Full text of Office Administration for Organizations Supervising the Health of Mothers, Infants, and Children of Preschool Age, with Special Reference to Public Health Nursing Agencies, Bureau Publication No. 101

View original document

The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.

U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary

CHILDREN’S BUREAU
GRACE ABBOTT, Chief

OFFICE ADMINISTRATION FOR
ORGANIZATIONS SUPERVISING THE HEALTH OF
MOTHERS, INFANTS, AND CHILDREN OF
PRESCHOOL AGE ^

WITH
SPECIAL REFERENCE TO
PUBLIC HEALTH NURSING
AGENCIES
By

ESTELLE B. HUNTER
9
Bureau Publication No. 101

WASHINGTON
GOVERNMENT PRINTING OFFICE
1922

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

isii ■

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CONTENTS.
Pa»e.

Letter of transmittal........................ ............................................................... ¿C. . . .
Introduction.................... ........... . .............................................................................
The need for scientific office administration in public health nursing or
ganizations................................... .........................1.........................................
Studies of office administration conducted by the U. S. Children’s
Bureau...........................
Field of pamphlet............................................ ........................................ ......... .
The ‘‘office ’ ’ defined...................................................................................
Office management....... ...............................................................................
Purpose of pamphlet..... .................................................. -.................................
Organization, functions, and duties..............................................................
Importance of sound organization....................................... ............. ..............
Functions and duties...................................................................
Donors............................... ................................ ............................................
Board of managers..............
Committees— .........................
Appointment of committees..................................................> .. ___
Committee on nursing....................... ...................; ........... . ......... .
Committee on office administration..................................................
Chief executive.......... .............................
Supervisor of nurses.....................................................................................
District supervising nurses.........-......................................................
"
Senior nurses.................................................................................... ............
C
Office manager............................................ ................................. '..............
General clerical staff......................................................................
Volunteers...................................................................... . . . . . . ..................
The selection and training of employees...............................................................
Expense of labor turnover.................................
Selecting employees....... ..............................
Impression blanks...............
Selecting the chief executive............................................................
Selecting office employees...................
Selecting nurses..........................................................................
Tests................................
Training employees.........................
Training office employees......................................................................
Group conferences................................................................................
Training staff nurses................................................................
Training districts......... ............................................. : ......... ............
Efficiency records....................................
Statistical training...................
General staff conferences as educational aids............................... .. ..
The library as an educational aid..................

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

vn
1-6
1
l
$-5
3
4
5
6-22
6
8-22
8
9
9-11
9
10
10
11
14
14
15
15
17
17
22-33
22
22-27
24
24
26
27
27
27-33
28-29
29
29-30
29
29
30
30
32

CONTENTS.
Page.

Office location and layout.......................... .............
Location of b u i l d i n g . ............ -...............
Construction of building.................................
Tenants..................... - - ...............- .....................
Nuisances............................................................
Building service............................................
Building storage facilities........................
Location within building...............................
Light................ - ..........................................
Ventilation..................................................
N eighbors....................................................
Rental..... ...... ........... - ....................
Laying out the office.............................
Office storage space.......... ..........
Office furniture, equipment, and supplies.------Selection of furniture and equipment.... - —
“ Cheap” furniture.....................- .............
Standard equipment................-................
Desks......................... ..................- .............
Tables...........................................................
Files......................... - ..................................
C hairs..............-.......................................
Telephone service.. ;.......... - .............
Typewriters....................................... *----Copyholders..........................— ...............
Labor-saving devices.................................
Arrangement of furniture and equipment—
Equipment versus supplies..............................
Equipment inventory system.........................
Equipment inventory...............................
Classification process.............................- Record.................................. - ......... ...........
Supplies................................................... .
Purchasing supplies....................... : .........
Perpetual inventory...........................
Requisition slips.................................
Proper storage facilities....... . - —
Systematic replenishing of supplies
Planning case record systems..................................
The purpose and importance of case records.
Case record systems...........................................
Call books versus call slips....... ..............
Call book.......................................... ..
Call slips................- ......... ...................
Field record...........................................
Address book...................................
Daily report sheets.............................
Street book forms...............................
Time book, or day book.................. ........
Permanent case records...........................
Case record planning....................
Preparing instructions...............

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

3333
33
33
33
34
34
3434
35
35
35
3637
37- 52
37-44
37
39
39
40
40
41
41
42
43
43’
45
45
4646
46
46
4747-52
48
48
50
51
52-70
52
5556- 57
56
57
5757
5J8
58
59
60-68
62-68
68

CONTENTS.

Planning case record systems—Continued.
Case record systems—Continued.
PagePoints requiring special emphasis in record keeping..... .....................
68-70
Dates...... ...................... . ............................. . ......................................
69
69
Abbreviations........................................................ ...................... ........
“ No reply” ......................................................... ................................
69
Notes......................................... . . . . . .............................................69
Changing item s....... .......................................................
.
69
Confining entries to proper space............................. *_..........
70
70
Checks............ ; . . . ..................................................... ......... ............ ..
Defining item s......................................... ...................................... . .......... .
70
Statistics...... ............................... 1................................................... ......... ...............
70-76
Tabulating facts from case records......................... .......................................
70-76
71
Causes of failure to utilize case record material.................. .
Preparing statistics for annual report......................................................
71
72
A simple tabulating scheme........ .........................................................
Record filing................................................................................. ...................'.........
77-91
Importance of record filing............................................. ........... ...; ............
77
Planning a record-filing system...................................................... ................
77
Index and summary card filing systems....................................: ...............
78-79
7g
The l)ook i nde x. . ....... ...........................................................................
The vertical card index...........................................................................
78
78
The visible card filing system................. ............. ..................................
79
Cross indexing............ 1......................................... ............................................
Filing methods..... .............................................................................................
80-83
Alphabetical filing............................
80
Geographical filing...................................................................
81
Numerical filing................................. ............................. .......................... _ 82
Combined filing methods........................................ ...........................
82
83
Indexing.................................................................................................. . .
Record filing equipment............................................................
83-84
Filing aids................................... ...............................................................
84
Folders............. .......... ....... .............................. ................................... .
84
85
Protection of records................................................... ...................................
85-87
Discharged records....................................
O v e r a g e ........................
85
Dead......................................................... ............................................... d
86
Lost address, noncooperative, moved from c ity .. ; ..............................
86
Special information files................................................. .................................
87
Checks on filing....... .......... .......................................................... ....................
87
An illustrative filing plan...............................................
88
Responsibility of office manager for the files............. ..........................
91
Financial administration................
91-97
Responsibility for finances__ . . . . . ___ 7 .......... .........................
............
9^
Essential accounting principles....... ............ , ............ ................... .•............
92-93
Bookkeeping.; ........
92
Illustrative system of bookkeeping.......................................................... ..
93-95
93-95
Books..................... ...................................... .......... ...................................
Combined journal and c a s h b o o k . . ........ ............................
93
General ledger............. ...................................... ...............................
95'
Membership and ledger cards.................................................... . . .
95
Petty cash...........................................................
95

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CONTENTS.

Financial administration—Continued.
Page.
Methods of preventing mistakes....................... ..........................................- - 95-97
Patient’s receipt card..... .........
96
Fee envelope.... . ............................ ................................ - - - - .....................
.96
97
Car tickets. . ...................................... ......... ............ •.................. ~...... ............ Publicity..............................................- - - ....................... . - - 5- ......................... I - ■> 97-108
Functions of publicity.................... - ................................. ...................- -----97
Mediums of publicity....... . ................................................... ................- ......... 98-108
Annual report’. ......................
98-100
98
Size........................
Content...........•........................... - - - - ......... : .................'■>,-------- -----98
Text........ . - .................................. ......................................................... 99-100
Interpretation of statistical da t a . . .................................
99
100
Photographs and stories................
-Charts........... .............................................................. - - - - ......... 100
Maps.............................. ...........................- - - ................ .- - - - - - 100
Monthly reports...................................................- .............................. - - - 101
Exhibits..............................................................................................- ----- 101-103
Planning and preparing exhibits................... - ................................
101
Charts...................................... - ....................................................... - - 102
Location of exhibits................................................ ......... ......... v - - - -•
102
Sources of exhibit material........................................................—
103
Library cooperation............................. ......... .......................... - ............. - *
103
Newspaper articles.......................................................................- - - -----103
Public m eetings.............................................. ..............- ..........................
105
106
Educational classes.........................................
Little Mothers classes— .........................
106
Women’s club programs.......................................... .....................106 .
Contests....................
106-107
Baby health conferences............•.................................... - - ......... - - •
107
Poster contests.........................................................*......... - - ......... - 107.
Motion pictures............................. ........... - ......... ..........................
107
Distribution of literature. I..................................... - ............. - ...............
108
The office manual............................................................ - ......... ............. ........ . - - 108-116
108
Purpose of the office manual...... ................................. - - - ......... - ...................
Need for office mannals in public health nursing organizations.................
109
Form of the office manual. . ^.......................................- - - ............................ 109
Preparation and development of the manual............................. . - ..........
110
Contents of manual............................ ...............................................................•
H2
Interchange of office manuals.................. ..............- .......................................
115
Objections to the office manual.................... ..........................- - - - ......... •
H®
Value of the office manual................................... ............................ ................
116
Bibliography.................... ...................................... ................................................. H'
Appendix..... .......................................*....... ............................................................. 119-207
Record system I ....................................... - - - - ....... ..........................................
121
Record system I I ---- . . . . ....... ............................. - ...................- - - - .................
1™
Record system I I I .................................. ........ - ....... ..................- ...............- 16'
Record system IV ...................................... ........................................................
192
Index.......................................- ...................................................................................
^99

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

LETTER OF TRANSMITTAL.
U. S.

D epartm ent of L abor,
Ch i l d r e n ’s B u r e a u ,

Washington June IS, 1921.
I transmit herewith a report entitled Office Administration
for Organizations Supervising the Health of Mothers, Infants, and
Children of Preschool Age, prepared by Miss Estelle B. Hunter, who
organized and carried on the Chicago office of the Children’s
Bureau.
This report sets forth in detail the principles and methods of
modern technical office management applied to the uses of an asso
ciation. supervising the health of children of preschool age. But it
recognizes, in the words of the writer of the report, “ that the office
exists not as a separate activity but as a tool whose main function is
to expedite every activity of the nursing staff and to aid the executive
in obtaining any information she needs for furthering the work of
the organization.” And again, the report is written with full
knowledge of the financial limitations which hamper many struggling
societies. As a wise member of the nursing profession has said, “ a
public health nursing organization differs from a business concern in
several fundamental ways, one of which is the fact that the nonpaying
business concern goes out of existence while the public health nursing
organization usually struggles on through many lean years doing
countless things plainly undesirable from the mere inability to meet
expenses.” I t is believed timely to publish this bulletin because it
is indisputable that in the long run modern office management enables
a society to do more work and better work than was possible at the
same cost in the old ways. Intelligent and precise records mean that
the humanitarian work they record is on the whole better done;
while they have a vast secondary use in the light shed by accumu
lated data On many aspects and relations of the work itself.
Singularly enough this technical report grew directly out of the
popular child-welfare activities of Children’s Year (the second year
of this country’s participation in the World War). In one of the
larger cities of the country the mayor became greatly interested in
the Children’s Year activities and raised a large fund for improving
the care of young children. The money was turned over to a city
society already engaged in supervising the health of children from
Si r :

VII

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

LETTER OF TRANSMITTAL.

V ili

birth to school age, with supplementary clinical facilities, and large
extensions of service were at once made possible. The directors of
the society had a deep sense of responsibility for the wise expenditure
of its increased resources and asked the Children’s Bureau for advice
in reorganizing their plans. Two agents of the bureau, Miss Hunter
and Miss Geister, a trained public health nurse, spent months in study
and consultation, gaining much information of general interest in the
course of aiding in the new development of this society. Following this
piece of work other similar requests were received from cities offering
varying conditions and problems and several other studies were made by
Miss Hunter or under her direction. The reorganizations effected by
the societies studied were on the whole so satisfactory that it was
determined to prepare a practical bulletin embodying the results of
the studies made and drawing from the best available material upon
office management in the business, world.
While the report is directed especially toward the needs of agencies
supervising the health of mothers and young children, certain funda
mental principles of administration here set forth are essential to the
efficient conduct of any office in the social field.
Miss Hunter desires to express her indebtedness to a very large
number of persons and societies who have aided in the preparation of
this report. First perhaps should be mentioned the societies whose
desire for better administrative methods opened the opportunity for
the studies upon which this report is based. Authorities in the
management of business enterprises have aided generously.
The report has been submitted to about 30 persons, directors of
organizations in the child-welfare field or allied territory, and has
profited by valuable criticism.
I t is offered to the public in the hope that it will serve to make the
funds available for child welfare do more work and better work for
children.
Respectfully submitted.
J u l ia C. L a t h r o p ,

Chief:
H o n . J a m es J . D a v is ,

Secretary of Labor.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION FOR ORGANIZATIONS SUPERVISING THE HEALTH
OF MOTHERS, INFANTS, AND CHILDREN OF PRESCHOOL AGE.
INTRODUCTION.
THE NEED FOR SCIENTIFIC OFFICE ADMINISTRATION IN PUBLIC
HEALTH NURSING ORGANIZATIONS.

The rapid development of public health nursing has of necessity
concentrated attention upon the technique of the service, which
has expanded from the philanthropic act of caring for the sick poor
to the ever-widening sphere of health interpretation to all grades of
society.
Recent years have witnessed an awakening to the fact that if high
standards of nursing service are to be maintained strict requirements
regarding the education, training, experience, and character of the
nurses must be compensated by adequate professional salaries. It
is now apparent also that if an organization is to render the highest
type of service to the community the skilled nursing staff must be
supported by a skilled office force, intelligently and adequately
equipped and directed.
In recognition of this fact public health executives in constantly
increasing numbers are seeking assistance in finding better methods
of executive control, and many of those responsible for the health of
infants and children of preschool age have repeatedly requested
guidance in administrative methods from the Federal Children’s
Bureau.
STUDIES OF OFFICE ADMINISTRATION CONDUCTED BY THE U. S.
CHILDREN’S BUREAU.

One of the first requests for assistance came from an organization
in the South, which proposed to quadruple the number of nurses
upon its staff. The aid of the Children’s Bureau was asked first to
standardize the field service of the nursing staff, but it was soon
demonstrated to be quite as important that assistance be given in
reorganizing and developing the office administrative features of the
organization. Accordingly, in addition to the public health nurse,
the bureau loaned the services of its organization adviser, who rec
ommended and installed changes in the methods of office adminis
tration, based upon an intensive survey of the current customs and
proposed development of the organization. The combined findings
of the studies in the field and office administration were given per
manent form in an “ Office Manual.”
l

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

The immediate visible results of this reorganization were:
1. xA marked increase in the nurses’ time available for field
work. This was due to elimination of duplicate clerical
work on the part of the nurses and increased office clerical
assistance.
2. An increase of office output, due to redistribution of duties
and orderly rerouting of clerical work.
3. Increased accuracy in handling records and office detail.
4. Elimination of lost motion, and consequent waste of time,
energy, and space. This was accomplished by standard
izing all routine duties and rearranging the office equip
ment.
In addition to these immediate results' the new system laid the
foundation for orderly development and future economical adminis
tration of the association’s affairs. In brief, its initial experiment
in assisting in the reorganization of a child health organization
demonstrated to the Children’s Bureau that a new and great oppor
tunity for service to children lay in the advancement of knowledge
regarding efficient office administration among those responsible
for the conduct of public health organizations supervising infants
and children. In order to insure a practical foundation for a report
on office administration for such agencies, the bureau made a study
of the records and methods in use by 200 nursing agencies.
Study of these records revealed wide diversity in forms of organ
ization, scope of work, and area served, as the following summary
indicates:
1. Responsibility for supervision may be vested in the State,
county, city, or in a group of private individuals.
2. The district supervised may consist of an entire State, one or
more counties or cities, or specified sections or groups
within these governmental units.
3. The function of the organization may be limited to supervis
ing the health of children of special age groups or it may
include one or more additional types of public health service.
4. The complete program for health supervision for a community
may be carried out under the auspices of one organization
or it may involve a division of work among a number of
organizations.
In addition to this analysis of nursing agencies, intensive field
studies were made of five distinct types of organizations supervising
the health of infants and children, as follows:1
i 1. Child Welfare Association, New Orleans, La. (In 1920 this organization added complete maternity
service to its program and extended its supervision of infants and children to cover the entirecity.)
2. Child Welfare Committee, Kansas City, Mo. (In 1919 reorganized as the Kansas City, Mo., Children s
Bureau.) 3. Visiting Nurse Association, Bridgeport, Conn. 4. Delaware Reconstruction Commission,
Child Welfare Division, Wilmington, Del. 5. Maternity Center Association, New York City, N. Y.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

INTRODUCTION.

