit
Record of Accounts – Credit
Record of Accounts – Balance

Within each alphabetical division, several of the folios are divided, along the lefthand edge into five separate patient accounts, each with the following headings:

Consultation Record
Obstetric Record Mortality Record Vaccination Record Case Record

Other pages, within each letter category, are divided into three sections for “Short Family Accounts,” and some pages are left un-divided for “Long Family Accounts.”
Following the patient and family records are a number of pages for recording consultations. These provide space for such data as the patient’s name, dates of consultations, details of operations, diagnoses, name of primary physician, other consulting physicians, and, of course, the financial records described earlier.

Next come obstetrical records which provide for the entry of the names of the parents, birth weight of the child, sex, color, dates of confinement and remarks. Following these are mortality records which include name, cause of death, date, marital status and de¬pendents. Interestingly enough, neither the obstetrical records nor the mortality records provides space for entering financial data. (This is easier to understand in the case of mortality, perhaps, than in the case of a birth.

The volume ends with sections devoted to recording vaccinations and other immunizations, and with several pages for entering de¬tailed descriptions of special cases.
Essentially, The Physician’s Memorandum and Account Book is a client ledger, providing for the direct entry of financial informa¬tion along with considerable detail relating to the specific services provided and the status of the case. The information is segregated appropriately according to the activities of the user, and is further segregated by individual or family as the situation dictates.

Whether or not Williams was successful in his publishing venture is not known, although he had previously published a similar vol¬ume for dentists. He points out in the Preface that the high price of the book5 (unfortunately not specified) is justified by its material quality, usefulness and longevity. Williams estimates that the book will serve a physician for three to five years of recordkeeping, prob¬ably correctly. The volume appears to provide space for most, if not all, of the records needed by a physician, especially a tradi¬tional country doctor. This total information system would allow him to evaluate and review any past cases, and, not the least, pro¬vide him with an up-to-date summary of the financial position of each patient.

The particular volume examined for this paper had not been used. It would have been interesting to see how the country doctor would have recorded various activities.

FOOTNOTES

1Williams, Preface. 2Williams, Preface. 3Williams, Preface. 4Williams, Preface.
5Market prices have apparently fallen. The particular copy examined was pur-chased for 50$.

BIBLIOGRAPHY

Williams, O. E. The Physician’s Memorandum and Account Book, Combined and Complete, Marietta, Ohio: O. E. Williams