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The examination is often made in a very perfunctory manner, and such inconclusive results are very unfair to the insurance company. In one case the doctor noticed a small ulcer at the side of a man's tongue, but was satisfied with the explanation that the tongue had been scratched with a sharp tooth. Three months later the individual died from cancer of the tongue, and the company had to pay the large sum assured for.
Let the examination be very complete. Are there any signs of intemperance ? Is he unduly stout or thin ? Does he look his stated age or beyond it ? What is his occupation ? Is it one which tends to alcoholic excess, e.g., publican, innkeeper, brewer, butcher ? Those who work in dusty trades have not very good lives, as masons, millers, or those exposed to trade poisoning, as compositors, painters, plumbers, etc.
Test the vision; feel the tongue; examine the throat; are the fingers clubbed or cyanosed ? The heart and lungs must receive very careful attention as well as the vascular system (arterio-sclerosis, aneurism, etc.). The digestive system must be thoroughly investigated and the abdomen palpated. The urine must be examined for albumin and sugar and the urea estimated. As nervous diseases are often latent, a careful examination of the various reflexes must be made in order to discover if any incipient signs are present of general paralysis of the insane, locomotor ataxia, etc.
One must carefully inquire into what are called hereditary diseases. Thus, insanity or nervous diseases in the parents may in the children exhibit themselves as hysteria, neurasthenia, epilepsy, etc. If the proposer has reached middle life, the tendency to these decreases greatly. The liability to tuberculosis also shows itself markedly in certain families, but here again, as age advances, the tendency lessens.
Gout, diabetes and cancer are also often present in succeeding generations of the same family.
Asthma and acute rheumatism also often develop in children, one of whose parents has suffered from either of these diseases.
Intemperance shows a hereditary tendency, as does also the tendency to suicide. The life of the
tippler" is far more risky than that of the man who indulges only in occasional bouts of drinking.
The presence of albumin in the urine usually implies rejection of the application, but care must be exercised to determine whether it is not functional or dietetic in origin.
Syphilis, if recent, is usually a bar to life insurance, and so also is hernia, unless a well-fitting truss be worn.
Otitis media also places the individual in a dangerous position, owing to the possibility of mastoid disease or thrombosis of the lateral sinus.
This is a form of work which is usually very unattractive to the ordinary practitioner. The reason for this is that he is accustomed to active mental work, and book-keeping is essentially a monotonous and uninteresting piece of work.
Systematic book-keeping is by many doctors greatly neglected, with the result that their book entries fall into arrears, and when the books have to be made up more time is lost in unravelling and posting them up than would have been the case if they had been attended to periodically and systematically. Incidentally, much money is lost to the practitioner by this loose and haphazard method of keeping his records, not to speak of his forgetting to note visits made, operations performed or medicines or appliances supplied.
The business books which a medical man requires to keep are few, and his form of single entries are simple when compared with the cross or double entry system employed by business firms.
The doctor requires only to keep a (1) visiting list, (2) cash book, and (3) ledger.
(1) The Visiting List is usually carried by him, and in it he records every visit made. This list may be ruled for each week, but preferably for one month, as this necessitates writing in the patients' names only once a month. Each evening this list is gone over, and a mark () is made against those patients' names whom we mean to visit next day or subsequently. When the visit is completed we change this into a cross (X). At the end of each week or month the total number of visits paid to each patient is posted to the ledger.
Frequently, however, practitioners keep a small pocket diary, and into it they enter every night the names of those patients to be seen next day and the order in which they are to be visited. Then they transfer the visits they have made that day into the visiting list, and in this way the latter is kept clean and free from errors. Any special or late visit, operation done, medicine or apparatus supplied, is also noted in the visiting list as well as any money received.
The doctor also enters into this list the names of all those who have consulted him that day, either at his own house or at his surgery, and so the day's book-keeping is ended. It is often very late at night before this can be done, but done it should be every night, and not left over until next morning. If so, perhaps urgent cases come in or the doctor is called away early, and thus the record of the former day's work gets confused in the mind. It may be that entries are made where visits were not paid, but more often it happens that he omits to enter visits, etc., which he has made.
(2) Cash Book.—Into this book every item of money received, with the name of the payer, or paid out, with the name of the payee, is made, and at the end of each week or month the former items
are posted in the ledger. It is absolutely necessary to enter every payment, for you cannot irritate or annoy a patient more than by rendering your account twice. This you are very liable to do if you do not at once note that payment has been made. This rendering of an account twice may be a source of much mental disturbance to your patient if by chance he has mislaid, lost or destroyed the receipt for the first.
The cash book consists of one page on the left side in which you enter all moneys received (Cr.) from whatever source, and on the opposite page all moneys paid away (Dr.) for whatever purpose. It shows your income and expenditure, and ought to be kept at hand so that no item may be omitted to be entered.
(3) Ledger.-The ledger is a large book with an index and numbered leaves. An account for each family is opened, and their name entered in the index with the corresponding page on which their account is.
At the end of each week preferably, or certainly not later than the end of each month, the number of visits paid to each family is entered under each separate account, with the amount to be charged in the money columns. Any extras are also noted (e.g., special or prolonged visits, appliances, etc.), and thus at a glance the completed account for each family is seen.
At the end of each half-year one has merely to sum up the total for the past six months, and the account is completed. As soon as the account is paid, the sum which was noted in the cash book is