1. A public health nursing organization responsible for the
health of children from birth to school age in selected dis
tricts of the city.
2. A permanent committee of lay women who selected as their
field:
a. Maintaining a perpetual census of all children in the
city under school age.
b. Conducting annual weighing and measuring tests in
cooperation with a staff of physicians and the local
visiting nursing association.
c. Cooperating with several local organizations in the
operation of health stations.
d. Giving follow-up service to health station cases; e. g.,
persuading parents to have their children given
treatment as recommended by the health station
physicians, or taking children to the health station
when the mother is unable to leave home, etc.
3. A Visiting Nurses’ Association wljjch gives all types of nursing
» service except that in the schools. The health centers in
the city are conducted by the city, department of health,
but the nursing service is supplied by the Visiting Nurses’
Association.
4. A State public health nursing service responsible for the
health of all children in the State.
5. A public health nursing organization, specializing in prenatal
care and the care of infants under 1 month of age, in certain
districts of the city.
Undoubtedly numerous other combinations of public health nurs
ing service exist, but it is believed that intensive study of these five
types provides a basis sufficiently varied to insure the usefulness of
this report.
FIELD OF PAMPHLET.

This pamphlet is limited to the field of office administration, and
it touches upon the activities outside the office only as it is necessary
to do so in order to secure a thorough understanding of their rela
tionship to the work carried on in and directed from the office.
The “office” defined.
The term “ office” as used in this bulletin includes the clerical
work and equipment necessary to the proper control and functioning
of the organization. The office and its administration are the
immediate responsibility of the office manager. The duties of its
staff in the majority of public health nursing organizations comprise
those of registrar or recorder, file clerks, accountants, clerical assist
ants, stenographers, typists, and volunteers; in addition, all cleri
cal work performed by the nursing staff is the concern of the

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION-.

office manager, although a supervising nurse must he responsible
for any portion of it which involves knowledge of nursing technique.
I t may appear at first glance that the contents of this pamphlet
apply only to the larger associations. The executive of a small
society having but two or three staff nurses and volunteer office help •
or of one composed of a supervising nurse, several staff nurses, and
an office clerk may believe that the principles of office administration
hold no interest for her. But if the executive of such an organization
will study the duties of the various positions as herein described she
will discover that one position combines the functions of several;
e. g., she may be holding the positions of superintendent, supervisor
of nurses, and office manager, while the office clerk is functioning as
stenographer, file clerk, and recorder. The very fact that each is
responsible for so many varieties of work makes it important that
the small organization shall be enabled to reduce its waste effort
and motion to a minimum through definite division and assignment
of duties, standardization and orderly routing of work.
I t is natural to believe that the waste occurring in a small organi
zation is not important because it is small in volume. But small
leaks may prove most costly because they are less easily detected
and apparently of little importance. I t is not unreasonable to
assume that the waste occurring in the small public health nursing
organizations throughout the Nation bulks greater than the total
waste of the large organizations. This is due partly to the fact that
the smaller organizations are more numerous and partly to the
better administrative machinery which necessity has forced upon
the larger organizations. The executives of small organizations can
render valuable service to the entire public health field through
careful application of efficiency principles in office administration
to determine the degree to which they are practically applicable
to the small association.
The office may be the desk of the one nurse who is executive and
staff at one and the same time, or in a larger organization employing
several nurses, the office may occupy several rooms and have a staff
consisting of office manager, bookkeeper, registrar, typists, and clerks.
Office management.
A thorough discussion of office management should include a
description of the actual work to be done, the organization which
must be built up to carry it on, and the machinery which will insure
prompt and complete execution of all its functions. But no discus
sion, however detailed, can supply the executive with an adequate
program of office administration. Satisfactory results can be ob
tained only if each executive exercises intelligent selection of proven
methods according to the current and special needs of the organiza
tion for whose administration she is responsible.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

INTRODUCTION.

To many persons unfamiliar with the processes for reducing office
routine to order, such terms as “ office management” or “ executive
control” suggest the elimination of all human relationships and per
sonal values from the daily contacts occurring in connection with the
work of an organization. I t is true that such a result might be ob
tained by imposing a mass of restricting regulations upon an unwilling
staff or by an overzealous standardization of the work of the organi
zation, and the effect upon the service would be even more disastrous
than th at obtained by unregulated machinery. Furthermore, such
methods crush initiative and rob the staff of responsiveness and
interest, without which it is impossible to perform work of the
highest standard.
Office control as described in this pamphlet aims to enable each
member of the staff to perform her work easily, comfortably, quickly,
and accurately, through careful assignment of duties adapted in
quantity and type to the capabilities of the individual worker,
orderly routing of work, proper and adequate equipment, and pro
vision in every way for a maximum output with a minimum expen
diture of labor, time, and money. This program is possible if there
exists throughout the organization an esprit de corps based upon a
fundamental desire to serve—service which begins with the coopera
tion between the members of the organization staff and extends
outward to every individual or group with which the organization,
comes in contact.
PURPOSE OF PAMPHLET.

The principles of office organization and management as set forth
in the following pages have been adapted from the principles of
scientific office administration as practiced in the business world, so
far as they are applicable to the problems of public health nursing
organizations. I t is impossible to present a treatise on office admin
istration which will prove applicable in every detail to all organiza
tions, but an attem pt has been made to state the general principles
clearly and to give a sufficient variety of illustrations to provide the
reader with guides to the proper adjustment of her own particular
problems.
Each day is productive of new ideas in the field of scientific office
management and the progressive executive must be ever on the alert
for them, but she must also know how to weigh and judge them for
their usefulness to her organization. This pamphlet aims only to
offer a point of departure to the administrator who has specialized
in the field of public health nursing without opportunity for study
of the principles which govern every efficiently administered office.
I t is hoped that the application of the general principles herem set
forth will stimulate the production of other publications on the various
phases of office administration with definite application to the prob
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

lems of special groups and with special attention to the most effective
application of efficiency principles to the administration of the smaller
public health nursing organization.
ORGANIZATION, FUNCTIONS, AND DUTIES.
IMPORTANCE OF SOUND ORGANIZATION.

The proper functioning of a public health nursing association is
dependent, upon the soundness with which it is organized. The
elements of proper and enduring organization have been thoroughly
and ably set forth in publications of the National Organization for
Public Health Nursing;2 therefore it will be sufficient for the pur
poses of this pamphlet to point out that the field of the organization
must be clearly defined and its machinery built accordingly. Author
ity must be centralized, and both field and office must be adequately
staffed and supervised for prompt and efficient execution of work.
Too often the board of managers outlines the field to be covered,
determines the size of the staff according to the amount of money
believed available, and without further study of the situation leaves
matters to adjust themselves. As a result, the field is generally much
too large to be adequately served by the staff, the office staff is seldom
skilled, and the office administrator, who is usually the superintendent
or assistant superintendent of nurses, is faced with the alternative
of limiting the field or reorganizing the staff, either of which is exceed
ingly difficult once the machinery has been improperly set in motion.
Chart I (p. 7) shows the plan of organization common to the
majority of public health nursing organizations serving in urban
communities. Small organizations are obliged to combine in the
person of their executive the functions of two or more positions shown
on the chart, while large organizations often employ several persons
to fulfill the duties indicated as one position. In the latter case one
of the group should be designated as head, the others in the group
should be responsible to her and she should be responsible to the
person next higher in authority; e. g., as the filing staff in a given
organization is increased one clerk should be designated as head or
chief file clerk, and she should be made responsible to the office
manager for the work of all other file clerks.
As it is impossible to draft a chart which will show the various
combinations possible, one has been arranged which will show all
positions which any urban organization could require and their duties
will be considered separately. This should prove helpful to the
executive who finds it difficult to limit the duties of a member of the
staff when improved finances of the organization make it possible to
increase the number of office assistants.
2 Gardner, Mary Sewall: Public Health Nursing. The Macmillan Co., New York, 1916. Brainard,
Annie M.: Organization of Public Health Nursing. The Macmillan Co., New York, 1919.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CHART I. EXECUTIVE CONTROL CHART FOR ORGANIZATIONS SUPERVISING HEALTH OF MOTHERS, INFANTS, AND CHILDREN OF
PRESCHOOL AGE.

ORGANIZATION, FUNCTIONS, AND DUTIES
8 The medical supervisor should be a pediatrist, responsible for maintaining the same standard of service in all the health centers under the organization’s supervision. As the
chart indicates, administratively the medical supervisor is responsible to the chief executive, but upon all questions of medical technique he is responsible only to the medical com
mittee.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

FUNCTIONS AND DUTIES.

Donors.
A t the head of the organization chart stand those who make
possible the existence of the organization. They may be members
of the organization, occasional donors, or indirect donors such as
those who attend entertainments held for the benefit of the organiza
tion or in other ways contribute to its maintenance.
Donors differ from stockholders in the commercial sense in that
ordinarily they have no vote ih the administration of the organization
which they support, but they have a very definite and positive method
of demonstrating their disapproval—namely, by withdrawing their
support. I t is a fact frequently reiterated that each community has
a few prosperous public-spirited citizens who make possible the ex
istence of the private agencies which work for the welfare of all its
citizens. Accordingly, many public health nursing agencies sup
ported wholly or in part by gifts from private individuals or groups
of individuals have a comparatively short list of donors. Such
organizations have overlooked the psychological fact that an individ
ual’s interest in an undertaking varies according to his investment
in it or what he personally receives from it. His investment may be
in the nature of money, services, or other gifts, but all these have a
definite cash value to the organization. If these gifts are limited to
a few donors the community interest in the support of the organiza
tion will be likewise limited. A constantly growing group of donors,
regardless of the type of their gifts, is a reliable indication that the
organization is increasingly established in the confidence of the
community.
One public health nursing organization has recently determined
upon a policy of securing at least one member in every home in the
city which it serves. Such a program gives increased publicity to
the work of the organization, spreads the doctrine of health preserva
tion and prevention of illness, and secures city-wide enthusiasm and
support for the organization.
But whether the donors are numbered b y tens or thousands, they
have a right to, and should demand, a complete accounting at least
once a year. Such an accounting is usually given in the form of an
annual report, and it is only because the public has not been educated
to demand a complete and accurate account that the annual reports
of many social agencies remain unchallenged. The boards of
managers and executives of these organizations have long recognized
the deficiencies of their annual reports, and it is largely through their
efforts that attempts have been made both to standardize reports
and at the sapie time to educate the public to recognize whether the
accounting has been satisfactorily presented.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION, FUNCTIONS, AND DUTIES.

Board of managers.4
The board of managers is responsible for the policies of the organiza
tion, the raising and disbursing of funds, the selection of the chief
executive of the organization, the active maintenance of such com-:
mittees as are necessary to the conduct of the organization’s business,
and the periodic reporting of the organization’s activities to the public.
I t should be the responsibility of the board of managers to provide
adequate financial support which will permit securing the proper
type of employee for each position. To this end a progressive busi
ness man with a working knowledge of scientific office management
would prove a valuable member of the board of managers of any public
health nursing organization desiring to operate on an efficiency basis.
The official representative of the board of managers is the executive
of the organization, who should be able to guide the board in it&
policies and undertakings. This can be done only by a trained,
experienced person of the true executive type. Few board members
are trained or experienced in public health matters, nor have they
sufficient time to devote to study and to attending conferences in
order that they may keep abreast of the rapidly advancing program
for public health. Consequently, there are some lessons which
boards of managers of public health nursing organizations may well
learn from those bearing similar responsibility in commercial firms.
Chief among these lessons is insistence upon more scientific methods
of selecting the chief executive who is responsible for carrying out
the policies of the board; second comes provision for proper working
conditions, reasonable hours of work, and adequate salaries for a
scientifically selected staff, with opportunities for promotion as
responsibilities are increased.
Committees.5
Appointment of committees.—Practically all public health nursing,
organizations have, from their inception, at least three standing com
mittees—the finance committee, the nurses’ committee, and the supplies-committee. As the work develops, committees on records, pub
licity, printing, education, etc., are created in accordance with the
recommendation of the National Organization for Public Health
Nursing that a committee be appointed on boards of directors for
every department of administration and nursing work.
The success of the functioning of any committee is due largely to
the interpretative efforts of the executive of the organization, who
must be constantly on the alert for matters of interest to the commit* For detailed discussion of the duties of the board of managers see: Gardner, Mary Sewall: Public
Health Nursing, ch. 11, pp. 110-112. Brainard, Annie M.: Organization of Public Health Nursing, ch.
8,pp. 69-77.
. t Brainard, Annie M.: Organization of Public Health Nursing, Ch. VU, pp. 77-110.

57716°—22——2

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

tee; furthermore she must be able to present them in such a way that
they will arouse and retain the interest of the members. As has been
pointed out with reference to the entire board of managers, the com
mittee members all have their first interest outside the office of the
nursing organization—they are a shifting personnel of a^permanent
group, the board, and they are but temporarily responsible for the
problems referred to them. The wise executive can make this period
one of great value to each committee member if she takes the time to
prepare properly for each meeting of the committee and assists the
•chairmen in preparing their reports. But such assistance from the
executive is possible only when she is a trained, experienced person
with executive ability.
Committee on nursing.—The sudden increase in public health
interest subsequent to the war has forced into executive positions
many nurses obviously unprepared for the interpretative duties
attendant upon the relations between the executive and the commit
tee members. In such cases it should be the responsibility of the
committee on nursing to present to the board of managers some plan
which will provide for the further training of the executive if she
exhibits a tendency toward administrative ability. * A number of
committees on nursing have made it possible for their executives to
enroll for short courses on public health and allied subjects, attend
national or group conferences and make visits of inspection to confer
with executives in other communities who are directing the
same type of service. Experience has taught these boards that none
of these educational absences from the office should be deducted
from the executive’s vacation period. To do so would mean decreased
efficiency on the part of the tired executive. The total time to be
devoted to such absences mast be determined by the board as condi
tions require, but every board should expect to send its executive to
at least one National and one State conference annually in order that
its organization may be kept abreast of the times.
Small public health nursing organizations sometimes require their
executives to give part time to field service. When this is necessary
the committee on nursing should be certain that the executive does
not work solely in one district, for it is human nature to be most
interested in the particular thing one is doing, and the nurse who
works in one district only will be unable to consider the problems of
the city as a whole. There is danger, too, that the field work with its
more human appeal may encroach more and more upon the time
which should be reserved for purely executive work.
Committee on office administration.—-An increasing number of boards
of managers are creating committees on office administration, which
may combine the functions of the former committees on records and
printing and also of the committee on equipment. Reports from

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION', FUNCTIONS, AND DUTIES.

several organizations prove that such a committee if properly chosen,
can be of distinct, practical assistance to the office manager. Prac
tically every city has one or more trained librarians who have expert
knowledge of many of the detailed processes of an office, and several
communities have reported the advantage of having their librarian
advise in matters of filing, record keeping, exhibit planning, educa
tional programs, and publicity campaigns. Women or men with
executive office experience, private secretaries, and others with prac
tical experience, serving on the committee on office administration,
can do much toward improving that branch of the office management
with which they are most familiar. If there are no experienced
persons on the board, each committee can easily secure advice from
those local citizens best able to give it. I t is well to keep in mind that
vagueness begets vagueness, and the only way to secure constructive
assistance from committee members or other advisers is to present
to them clearly and concisely the points upon which their assistance
is desired.
Chief executive.
There is a growing conviction in the commercial world that one
individual seldom combines the ability to plan and organize with
the ability to carry out the plans. The chief executive must be of
the type able to plan for the growth of the organization and must
be able to judge results produced by her staff, but to the office
manager belongs the function of management and direction which
will produce the results called for by the chief executive’s plans.
There ^s sound psychology back of the commercial policy that each
business firm needs these two types of executives, for the mind
which plans in the large is seldom capable of giving to details the
attention they must receive if the plan is to be carried to successful
completion. Public health nursing organizations having but one
executive give point to this fact when members of the board com
plain that their superintendent makes excellent plans but seems
unable to carry them out, or, on the other hand, that their work
does not seem to develop because their superintendent is always lost
in a mass of detail. The former type belongs in the class of chief
executives and she needs an office manager to attend to the details
necessary for carrying out her plans. The second type might make
a satisfactory office manager if properly trained.
Obviously, the ideal executive for a public health nursing organi
zation would be a public health nurse with training and experience
in office routine and office management as well as in public health
nursing and nursing supervision. Many public health executives
maintain that the chief executive of a nursing organization should
always be a nurse because the business of the organization is nursing.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Unless such an executive has had generous training and experience
beyond that afforded in high schools, training schools for nurses,
institutional training and experience, and field work in public health
nursing organizations, she will require an office manager capable of
planning and directing the activities of the association which lie
outside the knowledge of the chief executive.
In the opinion of many board members and executives, nursing
service is only one of the functions of a public health nursing organ
ization. The executive chosen by persons holding this opinion might
be a person of executive type, with an intimate knowledge of the
public health field, but without technical training or knowledge of
nursing service. Such an executive requires as one of her assistants
a supervisor of nurses of high order who will protect the organiza
tion from professional mistakes which might arise were the nursing
service not carefully safeguarded.
The chief executive of a public health nursing organization is gen
erally entitled “ secretary,” “ superintendent of nurses,” “ super
visor,” or “ director.” She is responsible for carrying on the work
of the organization as determined by the board of managers and for
interpreting the performance of the organization and the needs of
the field to the members of the board and through them to the
community. In the majority of public health nursing organizations
the superintendent supervises the nursing service and administers
the office, which leaves little time for constructive work outside the
daily routine. As a rule these Superintendents are public health
nurses who have been promoted to executive positions because they
have shown superior ability in the field. This frequently works
great injustice, for superiority in nursing technique in no way assures
executive qualities. There is nothing in the training or field expe
rience of a nurse in a small organization which would fit her to
supervise the work of an office which requires the combined knowl
edge and abilities of a statistician, librarian, public speaker, teacher,
filing expert, accountant, publicity expert, and general office manager.
I t is obviously impossible for one person to excel in all these fields
but it is equally true that if an executive is to apportion the duties
of the staff to secure the greatest possible productivity, she must be
cognizant of all the elements entering into office work and must be
able to judge fairly the efficiency with which they are performed.
In addition, she must see the duties of the various members of the
staff in their relation to each other in order th at they may be redis
tributed as occasion demands. The executive who considers the
office work unimportant is at the mercy of her staff;, in addition, if
the members of the staff are not properly supervised they are unable
to render efficient service and the result is poor and expensive health
service for the community.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OKGANIZATION, FUNCTIONS, AND DUTIES.

In order to secure the accomplishment of all that should be required;
of the chief executive, she must plan her work and that of her sub-!
ordinates so as to leave her time free for general oversight, outside
contacts, investigation of the needs of the community in her field,
study of methods in use elsewhere, committee and group meetings,^
public speaking, attendance at National, State, and local conferences,and preparation of matters for the consideration of committees and
the board of managers. *
Many executives are at a loss as to a method of limiting their out
side activities, especially with relation to serving upon committees.
There is the temptation in a city having a number of progressive^
active organizations to absorb a great deal of the time of its leading;
social workers in committee work. The wise executive must learn through experiment and careful weighing of values which outside
activities will advance the work of her organization or the welfare
of the community. She should also take care not to give to outside
activities any of the time required by her own office administrative
responsibilities. The size and capability of her staff and the success
with which she is able to delegate routine duties to others are im
portant factors in determining how much time she will have for
outside activities.
I t is doubtful whether there is a clear understanding in the minds
of many superintendents of the nature of their responsibilities and
their field of action. If they do have a definite idea of their functions,
their board members may not hold the same idea, with the result that
friction is bound to occur. The danger of such misunderstanding
is avoided if the duties and responsibilities of the executive are
defined in writing by the board at the time she is selected. A state
ment of her duties should appear in the office manual and should
be changed as often as the duties change in volume or scope.
The office manual of one public health nursing organization8 defines
as follows the duties of its chief executive who, as executive secretary
of the board of trustees, fills the position generally designated as
director.
Executive secretary.—The executive secretary of the board is the chief administrator
of the association! She is responsible to the board for the personnel of the staff, the
expenditures of the association, the standard of nursing and medical service, and
the administration of all the offices and stations. It is obvious that probably no one
person is competent to supervise a medical staff, a nursing staff, and an office adminis
trative staff. It is therefore necessary to have a competent medical assistant and a
competent nursing assistant who shall be selected by the executive secretary and
approved by the board; however, it is necessary for the executive secretary to be
the executive head of all branches of the association in order that all branches may
be correlated and the association’s work kept unified. No member of the staff—
6 Child Welfare Association, New Orleans, La.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION-.

nursing, medical or clerical—shall be either, hired or discharged by anyone except
the executive secretary.
All correspondence written for the association by anyone on the staff or board of
directors should be submitted to the executive secretary before being mailed, and a
. copy should always be filed in the child welfare association’s files, together with the
original letter.
The executive secretary is responsible for the businesslike administration of the
Tnain office, district offices and stations, for the presentation to committees and the
board of all matters of policy and work which demand their attention-and for the
carrying Out of their recommendations. She must write monthly and annual reports
on the progress of the work. To do this she must have compiled reliable statistics
based upon case records and financial statements. These also serve as the basis
of the publicity for which the executive secretary is responsible.
In addition to the supervision of all the activities of the association, the executive
secretary is responsible for maintaining the highest level of efficiency in all branches,
and the maintenance of an esprit de corps without which no organization can operate
efficiently.
-

This illustration is not intended to supply a comprehensive state
ment of the duties of the chief executive of a public health nursing
organization but it is suggestive of the points to be covered in defining
her sphere of responsibility.
Supervisor of nurses.
The supervisor of nurses, who is frequently the assistant superin
tendent, is in direct charge of the field staff under the immediate super
vision of the chief executive. Her duties vary according to the size
of the staff and the responsibilities assumed by the chief executive,
but there are a few primary rules of organization which should be
observed if the office machinery is to run smoothly.
1. The superviser of nurses should be responsible for the field
staff, all matters pertaining to them to be handled through
her. This means that both the nurses and the office mana
ger refer to the supervisor of nurses all matters to be taken
up with reference to the office work. Even the chief execu
tive should give all directions to the nurses through the
supervisor of nurses except in certain specific instances as
set forth in the office manual.
2. The supervisor of nurses should perform as little clerical work
as possible and should restrict her office duties to those
which must be performed by a person with training in pub
lic health nursing.
3. All divisions of duties between the office manager and super
visor of nurses should be referred to the chief executive
for her approval and entered in the office manual.
District supervising nurses.*
In organizations too large to permit efficient direction of the staff
nurses by the supervisor, district supervisors are appointed who

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION, FUNCTIONS, AND DUTIES.

are immediately under the supervisor of nurses. In such organiza
tions the supervisor gives her instructions to the district supervis
ors instead of to the individual nurses, and the district supervisors
in turn deliver them to the nurses in their districts and are responsible
for the results. • The same rules which apply to the administrative
duties of the supervisor of nurses have equal weight in planning the
duties of the district supervisors.
Senior nurses.
In a few of the larger nursing organizations the nurses who are
considered eligible for promotion to supervisory positions are called
“ senior nurses,” and they are given certain responsibilities under the
supervision of the district supervisor. When a careful program is
followed whereby their special work gradually covers all phases of
supervision it proves a valuable training course and insures a steady
supply of supervisors.
Office manager.
The office manager is the executive responsible for carrying on
the clerical activities of the organization according to standardized
methods approved by the chief executive. The position is largely
determined by the size of the organization and the ability of the
•individual. In the small organization it may be necessary for the
office manager to add to her duties of supervision and planning,
those of recorder, bookkeeper, and even file clerk. As the organiza
tion grows it is possible for the progressive office manager to dele
gate the routine duties to others and to develop her field accord
ingly. But, as in the commercial field, it will always be her duty
to “ devise records, methods, and systems for carrying out the func
tion of control and for coordinating the activities of one department
■with another.” 7 Her field and the methods to be used should be
defined in the office manual and all proposed changes should be
approved by the chief executive and the manual changed accord
ingly. I t is the responsibility of the office manager to see that the
machinery of the organization runs smobthly, rapidly, effectively,
and economically, once the methods have been approved by the
‘ chief executive. She must have sufficient knowledge of all forms of
office procedure to be able to judge the ability of each member of
her staff. She must be able to direct the activities of the office and
at the same time to secure the active cooperation of each member
of the staff in increasing the efficiency of the organization. She must
be able to inspire in her associates a desire for constant improve
ment, to guide them in their search for improvement, and to super
vise them carefully without arousing antagonism._____
. _____
7 Galloway, Lee: Office Management, Its Principles and Practice, p. 4. The Ronald Press Co., New
York. 1919.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

A. W. Shaw states that an office manager should b e 8 alert, con
scientious, dependable, diplomatic, enthusiastic, firm, experienced,
educated, honest, ingenious, intelligent, original, reserved, selfreliant, sincere, versatile, and the possessor of initiative, presence
and magnetic personality.
These qualities are equally necessary for the office manager of a
public health nursing agency, but, in addition, she should welcome
responsibility and know how to assume it without becoming officious,
how to select employees who are expert in their individual spheres
and to recognize that they can perform their particular tasks better
than she, although she is responsible for the methods of performance
and the results achieved. She must maintain whatever office disci
pline will result in the best working atmosphere for the entire group
and should at all times so conduct herself that her actions will
constitute an example of proper office behavior.
The observant office manager will be constantly on the watch for
improvements in the distribution of duties and the rearrangement
of equipment to eliminate w;aste motion. In one public health
nursing office it was the custom before the installation of businesslike
methods to permit each member of the staff to work wherever most
convenient, provided no one else was occupying the place at the
time she required it. Everyone able to do so used the typewriter,
the long table, the several desks, often leaving partially completed
work in one spot while some other type of work was done elsewhere.
This resulted in confusion and disorder of material and an inaccurate
and slow output of work because no one acquired the skill which
comes from specialization, and no one person was responsible for
any given task. Creation of orderly routine and individual responsi
bility for given tasks resulted in increased output, greater efficiency
and what was even more important to the development of the office,
greatly increased interest of each employee in her work.
The office manager’s duties other than routine are largely deter
mined by the superintendent or chief executive. But whatever they
may be, they should be clearly defined and limited and entered
in the office manual. As an aid to orderly administration, em
phasis should be laid upon the necessity for referring any question
relating to the clerical work of the nurses to the supervisor of nurses,
instead of taking it up directly with the individual nurse, unless the
supervisor requests that this be done.
One public health nursing agency having a staff of 30 nurses, a
supervisor of nurses, an office manager, a recorder, and a stenogra
pher, in addition to the executive secretary, defines the duties of the
office manager as follows:
.» Shaw, A. W., Co.: How to Manage an Office, Pt. II, p. 30, A. W. Shaw Co., Chicago, 1914.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION, FUNCTIONS, AND DUTIES.

1. Making all purchases on recommendation Of the executive secretary.
2. Checking all bills for purchases.
3. Making out all checks and being responsible for securing signatures and send
ing checks to all creditors and staff.
4. Keeping time records for staff.
5. Keeping all administrative files (bills, purchases, etc.).
6. Keeping all correspondence files.
7. Keeping membership list.
(a) Addressograph list.
(b) Sending out bills and receipts to members.
8. Keeping inventory of all equipment and supplies.
9. Handling requisitions from district offices.
10. Keeping all books (cash, ledger, etc.).
11. Keeping petty cash account.
12. Indexing and charge of the library.
:,
13. General responsibility for suggestions and improvements in the system and
keeping the main office up to the highest degree of efficiency.

General clerical staff.
This group includes stenographers, typists, file clerks, bookkeepers*
statistical clerks—frequently called.“ registrars” or “ recorders”—and
clerks who perform general office work. The bookkeepers m a y be
called cashiers or accountants, but as a rule their duties cover the
same field. As all of the work performed by the members of this
group is routine and can be standardized, no consideration of separate
tasks will be considered. Each member of the clerical staff is
responsible directly to the office manager for accomplishing her work
in the maimer set forth in the office manual. Each should be en
couraged to seek better methods for performing her work, for it is in
the clerical department that wasteful methods are most prevalent
and most difficult to detect.
Volunteers.
Whether volunteers should be used in connection with the offices
of public health nursing organizations is a question which has given
rise to many sharp debates, and nursing executives are divided into
three groups—(1) those who bar all volunteers because they have
found from experience that, as a rule, volunteers are not regular in
attendance, are difficult to train, and can not be controlled as can
paid employees; (2) those who welcome all volunteers, especially
members of families with high social standing; (3) those who limit
the number of volunteers according to the needs of the organization.
This third group is small and no member of it is known to apply fully
the same tests to volunteers as are made for applicants seeking a paid
position, nor to exact the same service from the volunteer as is exacted
from the regular staff member. Many will insist that both these
principles are impracticable, but they should not prove so if the execu
tive works out a careful program for selecting and employing volim
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

teers and makes this program known, presenting at the same time the
reasons for each requirement.
Volunteers can be made an extremely valuable asset to any office
if the person responsible for selecting them will remember that the
volunteer is not a special type of individual beyond the fact that she
is willing to give her services gratis. Volunteers may be divided into
two groups, trained and untrained. The former should be catalogued
according to the skilled work they are able to perform and the number
of hours and days per week they are willing to give. The untrained
workers should be classified separately, their cards showing the
special type of work in which they are most interested.
I t is popularly supposed that volunteers are recruited entirely
from the leisure class, who form a generous proportion of the donors
to the organization’s funds. Some nursing organizations have found
it profitable to present their needs for specialized office service to
groups not commonly approached with requests for volunteer service.
An example of such initiative is found in the executive who appealed
successfully to the students in the local business college for assistance
in sending out the annual reports, and also for typing monthly and
special committee reports. Boy scouts, camp-fire girls, art students,
trade-school students, and many other groups offer fruitful sources
for a supply of volunteer service to the comprehending executive.
The proper utilization of volunteer service is an exceptionally wise
and profitable means of securing and holding the interest of the
public and is an entering wedge for educational work among many
who might not otherwise come under the influence of the organization.
In order to raise volunteer service to a dignified plane, organiza
tions having a large available supply will find it profitable to issue,
in printed form, a statement covering the value of volunteer service,
the necessity for holding volunteers to certain standards of service,
and the types of service for which volunteers can be utilized. Vol
unteers will take greater pride in rendering service of a definite
standard than they will in giving haphazard service which too often
is very apparently “ busy work.” . I t is a simple m atter to prove to
the would-be volunteer who is unwilling to be held to any sort of
restrictions that such service is expensive to the organization. There
is a certain amount of oversight and instruction for volunteer service
which may be charged legitimately against the educational work
of the organization, but unskilled, unsupervised, and inefficient vol
unteer service costs the organization large sums of money in addition
to lowering its efficiency and should not be tolerated.
But before designating volunteers as inefficient the executive should
consider carefully whether the volunteer or the executive herself is
to blame. Careful assignment of congenial, interesting work, per
formed according to definite written instructions, under the super
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION, FUNCTIONS, AND DUTIES.

vision of a regular member of the staff or someone trained to super
vise, will generally awaken and hold the loyal interest and regular
service of volunteers who have proved ineffective under less definite
conditions.
Volunteers should be required to read the sections of the office
manual which state the purposes and policies of the organization and
the description of the duties they are to perform. Their work should
be carefully supervised and they should be subject to the rules of the
office during their service in it. They should understand the neces
sity for maintaining the strictest silence upon all matters connected
with the work of the organization which they learn during their serv
ice with it and should always refer to the superintendent any re
quests for information regarding the work or plans of the organiza
tion. A section of the office manual dealing with special points
which should be brought to the attention of volunteers would prove
a simple way of instructing all volunteers in the ethics of volunteer
service and would prevent any misunderstanding or later unpleas
antness due to ignorance on the part of the person who desired to be
of service.
There is an occasional volunteer trained as stenographer, book
keeper, file clerk, etc., who would be glad to give a specified amount
of time each week gratis or at a reduced rate. Such volunteers are
valuable and their services should be utilized on the same basis as
other volunteers. Untrained volunteers can he given special tasks
such as addressing, sealing, and stamping envelopes during financial
campaigns and at the time of sending out the annual report, but they
should not be permitted to perform any of the duties relative to
carrying on the daily routine. The regular work of the office must
be done by those who are responsible for its performance; if it is left
to volunteers it can not be kept up to date and the flow of work will
be retarded and confused.
Proper designation of work for volunteers demands great skill,
and the imaginative executive will find in this field ample room for
her ingenuity. One executive created an art committee of volun
teers responsible for all sorts of artistic productions in connection
with exhibits, furnishing health centers, preparing advertisements and
posters, etc. These young women were students or graduates of the
art department of the local college, and they gave much more inter
ested, intelligent, and skilled service in this field than they would have
in performing simple clerical tasks under conditions with which they
were unfamiliar. Doubtless every public health executive would
find it to the advantage of all concerned if she would review the volun
teer service of the organization she directs with a view to reassigning
those volunteers who might more profitably render a different type
of service.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Volunteer service which serves has a very definite cash value to
the organization and community; accordingly it is important to keep
records which will show the amount and kind of service and its cash
value, so that the total amount and value of such service rendered
during the year may appear in the annual report. An interesting
example of this appears in the report of the Kansas City (Mo.)
Children’s Bureau for the period July 1, 1919', to June 30, 1920.
Our volunteer auto service has amounted to $327.50, calculated on the basis of taxi
charges. Our other free service amounts to $6,486, calculated on the basis of $3 a day
for six hours’ work. We keep a record of all services of this kind, very little of which is
intermittent. Volunteers have regular hours and days of the week. One volunteer
gave five months’ regular daily six-hour service of the best kind. In districts where
there are parent-teacher associations we have used their members in census taking,
in assisting in examination centers, in follow-up work, and in the office. We find that
they have given the equivalent of over two years of valuable daily service, or 816 days.
In districts where there are juo associations the members of the collegiate alumnae,
the Panhellenie and the junior college classes in sociology and many lay women have
done the work. In the parochial schools, the Amberg girls, the Catholic women’s
club, and lay women have covered the ground. These organizations have also fur
nished 72 experts for the examination centers and have done much of the record work
in the office. What they have done is equivalent to almost four years of service,
1,346 full six-hour days. Allowing the very modest daily wage of $3, the service
listed above would amount, to $6,486.

The volunteer work in the Kansas City Children’s Bureau is care
fully classified and supervised, and the results justify the expenditure
of the extra effort. In order to be able to give a complete and accu
rate report of the amount, kind, and distribution of volunteer service
during the year the organization keeps a daily record, using the follow
ing methods and forms:
1. A card 3 by 5 inches in size is made out for each volunteer, giving her name,
address, and telephone number. These are filed alphabetically.
2. For service outside the main office the volunteers are given report blanks made
into pads. (See Form 1, p. 21.) These slips are sent to the main office by
the volunteer at the close of each week. . As each group is eager to have
credit for all volunteer service performed by its members there has been
little difficulty in securing these reports promptly.
3. An 8 by 11 inch loose-leaf ledger containing an alphabetical index is used to
contain the record of the volunteer office service. Each volunteer makes her
own entries at the close of each period of service on the page reserved for her
record. (See Form 2, p. 21.) This book is called “ The Volunteer Office
Service Record.”
4. In another loose-leaf ledger, 8 by 11 inches in size, is kept what is termed
“ Summary of Volunteer Service.” In this appear the daily total of horns
given to each kind of service according to the organization represented.
(See Form 3, p. 21.)
5. At the end of the month a report is prepared showing the total number of hours
served according to type of service and organization, a separate sheet being
used for each organization. (See Form 4, p. 21.)

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

ORGANIZATION, FUNCTIONS, AND DUTIES
FORM 1.
[Size: 5 by 8 inches.]
VOLUNTEER REPORT RECORD.
N a m e........................................ Day of week.

Week ending......... 1920.

Type of service.

Place.

No. of hours.

Monday................
Tuesday................
Wednesday..........
Thursday.............
Friday...... ...........
Saturday.............
FORM 2.
(Size: 8 by 11 inches.. The headings are given below. The actual sheet is ruled the entire length, and both
sides of the sheet are alike.]
VOLUNTEER OFFICE SERVICE RECORD.
N a m e...............................................
Date.

M o n th ....... 1920.;

No. of hours.

Type of service.

FORM 3.
[For book, “ Summary of Volunteer Service.” Size: 8 by 11 inches.]
Volunteer’s report by organization, type, and hours of service.
Number of hours office.
Date.

Number of hours field.«*

Organization.
Clerical. Typing.

Filing.

Total. Canvass. Follow
up.

Total.

Grand
total.

a Other forms of field service which should appear on the record are auto service; health-center service,
clerical; health-center service, personal (this includes serving as hostess or performing duties other than
clerical).
FORM 4.
[Size: 8 by 11 inches.]
Summary of volunteer service by organization,, type, and hours.
Organization . ................................... .........
Type of service.

Month,.......... 1920.
Number of hours served.

Total.

Clerical........ ! . . . ...........................................
3, 6, 9,10, 6, 4, 3 .
Typing......................... :........................, ........ . 2, 4' 2, 3, 2, 4, 3.
Filing...............................................
6, 7' 5,' 4,'3,' 2,'9, 12...

Total office......................................................
Canvass...........................................................
Follow-up........................ ......................

3, 2, 4, 1, 2, 4, 9, 3, 2, 7.
40

Total field......................................... .

77
Field plus office totals=186 hours.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION-.

In order to prepare this sheet, the records for all volunteers are
first sorted according to organization. Without attempting to enter
dates, the record for each volunteer is copied in order on the sheet
and the totals are shown in the column at the right. The figures
given in Form 4, page 21, show the correct use of this form.
THE SELECTION AND TRAINING OF EMPLOYEES.
EXPENSE OF LABOR TURNOVER.

Changing employees, whether they are chief executives, staff
nurses, or office employees is expensive. I t involves:
1. Loss of time during training period or period of adjustment.
2. Loss of money due to loss of time during adjustment period.
3. Waste of materials due to unfamiliarity with new surround
ings.
4. Confusion in routine due to entrance of new member of staff.
5. Errors due to unfamiliarity with office and organization rules.
6. Loss of time of supervisor during training period.
SELECTING EMPLOYEES.

I t pays to avoid such losses. The commercial world has demon
strated that they can be greatly reduced by more careful selection
of all employees. Leading firms throughout the country now select
employees for specific positions according to special tests. The appli
cants are tried out under supervision, given specialized training if
necessary, and promoted as rapidly as their improvement justifies.
Standardization of requirements for each position results in uni
formity of type of employee, which is highly desirable because it
means a standard of employees which will be recognized by the pub
lic, and because persons of the same general type, professionally,
work together more harmoniously.
Formerly when the employer wished to fill a position an applicant
was interviewed, and if he seemed fairly intelligent he was given a
trial. This old-fashioned method of interviewing applicants was
founded on the attitude that the employer was the only one to be
suited. I t has been found much more productive of permanency if
the employer recognizes the right of the applicant to know the ad
vantages and the disadvantages of the position, opportunities for
advancement, hours, salary, vacations, provisions for special leave
occasioned by illness or accident, half holidays, overtime provisions,
office dress, uniforms, duties of the position, etc. In order to be
certain that all these points are covered, the person responsible for
interviewing the applicant should note carefully in advance the
points to be covered during the interview, and they should be checked
off as they are taken up.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE SELECTION AND TRAINING OF EMPLOYEES.

In order to select the best person for a given position it is necessary
to determine :
1. The minimum qualifications for the position.
2. What tests will determine with a fair degree of satisfaction
whether an applicant meets these requirements.
The qualifications will appear on the application blank if it is
planned properly. They may be subdivided into—
(a) Education.
• (b) Experience
(c) Health.
Under each of these subdivisions varying according to the require
ments of the individual organization will appear the items which,
when answered, will give information which will enable the employer
to determine whether the applicant is eligible for further considera
tion.
Granted that the application blank is carefully prepared by the
employer and understandable by one of ordinary intelligence, much
can be told about the applicant from the manner in which she fills
it out.
(a) Did she follow the instructions for making the entries ?
(&) Was she able to interpret the questions without assist
ance ?
(c) W.ere her answers definite and accurate ?
(d) Did she answer every question ?
(e) How long did it take her to fill out the blank?
The first step in impressing candidates with the necessity for being
accurate and making complete records is to insist th at all entries
called for shall be made and to inform the candidate th at the manner
in which she fills out the application blank will be used, in part, as a
basis for determining her fitness for the position.
All of these tests can not be applied to application blanks filled out
at a distance, but correspondence offers much asistance. If a letter
from the applicant accompanies the application blank, the compo
sition of the letter, use of English, ease of expression, its general
appearance, the style of stationery, etc., are clues to the personality
and character of the writer. I t is natural to condemn the writer of
a misspelled letter or one who writes illegibly, but neither of these
is necessarily of importance as a clue to the character and ability of
the applicant. All communications of the organization should be
typed; therefore the handwriting and spelling of the executive are
comparatively unimportant, but the nurses and clerical staff should
write legibly and spell correctly if the record-keeping of the organiza
tion is to be done properly.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Impression blanks.
When the fitness of an applicant must be determined by corre
spondence she should be required to fill out an application for a
position blank and it would be found of assistance if, in addition to
letters of recommendation, several persons could be asked to fill out
impression blanks such as many business firms use. The form of
the blank may be determined by the individual executive according
to her needs, but possibly the impression blank used by the Elliott
Fisher Co. (see below) will contain suggestions which will aid the
executive who plans such a record. When the applicable items
have been selected they should be numbered, instructions prepared
for the guidance of the person holding the interview, and copies of
the form and instructions for its use should be inserted in the execu
tive’s copy of the office manual.
IMPRESSION BLANK.

Name of applicant.................................................................... ..................................... .
Address.-------: ................................................... -.............. .......................................................
Position considered for....... ........ -............................................................................. .
Interviewed b y .........-................................. . ................................................... .....................
What was your first general impression of the applicant?................................. ............
Personal appearance.................................... .....................................: ............. ......... ............
What, if any, peculiarity or characteristic impressed you?............. .*............................ :.
Instinctively did you like or dislike the applicant?............... .........................................
W hy?............. ................ ..................................... ............................... .................................... .
Do you think the applicant is fitted, or can fit himself, to the position applied for?..
What, in your opinion, is the applicant best fitted to do?.................................................
Do you think the applicant temperate?
H ealthy..................... .......... Happy................. .. ............ Honest.. .. .
Trustworthy............. .......... A worker................. ............ Steady.......
............ Neat______
Patient.......................
Selfreliant................ .......... Obedient................. ............ Respectful.
Courteous................... .......... Punctual.............................. Orderly....
Ambitious................. .......... Accurate................. ............ Optimistic.
Did the applicant impress you as being well-bred?......................................................... .
How old did the applicant appear to you?................... ....... .......... ....... ............................
Would you like to associate with the applicant?....... ....................................................
Would you personally employ the applicant?... , ........................ .................................. .
Remarks........................ ...................... ............. .......................................... ....... ’. . . . . . ..........

Selecting the chief executive.
In selecting an executive for a public health nursing organization
the board of managers is forced to rely largely upon the advice of
public health nurses in responsible positions and to govern its choice

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE SELECTION A]$rD TRAINING OF EMPLOYEES.

according to the material available at the salary it is prepared to pay.
Few organizations apply any tests to prospective candidates for the
position beyond requiring the applicant to fill out an application
blank.
If the new executive is to be selected from the staff of the organi
zation, there are several rules which may prove helpful in determin
ing which nurse would prove a satisfactory executive. A field nurse
should never be promoted to an executive position merely because—
(a) She has long been a member of the staff and “has a right to
the position.”
(b) She is the best nurse on the staff.
(c) She is popular in the community or with the staff, and the
introduction of an outsider would probably create fric
tion.
(d) She is recommended by some influential person, and failure
to appoint her would mean forfeiting the support of that
individual.
All of the above reasons ate frequently advanced as the basis of
selection for public health executives but no one of them should, be
permitted to influence the board of managers in their choice of a
.candidate unless, in addition to one or more of these facts, she posesses
the majority of the following qualities:
(a) Sufficient education and experience to insure holding the
services of competent nurses on her staff, the respect of
the board members, and the confidence of the community.
(&) The ability to comprehend the public health problems of
the community as a whole, to appreciate the part her or
ganization should maintain in the entire program, and
the desire and ability to cooperate with executives of
other organizations in the interests of the community
program. This requires a well-developed sense of social
values and definite knowledge of the scope, aim, and
methods of all local social agencies.
(c) Organizing ability.
(d) Ability to direct through recognized leadership rather than
militant authority. This requires tact, resourcefulness,
sympathetic understanding, firmness, fairness, and a pleas
ing personality.
(e) Teaching ability.
(/) Ability to plan for community interests without lo sin g
sight of the interests of the individual patient.
(g) Appreciation of the value of sound statistics based on careful
record keeping.
57716°—22----- 3

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Qi) Ability to interpret the records of the organization in term3
of community interest.
(i) Ability to speak in public.
(j) Ability to write sufficiently well to present intelligently or
ganized reports.
(Jc) A sense of proportion regarding the relative importance of
the various branches of the organization’s work.
Selecting office employees.
The fact that most executives of public health nursing organiza
tions are themselves nurses is responsible for the care with which
the staff nurses are selected. In addition, the National Organization
for Public Health Nursing, through its national conferences and pub
lications, has set up certain standards for the selection of public
health nurses as indicated on the application blank approved by them.
But there has been little if any recognition of the necessity for se
lecting office employees with the same care and attention to their
fitness for the tasks they are called upon to perform.
The efficient office functions easily and secures the greatest and
best results with the least expenditure of energy, time, and money.
This implies a competent, trained office force under expert super
vision, instead of the miscellaneous assortment of volunteers and
untrained, unsupervised young women who form so large a percentage
of the office employees in the public health nursing organizations
throughout the country. This condition is due to the fact that the
public health executive is generally not interested in office work,
primarily because she is unfamiliar with it; consequently she does
not know how it should be done, nor is she prepared to direct and
instruct new employees in the proper methods of performing office
tasks. The organizations which have recognized this fact and have
installed trained, competent office managers have saved the time of
their executive for other tasks and, simultaneously, have saved
money through skilled conduct of their own affairs.
I t is essential to the smooth running of the office machinery that
all members of the office staff be acceptable to the office manager.
Therefore, it is a wise plan to rule that she shall conduct the first
interview with all applicants for positions under her immediate
supervision. During the interview she should fill out an impression
blank. If the applicant is acceptable to the office manager she is
asked to fill out an application blank. This and the impression
blank are sent in to the superintendent, who reviews them carefully
before sending for the applicant. This gives her information necessary
for an intelligent secondary interview. If the applicant is approved
by the superintendent, she O.K’s and signs the application blank,
and sends the applicant back to the office manager.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE SELECTION AND TRAINING OF EMPLOYEES.

-In Case the impression made upon the superintendent is greatly
at variance w ith.that recorded by the office manager on the impres
sion blank it would be advisable for the superintendent to fill out a
separate impression blank, which should be kept on file as a matter
of record. Both the application blanks and the impression blanks
should be considered confidential and should be filed in the folder
kept for the records of applicants or employees, as the case may be.
Selecting nurses.
The supervisor of nurses should interview the candidates for
positions on the nursing staff, following the same procedure as that
described for interviews conducted by the office manager. If the
supervisor of nurses is not the chief executive she should fill out
an impression blank to be given to the chief executive with the
application blank.
Tests.
In planning the tests which must be passed satisfactorily by
candidates whose application blanks qualify them for further inter
views, executives will find suggestive the tests used by business
firms. They can be adapted to the needs of the nursing service
and can be adopted without change for those positions which the
public health office has in common with the commercial office; e. g.,
file clerks, stenographers, etc.9
TRAINING EMPLOYEES.

“ One of the most pernicious causes of waste in business to-day
is the lack of proper training of employees,” says J. W. Schulze in
his book on office administration.10
One cause of this in the offices of social agencies is due to a tend
ency among employees, in all types of agencies devoted to social
betterment, toward the attitude that such offices should be different
from commercial offices; that rules tend to institutionalize, and that
only by granting entire freedom to each employee can the organ
ization escape the curse of “ commercialism.” Such an attitude
results from failure to realize that real freedom to work is attained
by the group only when through unanimous agreement each member
of the group abides by whatever regulations will promote the best
working conditions for the group as a whole. Some executives
hold that what they term “ classroom methods” of discipline are
out of place in organizations staffed by adults; furthermore, they
contend that an expert or person engaged upon special work can
not be held to any standards other than those acceptable to the
• Schulze, J. William: Office Administration, Ch. III. McGraw-Hill Book Co., Inc., New York. 1919.
Galloway, Lee: Office Management, Its Principles and Practice, P t. VI, Ch. X X X .
i®Schulze, J. William: Office Administration, p. 35.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

individual. The result of this attitude is seen in the unbusinesslike
offices in which there is a distinctly social atmosphere. Many hours
are wasted daily in irrelevant conversation, much of which is “ pro
fessional gossip,” the term which should be applied to all discussion
of cases, methods, etc., which is nonproductive of beneficial results
either to the individual, the organization, or the community. One
commercial organization which became convinced that many needless
interviews were being held, asked each member of the organization
to fill out a slip for every interview within the office for a period of a
week. The slip showed names of persons interviewed, subject and
duration of interview, and person responsible for the interview.
Analysis of the slips at the conclusion of the week divulged several
types of interviews which could be eliminated through the adjust
ment of office routine, and a large amount of social conversation,
which was presumably at a minimum during the inquiry. I t is
possible that some public health nursing organizations might find
such a study profitable, and it is not improbable that the executives
might find themselves among the chief offenders in the m atter of
“ nonproductive” interviews.
Training office employees.
The training of every employee should begin simultaneously with
her entrance upon duty. But generally the stenographer, clerk,
typist, or volunteer who is employed to perform some one of the
clerical tasks in a public health nursing office is introduced to the
other members of the office force, seldom to the nursing staff, and
then permitted to grope her way through her duties, often learning
what is expected of her through the expensive and nerve-racking
method of making mistakes. She is seldom properly supervised or
checked, and no suggestion is made regarding methods of improving
her own work, nor is she given an opportunity to learn the relation
of her work to that of the entire organization.
If she is diligent, the fact that she is working improperly is seldom
discovered until many errors have occurred and the employee has
become firmly established in the wrong method of performing her
duties. The employee who works steadily without asking questions
is often credited with an ability she does not possess, while the one
who asks questions may be judged incapable if the executive dis
likes to be interrupted. The use of an office manual will obviate
the necessity for many questions, but the executive should wel
come intelligent inquiries and suggestions, and should regard with
doubt the employee who is always satisfied with conditions as they
exist, who never sees a better way to perform her duties, and can
never make a suggestion for the improvement of matters which
come under her observation.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE SELECTION AND TRAINING OF EMPLOYEES.

Group conferences.—In addition to supplying specific instructions
covering the duties of each member of the office staff, group instruc
tion in matters of general importance to the organization give impe
tus to a steadily rising standard in that department. Group confer
ences have been provided for the nursing staffs of many organiza
tions, but practically no attention has been given to training or pro
viding opportunity for instruction for the clerical members of the
staff, although they stand in as great need of it as the nurses. A
superintendent will frequently state that a nurse who has been doing
any one of the numerous varieties of specialized public health nurs
ing must be given additional training before she serves satisfactorily
on the staff of an organization giving generalized service. Again, the
superintendent of an infant-welfare society will emphasize the need
for careful instruction and supervision of the nurse who comes onto
her staff from a visiting nursing association where generalized service
has not afforded the opportunity for highly specialized care of in
fants. If it is necessary to remodel the training of a nurse who has
had not only her nurse’s training but, in addition, experience in some
other form of public health nursing, how much more should it be
necessary to give careful attention to the instruction of the person
who is to be responsible for the clerical work, which is the medium
between the nursing staff and the public, and to whom the field of
public health nursing is quite unknown.
Training staff nurses.
There is a constantly growing recognition of the need for definite
training of staff nurses who have been added to an organization, es
pecially in the case of those nurses who have had only institutional
experience. Organizations located in cities where there are facilities
for classroom work frequently arrange for special courses bearing
upon public health nursing or related subjects and, in addition, give
technical instruction, both individual and in weekly group meetings
with the supervisor or superintendent.
,
Training districts.—In several of the larger cities nursing organiza
tions have set aside certain districts to be used as training districts.
Here, nurses on probation are taught the technique of the organiza
tion, members of the staff who manifest hitherto unsuspected weak
nesses are given an opportunity to correct them under close super
vision, and if there is a local course in public health nursing the
training district supplies the opportunity for supervised field work.
Efficiency records.—Instruction in the nursing technique of an or
ganization varies according to the standards of the director or super
visor of nurses responsible for training the staff nurses. I t is cus
tomary for the supervisor or one of her assistants to accompany the
new nurse on her duties at least once each week during the period of

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION'.

her probation, and at least once each month thereafter. In order to
determine the progress of the nurso in adapting herself to her duties,
and also to provide information regarding the efficiency of the super
visor, several organizations have adopted efficiency records which are
made out by the supervisor following each visit of observation with
a nurse. These records call for few items, but they are planned to
show whether helpful supervision has been attempted and to justify
the action taken in cases of promotion, demotion, or discharge.
Emphasis is placed upon the fact that general remarks have no value
unless supported by specific instances.11
Statistical training.—One feature of training for staff nurses which
has been, most neglected is that pertaining to record keeping, sta
tistics, and interpretation of statistics. I t is an accepted fact among
both the nurses and the general public that the majority of nurses
dislike keeping records and are not interested in statistics. Confer
ences with several hundred public health staff nurses have revealed
the truth that their indifference is imaginary rather than real; a little
instruction and explanation of the value of careful record keeping, a
few examples of statistics and their use and even the most bitter
critic of clerical work becomes willing to keep better records. Many
nurses have reported that they disliked clerical work chiefly because
so little use was made of the information secured. This is a legiti
mate criticism of much record keeping. If records are poorly
planned or poorly kept, they are of little value for statistical pur
poses and, as a result, it happens frequently that many hours are
wasted in unproductive clerical work. The section on case records
will develop plans for eliminating this wasted effort and suggest
methods for enlisting the services of the staff nurses in securing the
greatest amount of information with the least expenditure of time
and effort on the part of the nurses.
General staff conferences as educational aids.
In public-health nursing organizations, as in every other organiza
tion employing both a field and an office force, group antagonism is
not uncommon. I t is the duty of the superintendent to turn this
antagonism into a spirit of cooperation and mutual helpfulness.
This can easily be done by teaching the nursing staff the importance
of clerical work and by showing the office staff the numerous ways it
can aid the field staff. The spirit of unity can be fostered further
through requiring the attendance of both the field and office staff at
periodic meetings held at least once a month where matters of interest
to both groups are presented after careful preparation by the superr
11 Efficiency records have been in use in the following organizations: Boston Instructive District Nurs
ing Association; Philadelphia Visiting Nursing Association; Chicago Visiting Nursing Association; Chicago
Infant Welfare Association; Henry Street Visiting Nursing Association, New York City.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE SELECTION AND TRAINING OF EMPLOYEES.

intendent in conference with the office manager and supervisor of
nurses.
The entire success of staff meetings is dependent upon the skill,
enthusiasm, and careful preparation of the superintendent or person
who is to be in charge of the meeting. There should be encourage
ment of frank constructive criticisms, ready and sincere appreciation
of helpfulness, and a general spirit of united effort to improve all
phases of the organization’s work. Quick recognition and sup
pression of irrelevant discussion, fault finding as distinguished from
constructive criticism, and other disturbing features of the meeting
must be the responsibility of the leader.' Her task is difficult but
the results will prove it worthy of her best effort.
Illustrations, charts, maps, photographs, stories—all the methods
used to interest the public—may be used to advantage in presenting
facts to the staff. If there are several members of the staff who are
able to present material interestingly, each should be given charge of
a meeting or assigned to take part in one. The clerical staff will be
found to discover more interest in case records if they can occasionally
hear a well-prepared story of the experiences of the nurses in special
cases and in turn it will be equally interesting to the nurses to hear
reports from the office manager and her staff on the various phases
of the office service.
Among the subjects which should be covered in the talks to both
the field and office staff during the year are (1) the work of every
social agency and institution with which the organization has, or is
likely to have, any connection. If possible, it is desirable th at these
talks be given by a representative of the organization or institution
described; (2) an annual review of the work of the organization and
outline of plans for the coming year. This should not be the same
type of report as that to the board of managers or that for the public,
but should include discussion of the features of the work which would
be of interest only to those who are performing it; e. g., it might
include descriptions of a plan for new filing systems, rerouting the
clerical work to eliminate wasted effort, suggestions for additional
study classes, etc.; (3) a complete health program for the city and
the part the public-health nursing organization should take in it;
(4) record keeping as a basis of case knowledge, organization accom
plishment, public information, and education; (5) interpretation of
statistics based on case records.
Additional subjects for group meetings will be suggested by staff
members and will occur to the executive as the meetings proceed.
The interest will vary according to the skill manifested in planning
and directing the meetings.
One of the best organized plans for regular staff conferences is
found in the Instructive District Nursing Association of Boston. Its

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

weekly conference is attended by 130 nurses, including students, staff
nurses, and substitutes. In addition, the group includes several
delegates from the Baby Hygiene Association, members of the nursing
committee, and the extension secretary of the association. The
chairman of the program committee is a staff nurse, supervisor, or
assistant supervisor; one member is a delegate from the Baby Hygiene
Association; and a third is a staff nurse; the secretary is a student
from the School of Public Health Nursing. At the opening of the
meeting the director and assistant director of the Instructive District
Nursing Association, the director of the School for Public Health
Nursing, the director of the Baby Hygiene Association, and a member
of the program committee occupy the platform while the director of
the Instructive District Nursing Association presents to the conference
such matters as these officers think should be considered. The officers
then retire from the platform, leaving the chairman of the program
committee to preside.
Representatives of other agencies are frequently asked to address
these meetings, but the executives feel that the chief value of the
conferences lies in the general discussion in which all the nurses take
part.
The library as an educational aid.
The organization library may be built up in many ways and its
growth is usually gradual. The budget may provide for purchases
up to a certain amount each year, interested board members may con
tribute certain volumes, members of the staff may loan personal copies
of desirable books or magazines, and arrangements may be made
with the local public library to purchase and loan to the organization
books recommended by the superintendent. There is little need for
discussion of the desirable books and magazines for such a library so
far as they pertain to the nurses’ problems,12 but there is much to be
said on the subject of providing books and magazines on the admin
istrative side of the work dealing with the office. Any organization
in a city having a chamber of commerce may secure valuable advice
regarding books on office administration and allied subjects, for it
is rapidly becoming a feature of chambers of commerce to maintain
for the use of their members specialized libraries on the various tech
nical subjects in which business men are interested. If they can not
loan books to the nursing organization they will undoubtedly be
glad to arrange for their use in the chambers1 rooms. Help may be
secured also from schools of business administration.
I t is true that books written exclusively for commerical firms do
not apply in many respects to public health nursing organization
12Carr, A. M., and Bradley, Florence: Reading Lists on Organization, Administration, and Develop
ment of Public Health Nursing. National Organization for Public Health Nursing, New York, 1920.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE LOCATION AND LAYOUT.

problems, but careful selection will yield many valuable results and
the progressive superintendent of a public health nursing organiza
tion will find that both she and her office manager will profit by closer
study of the methods in présent use in commercial offices and there
will be many sections in commercial books which can be read with
advantage by all members of the staff.13
OFFICE LOCATION AND LAYOUT.
LOCATION OF BUILDING.

The central or main office of an organization should be centrally
located, and if the area served is large enough to make transporta
tion an important consideration it should be as near à car line as
possible.
District or field offices, where they exist, should be located with
reference to* the center of population of the district they are to serve
and not in the physical center of the district, unless the physical and
population centers are coincident. If these districts cover large ter
ritories, location of the district office near transportation facilities is
desirable.
„
'
CONSTRUCTION OF BUILDING.

The building should be well constructed; it should be weatherproof
and reasonably fireproof, with easily accessible exits constructed in
accordance with the best fire laws. Fireproof buildings command
higher rentals, but they provide greater assurance for the comfort
and safety of employees, make possible a lower rate of insurance,
and provide better protection for the equipment and supplies of the
organization.
• TENANTS.

The type of tenants permitted in the building must be considered.
Frequently it is possible to secure space in a building housing other
social agencies or the offices of physicians. This is highly desirable
if cooperation with these exists or should exist. Consideration will
be given later to some economies of office administration made pos
sible by such cooperation (p. 43).
NUISANCES.

I t is seldom recognized that the efficiency of office employees is
influenced to a great degree by the presence or absence of such
nuisances as jarring motions caused by heavy machinery in opera
tion, disturbing noises, and disagreeable odors. The building and
neighborhood should be studied carefully for such nuisances before
à lease is signed.
w For bibliography on office administration and allied subjects see p. 117 of this report.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION-.

BUILDING SERVICE.

Building service is an important factor to consider in connection
with rental. Janitor service, window washing, a modern lighting
system, heating, awnings, vaults, safes, cleaning, and free storerooms
m,ay be the cause of higher rental and may justify the difference.
The adequacy of the heating system and the quality of the service
maintained during the coldest months of the year may prevent fre
quent illness among the staff during the winter. Accessibility to
hot and cold water supply and adequate sanitary toilet and rest
rooms are also points of importance in the selection of the building
in which an office is to be located.
Building storage facilities.
Before selecting office space, it should be ascertained that sufficient
storage space is available to permit the purchase of supplies in large
enough quantities to secure wholesale rates wherever *practicable.
The storage space should be well lighted and protected from dirt,
mice, water, theft, and fire. If it is far from the offices—i. e., in the
basement or on another floor—it will be necessary to keep sufficient
supplies in the office for short periods, but this is preferable to en
deavoring to house all supplies in the office in the back of files, in
empty bookcases, and in other available spaces. Such false economy
results in the waste of hundreds of dollars annually, because it is
inevitable that all paper supplies will suffer some loss if carelessly
stored.
LOCATION WITHIN THE BUILDING.

Light, ventilation, quiet, fresh air, cleanliness, sufficient space
for present needs and satisfactory provision for expansion are the
fundamental points to be considered when selecting office space.
In this connection it should be remembered that the time spent in
transit between the office and the storeroom, toilet, or elevator may
be kept to a minimum by careful attention to the location of tho office.
Galloway says: 14
If choice is possible as to exposure, the east is generally found best, north second
best, with south following as a third. The west, because of the afternoon sun is con
sidered least satisfactory.
It must be> remembered that every office building has both advantages and dis
advantages which need to be weighed against each other and a balance struck in con
formity with the needs of the business.

Light.
With regard to the matter of light, both natural and «artificial
light must be considered. The former necessitates attention to the
number, size, and location of the windows and their outlook. Gal
loway says:15
_________
- .
u Galloway, Lee.: Office Management, Its Principles and Practice, p. 47.
15 Ibid., pp. 46, 47.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE LOCATION' AND LAYOUT.

A location above the surrounding buildings, say the seventh floor and over, ia
generally the best. The fifth floor should be the lowest lim it if the street is noisy.
As to outlook, the outside distant view is considered preferable. The outside view
over a large court is the next best, while the outlook upon a small court is the least
satisfactory.

Obviously, these rules would apply only to the central or main
offices of nursing organizations in large cities.
The artificial lighting system should afford a clear light which will
minimize shadows and glare, and there should be a sufficient number
of floor or wall sockets to permit supplementary desk lamps wherever
necessary. The room which is poorly lighted at midday in summer
will need artificial light the greater part of the year, which means a
greatly increased lighting bill. But what is still’more expensive, it
means eye strain and greatly impaired efficiency for the entire office
staff.
,
Ventilation.
Proper ventilation is one of the cheapest and best ways of increas
ing office output while at the same time increasing the health and well
being of the office staff, but it is seldom given the consideration its
importance merits. I t is an anomaly of public health work that
some of its executives permit violations in their offices of the ventila
tion principles which their staff nurses are paid to teach in the homes
of their patients.
Neighbors.
Even though the other tenants in the building are acceptable,
per se, they may prove highly objectionable as neighbors if the nature
of their work is such that it interferes with the work of those in neigh
boring offices. Practically all of the work performed in the main
office of a public health nursing organization demands a high degree
of concentration if it is to be performed accurately, quickly, and with
a minimum of nervous strain. For this reason it is highly desirable
that no noise, odors, or other nuisances from neighboring offices
shall be discernible.
Rental.
One of the most prevalent methods of reducing overhead expense
for public health organizations privately supported is in the matter
of rental. If quarters can be secured, rent free, in an undesirable
building, it is usually considered the proper economy to accept them
without further discussion. I t is frequently said that no organiza
tion can afford to refuse an offer of free or reduced rental even though
the quarters are not desirable, as to do so would bring the accusation
of extravagance upon the organization. If those responsible for
directing the organization know how to present clearly the false

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

economy of the proceeding, fair-minded people will soon realize that
such procedure constitutes extravagance in the long run.
' '
Free, or low rental is generally accompanied by one or all of the
following disadvantages:
1. The building is not favorably located for the work of the
organization.
2. The vacant space within the building available for office and
storage space is either inadequate or otherwise undesirable.
3. Repairs or other alterations will not be made unless imperative.
4. The tenant is in constant danger of being required to move
at short notice if a permanent, paying tenant is found.
This one item alone is sufficient to warrant refusal of free
rental because it involves—
(a) Cost of moving (this includes cost of employees’ time);
(b) Wear and tear on furniture and other equipment and
frequently loss of supplies in transportation;
(c) Cost incurred in changing address on all printed ma
terial bearing it;
(d) Inconvenience to the public and to the organization
in connection with mail distribution and in loss
of time to those who visit the organization’s old
quarters through ignorance or forgetfulness of the
change of address.
The false economy in accepting free quarters inconveniently lo
cated may be proved easily by computing the number of hours each
nurse wastes daily in traveling the additional distance. Business
men will appreciate having this loss of time translated into annual
waste of the organization’s funds. This is accomplished roughly by
multiplying the number of hours wasted daily by the entire nursing
staff by the number of working days in the year; this total is multi
plied by the average hourly pay of the staff nurse.
Laying out the office.
The executive of a public health nursing organization who systemat
ically plans the arrangement of her office before accepting gift space
or signing a lease finds the increased efficiency with which her office
functions ample payment for the time expended in the preliminary
planning.
Acting upon the principle that the office should express, in a meas
ure, the administrative organization, the first step is to determine
the number of rooms needed and their relation to each other. Next,
a detailed plan should be made on paper showing the location and
size of offices and the location of each piece of furniture and equip
ment. Care must be taken that the plan is drawn to scale and that
every member of the staff and-all equipment and supplies have been

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

considered. The plan must then be tested. This is done (1) by
studying each type of work performed in the office in order to be sure
that the various rooms are assigned most conveniently; (2) by
studying the work of each individual to be sure the equipment she
uses regularly is arranged so as to save her time; (3) by seeing that
the desk and other equipment of each employee are arranged with a
view to the convenience of other members of the staff whose work
touches upon hers.
Office storage space.—Following the residence building principle of
built-in furniture, the public health nursing organization will effect
a saving of money, space, and furniture if it is possible to build
lockers and shelved storage closets within the office space of the organi
zation. Sometimes a hall is unnecessarily wide and one side may be
profitably cut off, or there may be some available space in several dif
ferent rooms. Each organization must plan according to the space at
its command, but whatever plans are made, they should include ade
quate and proper space for the hats, winter coats, overshoes, and
umbrellas of the entire staff and also some space provision for addi
tional members of the staff who will be added as the work of the organization develops. The plan must also provide for storage space for
supplies. If all necessary supplies can not be kept within the office
space, provision should be made for locked space adequate to house
at least one month’s supply.
OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.
SELECTION OF FURNITURE AND EQUIPMENT.

Many offices of public health nursing organizations under private
control and some under public supervision are furnished with a miscel
laneous assortment of furniture and other equipment assembled
through varying periods and consisting of cast-off pieces from offices
and homes, donations from local merchants, and necessary additions
purchased from secondhand stores. When new furniture is purchased,
frequently the only guides are: (1) Will it serve the purpose? and
(2) Is it cheap ?
Even these requirements are seldom carefully and understandingly tested. The following discussion of typical office equipment sug
gests that the necessity for careful selection of office furnishings is
essential to the successful administration of the office of an organiza
tion, regardless of its size:
“Cheap” furniture.
I t is commonly supposed that the cheapest furniture, supplies, etc.,
are those listed as gifts; next come those purchased as second hand;
third, those that are new, but secured at a reduced price; and fourth

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

and most expensive; those purchased at regular retail prices. As a
matter of fact, the order may be reversed when tests are applied to
determine what constitutes real and apparent cheapness. A clear
example of mistaken economy is found in the case of an executive
who assumed that anything secured from a secondhand store was
necessarily cheaper than new furniture. She purchased some files
which were slightly shopworn, only to learn later that she had paid
several dollars more for them than new ones of the same style and
make would have cost had she secured them from the office supply
house. This shows the necessity for obtaining prices from all firms,
both regular and secondhand dealers before making purchases.
Another executive had purchased desks for the stenographers but
had accepted a miscellaneous assortment of chairs for their use from
the offices of two directors of the organization. Investigation showed
that the height of the chairs was such that the speed of each stenog
rapher was materially lessened, to say nothing of the added nervous
strain and other evils resulting from improper position. • The instal
lation of adjustable chairs regulated to the height of the desk, foot
stools for those needing them so that the position was comfortable
and proper, showed an immediate speeding up of output, lessened
fatigue, and improved disposition on the part of the stenographers—
in other words, the office efficiency was increased and the expense of.
this particular item of output was .decreased.
An item that may be very expensive from the point of view of
time and energy is files. A file drawer that sticks may consume sev
eral seconds or minutes in opening and shutting, when a smooth
running drawer will take but two seconds. If the wasted time is
multiplied by the number of times the drawer is opened and closed
each day and this translated into dollars and cents, based on the salary
of the person operating the drawer, it will be a simple matter to prove
to even the most skeptical that the file drawer which fails to function
properly is a loss in dollars and cents to the organization. What is,
or should be, equally important to an organization which exists to
promote health is the fact that a great deal more strength is necessary
to open the drawer which resists —the difference in pull often amount
ing to several pounds. This can be tested by attaching a spring
scale to the handle of the file drawer and observing the number of
pounds of effort required to open it. The cumulative effect of the
effort wasted in opening and shutting the drawers in poor working
order is to slow down production, thereby increasing the cost. More
important still, it consumes effort and strength needed for construc
tive work.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

Standard equipment.
Although it is not strictly necessary, it will be found advisable,
when possible, to select a standard type of furniture and to adhere to
it when making additional purchases. The office which presents a
uniform appearance as to the wood, finish, and style of its furniture
not only makes a better impression on visitors but it has a decided
effect upon the efficiency of the workers. There is a certain pride in
being connected with a neat well-equipped office and there is also a
stimulus and incentive to keep everything connected with it in up-todate order which frequently is lacking in the office that is a hodge
podge of styles in furniture and other equipment.
Desks.
Desks should be selected with a view to the purposes for which they
are to be used. Equipment houses have developed a large assort
ment of styles from which it is possible to select the exact type best
fitted to each kind of work. Few executives outside the commercial
world jgive this m atter the attention it deserves. Desks are ordered
according to the amount of drawer space available, not because the
drawers are needed but because they are convenient. I t should be
emphasized here that a desk should never be used for storage pur- •
poses, but should serve as a means for the prompt dispatch of busi
ness. The roll-top desk encourages disorder and storage propen
sities, and for these reasons has been banished from most up-to-date
business houses and the flat-top desk substituted.
The executive in selecting her- desk should apply the same tests
that she applies when choosing desks for other members of the staff.
Frequently the executive is the worst offender in the m atter of ac
cumulating in her desk drawers papers and correspondence which
should be in the files or otherwise cared for. Each drawer should
have a definite purpose which should be strictly adhered to, but great
care should be taken in defining the purpose if the desk is to be an
aid rather than a detriment to the functioning of the organization.
In assigning one drawer to “ unfinished business” the executive
should remember that her efficiency is properly gauged by the
promptness with which she disposes of all matters presented to her,
and her desk should aid in the prompt handling of all business that
comes to it. Selection of the clerks’ and stenographers’ desks should
also be made on the basis of the work they are required to do. The
drawers, if there are any, should be labeled and nothing should be
placed therein except the material for which they are intended. I t is
a great aid to the supervisor of the office if there is a strict rule that
no unfinished business shall be placed in the drawers of any of the
staff desks. Wire baskets which are collected and locked up each
night and redistributed each morning are an incentive to finishing

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

each day the work of that day, and this procedure does away with an
accumulation of unfinished odds and ends which so frequently be
come sidetracked in the desk drawer of some staff member. I t saves
much time if each clerk and stenographer keeps in her own desk a
supply of the stationery and record forms which she uses daily.
For this reason drawer space is desirable.in the desks used by these
employees. One drawer should be reserved for record forms, one
for stationery supplies, one for personal belongings, and one (gen
erally a shallow drawer in the center) for pins, rubber bands, clips,
etc. As most stenographers are required to do some clerical work
it is desirable that they should have combination desks. The best
of these for the small office is 32 by 38 inches in size. I t has three
drawers and a drop top for the typewriter. If the entire desk top is
needed regularly at the time the typewriter is in use, the side attach
ment for the typewriter may be used with any style of desk.
Tables.
The fact that many executives use tables to supplement their desk
surface has given rise to the manufacture of tables of various sizes
finished to harmonize or correspond to all sizes and styles of desks.
They are the proper height and may be utilized for many purposes.
Every office needs at least one, the size to be determined by thè size
of staff and number of volunteers. A long table is needed for meet
ings of the board of directors, for committee meetings, for the weekly
meetings of the staff, and for volunteers who do special pieces of
clerical work; e. g., sending out annual reports, where the work is
materially speeded up by having’ each person perform a specified
part of the task, provided that the workers are seated close together
in the order in which their tasks are completed—addressing, filling,
sealing, stamping. When there are books to be kept a large table is
invaluable, although many offices find it necessary or advisable to
use the old-style bookkeeper’s desk with the sloping top.
Files.
The small public health nursing organization generally needs one
four-drawer letter-size vertical filing cabinet for its correspondence
and records and forms of the same size, and sufficient filing space
for its case records. As practically every organization expects to
enlarge its work, the initial purchase of filing equipment should be
made with a view to the fact that the system is to be extended. . This
means that file drawers built for the unit system of files should be
purchased, which saves the cost of additional bases, panels, and tops
for each drawer purchased. I t is advisable that the person who is to .
make the purchases should call in representatives of the various
office-supply houses in the city, who will study the material to be
filed and advise the system best suited to it.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

In purchasing files the buyer should always remember that floor
space is valuable; therefore, the smallest and most compact files that
will serve the purpose should be selected.
One executive who was unused to administrative work ordered a
four-drawer letter-size file without making 'a careful study of her
needs. Later sHe found that she needed only one of the drawers,
and the remainder of the file became the storage place for all manner
of supplies and odds and ends—a most expensive storage room. The
needs of the commercial office have developed so great a variety of
filing devices that any executive can find exactly the proper type of
file for her material if in planning her material she has paid atten
tion to the standard sizes adopted by the commercial world for
stationery and record forms. The purchase of a file too large for the
material placed in it means waste file space, waste floor space, and
untidy filing—all expensive and unnecessary.
Material which is of permanent value but not in current use should
be placed in storage files of the same style but of cheaper material.
Chairs.
Chairs which are the proper style and height for the worker are
one of the cheapest methods of improving office output and at the
same time preserving the health and comfort of the employees. An
adjustable chair with a comfortable seat is the best type for most
purposes. “ Motion studies” in commercial offices have shown that
in office clerical work, especially typing, the best results are secured
if the worker’s wrists and forearm are level, and the upper arms are
30 degrees from the vertical. This necessitates careful attention to
the relation of the chair to the desk or table height. Interesting
discussions of “ posture studies” showing the importance of this
adjustment are found in practically every book on office management
and in many on factory management.16
Telephone service.
The telephone is one of the most important pieces of equipment
in any office which has a field force and which should be easily
available to the public. Few public health executives realize the
multitude of services the telephone may perform and seldom is the
importance of its position considered at the time of installation.
For the office consisting of more than one room it is a great saving
of time and effort if some type of inter-room service is arranged for
at the time the service is installed. If the office is located in a
building having switchboard service the additional charge for the
use of this service will generally not prove too high to compensate
!« Galloway, Lee: Office Management, Its Principles and Practice, pp. 187-197.

57716°—22----- 1

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

for the time saved. In case the Switchboard service is inefficient
the judicious use of extensions and buzzers will frequently supply
a satisfactory substitute. Practically all executives find need for a
private office; consequently an extension telephone should be placed
in it and it should be so arranged th at a call is indicated by a buzzer
from the outer office. A bell which rings in the executive's office
each time there is a call for the organization is an unnessary dis
traction and should be avoided.
If the staff nurses are required to do their telephoning from the
main office, there should be a telephone or an extension in the room
where they meet. In one office in which the nurses’ room was across
a wide hall from the main office room where the telephone was located,
a great deal of time was lost daily by each nurse going back and forth
and waiting for another nurse to complete her calls. If the line
was busy it meant more than one trip for the nurse and a correspond
ing interruption to her record work. By placing an extension
telephone on a table near the nurses’ work table, a great saving of
time and energy was effected.
All incoming calls should register only at the telephone on the
desk of the person responsible for recording calls for nursing service,
and it should be possible to send outgoing calls from any of the
extensions. A line for outgoing calls only is a great aid during
rush periods, epidemics, annual meetings, etc., and is practically a
constant necessity for an organization having a number of district
offices.
Typewriters.
No public health nursing office is too small to require the use of a
typewriter and generally the best economy is to purchase new
machines. Aside from the fact that every notice and all corre
spondence issued from the organization should be written on a type
writer and a carbon copy retained in the office files, a typewriter
renders invaluable service as a duplicating device and is a valuable
agent in maintaining legible records and legible files.
The organization which can afford an additional typewriter With
one of the longer carriages will find it particularly useful when pre
paring charts or tables which are too large for the carriage of ordinary
length. But unless the amount of long-carriage work justifies the
extra expenditure, only the short-carriage machines should be
purchased, because (1) the long-carriage machines are heavier and
therefore more difficult to operate, which retards production and is
wearing upon the operator; (2) they are more easily broken, owing
to the weight of the carriage; and (3) they are more expensive.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

Copyholders.
Galloway says :17
An indispensable typewriter accessory is a copyholder. The earliest form of this
device consisted of a small stand on which the notebook was placed and held in
position by means of an elastic band. The newest developm ent, which is a good
improvement over the old method because it aids both accuracy and speed, is a
device which is screwed to the desk behind the typewriter, where it holds the note
book or the matter to be copied. B y pressing a lever to the right of the keyboard,
the copy is raised one, two, or three lines at a tim e as may be desired. A “ lin e finder ”
also prevents the operator from skipping a lin e or two as she works. The device
prevents eye strain, because the copy is directly in front of the operator, both her
eyes are equally distant from it, and she does not need to keep her head turned to
one side as.she works. She is thus able to maintain a natural and easy posture.

Labor-saving devices.
Public health nursing organizations have made little use of many
labor-saving devices which are on the market, largely because they
are too expensive for small organizations. But many of them are
savers of so much time and labor that a group of social-service organi
zations might find it well worth their while to purchase cooperatively
one or more of the more expensive machines, particularly if the
organizations are located in the same building. This applies to
duplicating machines, addressographs, calculating machines, book
keeping machines, etc. Even the smaller organizations should soon
find it possible to purchase the portable calculating machines, which
would be found invaluable by both the bookkeeper and the statistical
clerk.
Perhaps the best summary of the value of labor-saving machinery
is found in Schulze’s volume on Office Administration:18
Much might be said in the way of description of various mechanical devices, but
such a discussion would,really parallel the advertising pages of some of the business
magazines. It seems more desirable to offer two fundamental suggestions in this
connection. First, decide upon the functions necessary to perform the task in hand,
and look for the mechanical device that w ill perform this work more quickly and more
cheaply than human beings or than any other device. Second, a machine capacity
is capable of measurement, and it is poor business to invest several hundred dollars
in a mechanical device on hearsay or on a chance. Careful and fair tests of several
machines should be made upon work as nearly as possible identical w ith that in hand
and the results should be tabulated in comparative form. The machine or method
which w ill perform the work more quickly, more accurately, and more cheaply than
any of the others should be selected, regardless of what experts think. There are
cases on record of the purchase of a three or four hundred dollar calculating machine
when a sim ple slide-rule at an insignificant cost would have served tlje purpose just
as w ell or better.
Before leaving the subject it should be said that an alert office manager w ill familiar
ize himself with all the various office appliances known and w ill approach his study
of each of them with an absolutely open mind. The original cost of the machine,
17 Galloway : Office Management, Its Principles and Practice, pp. 186-188.
18 Schulze, J. William: Office Administration, pp. 108-110.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

even if large, should not be a deterrent, provided its cost spread over the life of the
machine actually can be demonstrated to be sufficiently less than the cost of any
other known method or device to warrant the purchase. Not has the last word been
spoken upon office appliances. It is conceivable that an ingenious office manager
can invent an appliance to perform a special task better than a machine already on
the market, or by a specially devised attachment can improve a standard mechanical
appliance.

The last statement of the above quotation is especially true of
office managers for agencies supported by public or private funds.
Frequently sufficient money is not available for the immediate pur
chase of a labor-saving device, even though it be ever so desirable.
But careful study may reveal to the ingenious office manager some
principle which may be applied successfully to her own work without
the purchase of the expensive machinery. In a small way this was
illustrated by a clerk who was obliged daily to sort several hundreds
of cards, first alphabetically and then numerically. In a commercial
office she had seen the check sorters occupying only 4 by 6 by 8
inches of space, provided with both alphabetical and numerical
indexes moving backward and forward upon two steel bars. I t
occurred to her that it would be unnecessary for her to cover her
desk and an adjoining table with her records as she sorted them if
she applied the principle observed in the check sorter. Accordingly
she cut down the sides of a pasteboard box the size of the records,
inserted alphabetical dividers, and proceeded to sort much more_
rapidly and easily than when using her former method. Another
box provided with the numerical guides gave the same satisfactory
service.
Another example of versatility is found in the case of an office
manager who needed 30 loose-leaf binders for the field records car
ried by the nurses on the staff. The leather binders would have
cost $1.25 per cover, a prohibitive price for that organization.
Pressboard cut the proper size and punched in accordance with the
holes in the records was prepared by the printer for a small price;
pass^-partout tape was applied to form a binding for the back edge,
and loose-leaf-binder rings were inserted; thus each nurse was pro
vided with a durable loose-leaf binder for her records at a total cost
of less than 15.cents per binder.
Examples could be multiplied, but perhaps enough have been sug
gested to direct the thoughts of office managers to a new field for
profitable exploration. Each office requires different equipment
according to its work, and it is the duty of the office manager to
provide equipment which will promote the work most efficiently and
at the lowest cost. Nowhere is it more true that “ a penny saved is
a penny earned ” than in the office of social-service agencies.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

ARRANGEMENT OF FURNITURE AND EQUIPMENT.

Most women executives unaccustomed to commercial offices
arrange office equipment so as to give a pleasing effect to the un
trained eye, without considering the working efficiency of the arrange
ment. An example of this is found in the case of an executive who
banished the letter files from the front office because their finish did
not match the rest of the furniture in that room, although the change
meant many extra steps for two clerks and consequent loss of time
and energy. Another executive placed the case-record files in a
dark comer where their shabby appearance would not be so imme
diately apparent to the visitor although the new arrangement meant
added eye strain, extra steps for the file clerk, and considerable
addition to the electric-light bill.
I t should be remembered that every drawer in daily use should be
easily accessible to the clerks using it and that file drawers placed
in positions which require extra effort on the part of the clerks are
expensive in time, energy, and general efficiency, which again can
be reduced to actual money loss. One executive had three single
drawer files placed in a vertical row on top of the four-drawer letter
file, thus necessitating the use of a chair each time the two top
drawers were consulted, which was many times daily. The clerks
wasted a great deal of time and energy procuring the chair and
climbing up and down with the drawers. This was eliminated by
placing the drawers side by side on a table which was not in use.
The chief points to be observed in arranging office furniture and
equipment are as follows:19 Economy of space; best possible light;
desks facing the same way to give uniform appearance, if compatible
with other requirements (desks should not face each other,' if it is
possible to avoid this); clerks who work together near each other;
grouping together of equipment used by each individual; grouping
together of equipment used by individuals who work together;
arranging of equipment of individuals responsible for consecutive
duties according to order of flow of work. In addition, equipment
used only occasionally should not be given space which could be
more profitably used by some piece of equipment in more frequent
use.
EQUIPMENT VERSUS SUPPLIES.

Equipment differs from supplies in that the former is of permanent
durability, while the latter is consumed in the course of the work of
the organization. Different forms of the same article may belong
under different classifications; e. g., a wooden lead pencil belongs
under the heading “ supplies,” but if the organization believes i t ;
19 Schulze, J. William: Office Administration, especially p. 158.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

better economy to provide metal pencils, these would be listed as
equipment, although the lead which must be replenished would fall
under the classification “ supplies.”
EQUIPMENT INVENTORY SYSTEM.

Every commercial firm of acknowledged business ability keeps an
inventory of its furniture, machines, and other equipment, as well as
a separate inventory for all supplies.
Equipment inventory.
Property which is not destroyed through use is one of the assets
of the business. In listing it a system is needed which will identify
each piece of equipment regardless of its position in the organiza
tion’s offices. The following system has been used with success by
several public health nursing organizations:
All equipment not listed as “ supplies” should be included in the
inventory, which should be checked once each year at a stated time.
Classification process.
Classify each type of article, giving a different classification to
different varieties of articles usually considered as belonging to the
same type; e. g., chairs may be divided into revolving chairs, caneseated armless chairs, wooden-seated chairs with arms, etc. Assign
a number to each article, commencing with “ 1” for each classifica
tion. This automatically gives the number of articles in each classi
fication and prevents confusion when additions are made.
The inventory number is put on the article in numbering ink in
some inconspicuous place. I t is well to use the same place on each
article so that the number may be found easily.
Record.
Two types of record are necessary for keeping the inventory of
equipment: (1) A typed alphabetical list showing the quantity on
hand, the date of the inventory, and the inventory numbers, and
(2) a card index of the property listed in the alphabetical list. On
the typed alphabetical list the item, “ flat-top desks, Catalogue
No. 147—Inventory numbers 7 to 12, inclusive,” would be entered
under the letter D (desks, flat-top). The headings for the sheetmight be so arranged to eliminate some clerical work; e. g.,
Article.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Catalogue
No.

Inventory
Nos.

147

7 to 12, inc.

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

If the manufacturer’s catalogue number can not be ascertained,
the article must be identified on the inventory by description, as
illustrated in the above paragraph showing classification process.
When the organization adds to its possessions, they should be
given inventory numbers and the last number changed accordingly
on the inventory list described above.
The card index which constitutes the second form of inventory
record for equipment is divided into three sections:
if Furniture.
2. Machines (typewriters, addressographs, calculating machines,
mimeographs, etc.).
3. Accessories (inkwells, book ends, filing baskets, etc.).
Typewriters do not require an inventory number, because they
bear the manufacturer’s serial number and can be listed by that.
Each article is listed on a separate card, 3 by 5 inches in size,
which shows in the upper left-hand corner the classification of the
article. This is followed by the inventory number. On the following
line is given the catalogue number or the description of the article,
and at the bottom of the card should appear the date the inventory
number was assigned. When any article is moved from the office,
note of such removal should be made on its inventory index card, but
the original typed list should not be changed, nor should its inventory
number be assigned a new purchase. New purchases should be
assigned new numbers and cards made for them showing the date
they were added to the inventory.
SUPPLIES.

The control of those articles of the organization’s property which
are consumed in the process of carrying on its business constitutes
the most perplexing problem of the office manager. At the same
time it is in this matter that she may prove most valuable to the
organization from a financial standpoint, as lack of proper control
permits the greatest waste to occur in both the purchase and care of
supplies.
Purchasing supplies.
Centralized purchasing is practiced in the majority of public
health nursing organizations, but comparatively few of them give
the m atter the thought and attention it deserves. In many organi
zations supplies are purchased in small lots as required. The order
is frequently placed by telephone without follow-up typed verifica
tions, and the amount ordered is often determined by chance. A
businesslike office manager by substituting for this careless fashion
of purchasing one which accords with modern business methods

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

frequently can save the equivalent of her salary several times over
during the course of one year.
The requisites for intelligent and economical buying are an accurate
knowledge of supplies on hand, a daily record of supplies used,
knowledge of the length of time needed to replenish supplies, and a
thorough knowledge of the market in which the supplies are to be
purchased. A system which is a great aid to intelligent buying
includes the following: (1) A perpetual inventory, (2) the use of
requisitions, (3) proper storage facilities, (4) systematic replenishing
of supplies.
Perpetual inventory.—The initial step in keeping a perpetual
inventory is the first complete stock taking. This should be done
in an orderly manner and as each count is completed by the stock
taker it should be recounted for verification by her assistant. For
the purposes of the majority of public health nursing organizations,
the following system will be found more acceptable than the more
elaborate systems described in many of the books on office manage
ment.
A letter-size loose-leaf ledger containing ruled sheets may be used
for the inventory entries. Assign a separate sheet for each kind of
article listed; e, g., if several types of pencils are used each variety
should be listed on a separate sheet, the name of the manufacturer
and the number of the pencil being given as an additional identifica
tion of the article.
A simple form for the inventory page follows:
Perpetual Inventory. (Supplies.)
Article....................................................
Date.

Amount on hand at
beginning of week.

Manufacturer...............................................

Amount added dur Amount withdrawn
dining week.
ing week.

Factory No__

Amount on hand atclose of week.

Requisition slips.—When the initial inventory is once under way,
no supplies should be given to any member of the staff without the
presentation of a requisition slip. If the executive chooses to alter
this rule it should be altered in such a way that the supply clerk is
required to fill out a requisition slip for all supplies requested orally.
As they are for temporary use only, any scratch pads or old forms
no longer in use may be cut to conform to the size chosen for the
slips, unless large quantities are needed and a printed form is found
more convenient. The size should conform to the needs of the office,
and it is not wise to dictate a standard size, but it is worthy of note
that a number of organizations having district .offices find the follow
ing form satisfactory. I t is filled out in duplicate, the carbon copy of
a different color being retained at the district office to be used in

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

checking the order for completeness when it is filled and the goods
are delivered.
Requisition No................................................

109

(Date.)
INFANT

WELFARE

SOCIETY

OF ...............................................

To the Superintendent:
The following supplies are needed at
Station ................................ .............
Quantity.

Article.

Estimated cost.
$

Requested b y ......... ...................................................... .........
Approved.................................................................... ..

The form, however, is not so important as is the unceasing and
constant use of these slips for every article removed from the store
room.
If regularity in the presentation of requisition slips is required,
it will do much toward eliminating unnecessary requests for emer
gency supplies. Through experience the persons responsible for mak
ing out the requisition slips learn the amounts required for a given
period. This is true also of the office manager who handles the slips
in the office and she is able to gauge the amounts to be ordered much
more easily than she can with a haphazard method of requisitioning.
Once each week at a stated time the requisition slips should be
sorted by the office manager according to type of supplies and the

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

total amount withdrawn should be entered on the appropriate pages
of the inventory ledger, the totals being entered on the form in the
manner shown below. Once each year it is advisable to check the
report as shown by the inventory with the material on hand, in order
to ascertain whether the supply clerk has maintained an accurate
account. Unless the supply clerk realizes the importance of the
strictest attention to every step in maintaining the perpetual inven
tory the system will result in failure and the entire time devoted to
it will be wasted.
NOTE BOOKS—NURSES—NO. 29.
Balance brought
forward.
Date.

Feb
Mar..

No.

New supply.

Date.

Unit.

No.

Total.

Unit. No. Unit.

2 10 each .. J an . 14 25 each.. 35
1 30 each .. Feb. 10 10 each .. 40
35
1

...

Given out.
For
month.

each. January..
each. February.

No. Unit.

Balance on hand.
Month
ending. No. Unit.

5 each . Jan . 31 30
5 each . Feb. 28 35
Mar. 31 35

each.
each.
each.

Proper storage facilities.—I t is at once apparent from the above
statements that, if the requisition system is to be a success, the sup
plies must not be accessible to anyone but the supply clerk or some
one authorized to act for her. This implies that both the general and
office storerooms must be kept locked and supplies must be issued
only upon requisition as explained above. The ease and rapidity
with which supplies are found and transferred to and from the store
room is one indication of the supply clerk’s efficiency. Wasted time
and effort in the storeroom is as expensive as wasted time and effort
in the office. I t should never he necessary to make a trip to the store
room to determine how large a supply of a certain article is on hand.
This should always be obtained readily from the inventory ledger.
All supplies should he wrapped in packages containing the supply
generally requisitioned at one time. Each package should be so
placed that its contents, plainly printed, will be visible without mov
ing other supplies. A sample of the contents of packages of records,
stationery, etc., securely fastened to the visible side of the-package
is helpful in locating the desired article. When the package is given
out the sample should not be destroyed. If it is too soiled for use
but not too soiled to serve again as a sample on the outside of the
package, it should he saved for this purpose. Few public health
office clerks realize the saving effected by constant watchfulness for
small leaks' Unless the saving is less than the cost of the time spent
in effecting the salvage, it should always be accomplished, regardless
of its size.:

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE FURNITURE, EQUIPMENT, AND SUPPLIES.

Systematic replenishing of supplies.—A properly conducted inven
tory system makes unnecessary the frequent purchase of emergency
supplies and permits regular buying in quantities large enough to
secure the advantage of wholesale prices from the lowest bidder. It
is sometimes said to be a wise policy to buy from board members who
happen to own stores carrying materials which are needed in the con
duct of the organization’s affairs, but because the organization’s funds
are public money there should be no favoritism shown and awards
should never be made without investigating the market thoroughly
and securing bids from all firms handling the desired article. I t is
not sufficient to be familiar with the local resources, for many small
towns have no firms carrying varied and large amounts of office
equipment and supplies. I t is advisable, therefore, that office man
agers keep themselves advised of sources from which they may pur
chase by mail, in order that the best supplies may be obtained at the
lowest prices. Mail-order firms are glad to supply catalogues upon
request and all firms advertising in the business magazines will send
complete information regarding their products upon receipt of
inquiry.
In order to insure the most economical and advantageous buying,
it is imperative that all purchasing be done by one person, preferably
the office manager. The objection may be raised that a lay person
is not competent to purchase nurses’ and medical supplies. The
answer to this objection lies in standardization of all supplies. The
office manager should investigate possibilities and report her dis
coveries, in writing, to the superintendent, who should confer with
those best able to determine which article is best suited to the in
tended purpose. I t may even be necessary for the superintendent,
the supervisor of nurses, or the staff physician to make a tour of
inspection before the decision is finally made, but when it is once
made no further attention need be given such purchases, except by
the office manager, provided, of course, that the selection has proved
satisfactory.
Galloway states 20 very truly:
Be the organization large or small, the following features are necessary for the proper
carrying on of the purchasing function:
1. A purchase order.
2. Inspection and count of goods before the b ill is paid.
3. Ready answers to the questions:
(a) Have the goods been ordered?
(b) From whom ordered?
(c) Price last paid when an order was given.
( d) Have goods been received?
( e) When were goods received?
(f) Has b ill been paid? When?
(g) What amount of goods is carried during certain periods?
•Galloway, Lee: Office Management, Its Principles and Practice, pp. 273-274.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

All steps in purchasing, keeping, and dispensing supplies should be
put into written form and given their place in the office manual.
The standard for each article should he described and all information
provided which would enable a successor to the office manager, or a
substitute, to attend to her duties with as little disturbance of the
office routine as possible.
A card catalogue containing a card for each type of article pur
chased should be kept showing the name of the successful bidder,
the quantity ordered, price, and date of delivery for each order. All
bids should be made in writing and filed for reference. All orders
•should be made in writing or the oral order verified, in writing, at
the earliest moment possible.
Upon receipt of the goods the office manager should check them to
be certain they are as ordered and the new supply should be added
to the inventory ledger account before any requisitions for the
material are honored.
A safe margin should be set, below which the stock supply of any
article is not permitted to fall. One method of insuring a safe margin
is to wrap the stock reserve in paper of some brilliant color which will
automatically notify the supply clerk—-when all the available supply
except the stock reserve has been requisitioned-—that it is time to
order a new supply. The amount kept in the stock reserve should
be governed by the length of time consumed in securing a new supply.
As soon as the goods have been checked and approved by the
office manager, the bill should be stamped with her name, and the
date the bill was approved. The bill should then be filed until the
monthly or semimonthly payment of bills.
PLANNING CASE RECORD SYSTEMS.
THE PURPOSE AND IMPORTANCE OF CASE RECORDS.

The importance of properly planned and carefully kept case records
is, on the whole, little appreciated by the public health nurse until
she finds herself in an executive position where she is dependent
upon the records kept by her staff for the information which will
answer the inquiries of the staff, the board, and the public, and will
provide her with a definite knowledge of the past performances of
the organization and a sound basis for developing the plans for its
future.
Far too little time and effort have been expended in the direction
of informing the staff nurse of the importance of careful record keep
ing; furthermore, many nurses appreciative of the value of carefully
kept records have lost their interest because they have learned that
much of the information secured by them is not used by those holding

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING GASE RECORD SYSTEMS.

executive positions. Naturally, and. rightly, the feeling has grown
that to secure information which is not used is to waste time and
effort'which might be better spent in giving actual bedside care to
sick patients. The resulting indifference toward record keeping can
be overcome only by realization on the part of the public health
nursing executives that a new program must be launched which will
include record systems more carefully planned,'record keeping more
carefully supervised, records more usefully interpreted, and unity
of understanding and performance in the matter of record keeping
by both field and office staffs.
The executive who wishes to carry out such a program should give
her attention to the following points: (1) Explaining to the staff
nurses and to the office staff the purpose of each item on each record
and the part each record plays in completing the record system, and
requesting suggestions regarding items which seem vague or useless;
(2) holding frequent consultations with the nurses to insure that all
have the same understanding of the meaning of items appearing on
the records; (3) preparing carefully written instructions covering each
item on each record; (4) providing careful daily review and correction
of every record made out either wholly or in part during the preceding
24 hours; and (5) presenting to the staff, at least quarterly, the sta
tistical findings, in popular form, based upon the case records kept
by the staff.
The staff nurse who thoroughly understands, and is in perfect
accord with, the purpose of securing information called for by the
items on her records will secure the desired information much more
easily and accurately than the nurse who shows by her very manner
that she considers it of no value and therefore feels apologetic for
making the inquiries.
Another valuable feature of this program is that it will familiarize
the staff nurse with the entire scheme of the planning, keeping, and
interpretation of records, one of the fundamental features of sound
public health nursing administration. If, later in her nursing career,
she finds herself without previous administrative experience, called
upon to execute the administrative duties of an organization, she
will be able to enter upon them with a thorough understanding of at
least that part of her work which forms the framework of the entire
office administration.
Certain excellent record forms for the use of visiting nursing
associations have been suggested. Those designed for urban com
munities are for use in connection with cases of illness by organiza
tions which consider each illness of an individual a new case instead
of a readmitted case. This is the chief factor in the difficulties
arising from the adoption of these records for the use of public health
nursing organizations supervising the health of children of preschool

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

age. The latter organizations consider the individual, and not the
illness, the basis for a “ case.”
The function of the organization supervising the health of chil
dren is to keep the child well instead of placing the emphasis upon
curing illness. This means that records must be devised which will
permit the keeping of histories of preventive measures continuing
over a period of several years, provision being made for the impor
tant points in the child’s development during that period.
These records will vary in complexity from one which provides
for one physical examination by a physician each year, monthly
home visits by the nurse, and periodic visits to the health center by
the mother and child, to a system involving special nutrition classes,
various clinics, hospital service* health centers, and home visiting
by the nurse, each service having a special series of record forms,
but all fitting into one complex system.
In planning its record system an organization should determine
the field it is able to serve and the facilities at its command.* The
next step is to select from proved record systems the'simplest method
involving the least clerical work which will, at the same time, supply
the executive with the essential information for complete control of
the situation. The system thus selected must be adapted to local
needs, given a thorough trial, and changed as experience dictates.
There is a strong tendency among public health nursing execu
tives to continue the use of a given form because it has been long in
service, assuming that long use justifies the continuance of its exist
ence. But changing service dfemands new records and new record
systems. Consequently every progressive public health nursing
organization should consider each year a new opportunity to test
the system of records in use the previous year and to endeavor
each year, by eliminating useless material and by adding helpful
items, to improve its record system. I t is highly desirable that
changes should be made only at the beginning of the year; otherwise
the basis for statistics for the annual report will be destroyed.
If a new service is created during the year, great caution should
be exercised in creating new records, especially if they are to be co
ordinated with records in use previously. I t is wise to have the
first supply of records mimeographed; if printed, the quantity or
dered should not exceed that required for three months. This pro
vides a satisfactory period for experiment and gives an opportunity
to make desired changes without sacrificing a large quantity of un
satisfactory records.
If items on records are found to be useless, they may be dropped
at any time without vitiating the statistics used in the reports of
the organization. But additions to records during the course of
the year mean partial reports at the close of the year, and they should

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING CASE RECORD SYSTEMS.

be avoided. Even though the report points out that certain items
were secured for a given period only, the public will be inclined to
compare them with the figures secured for other items during the
entire year, frequently drawing conclusions at variance with the
facts.
CASE RECORD SYSTEMS.

The performance of an act and the written description of that act
call for widely variant abilities, and it is difficult to find persons who
enjoy both forms of action. Perhaps this is one explanation of the
fact that record systems have been slow of development and have
always followed long periods of unrecorded action.
In all branches of record-employing work, whether it is business,
medicine, public health nursing, or some other form of social service,
the records were at first exceedingly simple but grew in number and
complexity as the administrators and their staffs realized the possi
bilities for their usefulness.
The commercial world is responsible for the greatest strides in
record planning and use, and also for the standardized equipment
which is accepted as a matter of course by office workers in other
fields. Public health nursing organizations have, for the most part,
adopted the standardized office equipment, but they have failed to
realize that proper record keeping involves attention to a multitude
of details which weave in and out of the entire fabric of office manage
ment; consequently they have not followed the commercial example
in the matter of planning record systems with a view to eliminating
all waste effort, which so easily creeps in through unnecessary dupli
cation of items, poor routing, and faulty clerical service.
In the business world, detection, of waste motion and effort is
considered so important that high-salaried efficiency experts are
engaged to investigate and point out how much unnecessary dupli
cation of effort exists, from the work of the office boy up to and
including the work of the president himself. These investigations
are based upon the principle that the machinery which enables the
business to move—to produce—is the system of records, and that it
is impossible, therefore, to build a workable system of records without
first having a comprehensive' view of the entire business. I t is
correspondingly true that a single record can not be planned intelli
gently without consideration of the entire system of which it is to
be a part, if unnecessary duplications and omissions are to be avoided.
As public health nursing organizations develop they frequently
add new types of service and for each new type there is a correspond
ing addition to the record system. One such organization recently
found itself entangled in a record system involving the use of 17
case-record forms which had accumulated as the result of gradually

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

increasing activities in the nursing field. Careful study of the situa
tion made it possible to revise these records so that, without forfeit
ing any of the essential material, the number of records was reduced
to five. This illustrates the need for a more general recognition of
the fact that every change in the service of an organization necessi
tates a careful survey of the entire case-record system to determine
whether revision of part or all of the system will permit the incor
poration of the new service without a great increase in the clerical
requirements for both the field and office staff.
,
Few public health nursing executives give great attention to caserecord systems, per se, and* when asked for a set of the records used
by their organizations, they will, almost without exception, present
the inquirer only with copies of the permanent case-record form
which is kept on file in the main office. The case-record system as
differentiated from the individual case-record form comprises all the
record forms required to record the action of the organization from
the moment a case is referred to it until the case is discharged, and
also sufficient record of conditions to justify the action taken. Ob
viously the system may vary in complexity according to the types
of service rendered and the facilities available for special treatment.
I t is as impossible and unnecessary to describe all the possible
record systems as it is to present case records in a sufficient variety
of forms to satisfy all organizations giving a specified service. But
it may prove helpful to discuss various types of records as they are
used by different organizations in the successive steps of their record
systems. In addition, four types of record systems are offered for
comparison in the Appendix, pages 119 to 207.
Call book versus call slips.
The call hoolc is a daily record of all calls recorded by the organiza
tion ; and it also shows who has become responsible for the call. Its
headings, reading from left to right, include date, name and address
of patient, remarks, source of call and address, initials of nurse,
district.
When the call is received the clerk makes all entries except in that
column reserved for the initials of the nurse. An entry in this column
shows that the case has been noted by the nurse and will be visited
by her during her next visit to her district. If these calls are given
to the-nurse by the clerk over the telephone the clerk’s initials are
entered instead.
The call book is generally used for all messages that are received,
and various methods are used to show which have been delivered.
The advantage of the call book is its permanency and the assurance
that once a call has been recorded it will not be lost. Its disadvantage
lies in the confusion resulting from several nurses attempting to take

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

P L A N N IN G CASE RECORD SYSTEM S.

off their calls at the same time and the danger that some of the calls
may be overlooked, owing to the variety of districts represented on
each page. For this reason some executives prefer call slips.
Gall slips permit the entry of a greater amount of information
than the ordinary call book and have the added advantage of enab
ling the clerk to sort the slips according to district, so that the nurse
finds all the new calls for her district on her desk when she returns
from her visits. One organization used a call slip because it afforded
space for the following information:
Name of patient, address of patient, floor, nursing district, diagnosis, doctor’s
orders, name of physician, address of physician, reported by (name) (address), above
call received by (name) (address), date 192—, hour a. m.,
p. m., case visited
by (name)
date 192—, hour a. m.,
p. m.

This information was printed on yellow sheets 3£ by 5 | inches in
size, the printing running across the width of the sheet. As these
slips were kept for reference for one month following the visit, it
was found necessary to keep them in envelopes according to date.
This proved an awkward and time-absorbing method. Readjust
ment of the items made it possible to have a new form 3 by 5 inches
in size Containing the same information; the smaller size enabled the
clerk to file the slips in a standard card file and to locate a completed
call slip in a few seconds. (See Appendix, page 145.)
If calls are telephoned to the nurses while in the field the slip
should also provide space for the hour the message was given and
the initials of the clerk who did the telephoning; e. g., “ Phoned 3 p m
by S. B.”
Field record.
The second step in recording a visit is the means by which the
nurse carries with her into her district the information which she
has obtained from the call book or the call slip. This step may have
any one of a variety of forms:
Address book—Some organizations recommend an address book
which shows the names and addresses of patients and leaves sufficient
room for abbreviated notes which will show what has been done for
the patient, and the date of the visit. Unless the way in which
entries are to be made is carefully designated, such books can be
extremely wasteful. At best they encourage careless clerical work.
If they are used, nurses should be instructed so to arrange entries in
them that it will not be necessary to write the patient’s name and
address each time a visit is made, as many nurses have been doing.
The name of the street should appear at the head of the page. A
column at the left of'the left-hand page should be reserved for and
headed “ House numbers.” Then follow, in order, the names and
57716°—22-----5

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

addresses of the patients. The remainder of the page and all of the
right-hand page can be ruled to permit entries according to date.
The organization should determine acceptable abbreviations for
each service, and the abbreviations should appear in the manual;
these, and no others, should appear in the address book. The
squares should be large enough to permit the day of the month to
be written above the abbreviation showing the work done by the
nurse; e. g., “ 23 Mod.” means that a modification was taught on
the 23d of the month.
The use of the address book necessitates that the information be
copied onto the permanent case record when the nurse returns to
the office, which is one objection to its use. Another disadvantage
is the tendency to abbreviate in an address book, where there is so
little room for entries, until there is danger of losing valuable informa
tion. There is also danger, of error in the transfer of the information
from the address book to the permanent record.
Daily report sheets.—In some organizations nurses carry daily
report sheets instead of, and sometimes in addition to, the address
book. These daily report sheets offer an opportunity to record in
full the services performed and other information which can be
transferred to the permanent records by clerks or typists. As a
rule they are carried in the bag or pocket and at the close of the day
present a battered appearance. Often the pencil entries are almost
illegible. When typists copy the entries many mistakes are made;
sometimes entries are entered on the wrong case record and the fact
is not noted except by accident. If clerks do this copying it is
highly desirable that the record shall not be filed until the nurse
has verified the entries and approved them by initialing the record
at the right on the last line of the entry. This makes the nurse
responsible for the entry and makes it possible to destroy the daily
report sheet as soon as the nurse has made sure that it has been
copied properly. This system is in operation in several organiza
tions, all of which report it to be highly satisfactory.
Street hook forms.—One method of eliminating the copying at
tendant upon the use of daily report forms is the use of a record for
each individual case. This is carried into the field, generally in
loose-leaf cover. These records may be duplicates of the records
typed in the main office, as are those used by the Maternity Center
Association of New York City, or they may be part of a complemen
tary group, as shown in case record system I. (Appendix, p. 121.)
The entries are made in the field and the records refiled when the
entry has been approved by the supervisor.
Experience has demonstrated that these records can not be kept
sufficiently well to make them practicable as permanent records.
Even the ruling that they must be made out in ink and carried in

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANSriSG CASE B&COBB SYSTEMS.

stiff board covers can not overcome the difficulties arising from
peculiarities of handwriting and consequent illegibility. One organi
zation supplements this record, called in this instance a street book,
by a permanent record 4 by 6 inches in size containing a summary
of the information appearing in the street book. This permanent
record is kept in the main office in a file not used by the nurse, while
the street book record is kept in the nurses ’ file at the district office
and does not reach the main office file until the case is discharged.
At that time the-maf erial is summarized by a clerk, approved by the
supervisor of nurses and the street hook record is then destroyed.
Time book or day book.
The Visiting Nurse M anual21 defines a time book as u a calendar
record of patients seen and calls made monthly. I t is kept by the
nurse in the district and serves as an address book, a guide to the need
of each patient for frequent or infrequent visits and a basis for the
monthly statistical reports.” A form recommended for visiting
nurse associations has been published under the auspices of the
National Organization for Public Health Nursing. This was revised
for the use of a child-caring organization to provide for more types
of service entries, and also to eliminate some of the clerical work.
(See Appendix, Case-Record System I, pp. 133, 134.) Many organi
zations find that the chief value of the time book is the opportunity
it gives the supervisor to see at a glance whether the district is
covered satisfactorily and whether the nurse’s time is distributed
properly. Other organizations believe that the time book is an
expensive method of supervision and for that reason do not use it.
One superintendent21 reported:
Tim© books do not provide a satisfactory medium by which the supervisor may
insure the periodic visiting of well children.
The calendar sheet'covers only one month and is then reversed or removed from the
time book entirely. The well child under 1 year of age who should be visited at
4-week intervals may conceivably be visited the first week in January, and the last
week in February, a 7-week interval, and yet apparently come under the classification
“ visited once monthly..”
Unless some supplementary record is kept of cases not visited during the current
month, and there are many such cases among children of the preschool age, the super
visor can not from the time book alone ascertain what cases are neglected. We find
the time book of assistance in supervising an ill child, but inadequate for the super
vision of the well child who may not require visits more frequently than once in four
weeks.

If daily report sheets are used it is a saving of the nurse’s time to
have the time book kept by some member of the office clerical force.
The recorder is generally the logical person to assume this duty, as
it is from the time book she will secure much of the material for the
monthly report. This work is always available for inspection by
21 Foley, Edna L., Visiting Nurse .Manual. The Visiting Nurse Association, Chicago. 1919.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

the supervisor who reviews each nurse’s time book with her at the
close of each month.
The left-hand page of the time book described in the Appendix is
reserved for items of a permanent nature, such as name, address,
sex, date of birth, date of admission. The names of the patients are
arranged alphabetically, a space of several lines being left at the close
of each letter to permit the addition of names of patients admitted
during the month. The right-hand sheet contains the variable mate
rial such as age, number of visits forwarded, and the checkerboard
section containing a space for each day of the month. In these
squares are entered the symbols for the different types of nursing
visits—the mark I generally being used to designate an instructive visit
and X a nursing or working visit. Some organizations have a third type
of visit which may be represented by a dash (—), which means that
a visit was made, but the patient was not seen, nor was any instruc
tion given to the person responsible for the child’s care. There is
no objection to using abbreviations instead of the symbols suggested
above; e. g., I for an instructive visit, N for a nursing visit, and O for
the nonproductive visit.
The right-hand sheet contains spaces for entries for one month only,
I t can be so printed that it can be used for two months, one month
being shown on each side of the sheet. I t is" advisable that only one
side of the left-hand sheet be printed, as it is generally used until
it is worn out.
Permanent case records.
As mentioned earlier in this report, public health nursing organiza
tions supervising the health of mothers, infants, and children offer
such a variety of combinations of service that it is impossible to discuss
all possible desirable record systems. Several systems now in use by
public health nursing organizations which render such types of
service are given in the appendix and the following section will
present the principles which should govern the planning of a workable
record system. In addition, it should be pointed out that records
planned to record the care given a case of illness must differ essentially
from those planned to carry the supervisory history of the health of
an individual over a series of years. There is a great deal of discus
sion on the part of organizations which have specialized in service to
the sick in regard to the proper method of classifying cases of illness
occurring among children registered with organizations caring for well
children, Observation would indicate that each community must
arrange its plans according to the organizations existing in that com
munity. In a city having only one nursing organization it is gener
ally found more satisfactory to treat each child as a case rather than

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING CASE RECORD SYSTEMS.

to classify each illness as a case, although the latter method is adhered
to in the case of adults.
Complete maternity, infant, and child care by a public health
nursing organization is generally conceded to include:
1. Maternity care—
(a) Prenatal care (dispensary service by physician and home
visits by nurse).
(b) Obstetrical service.
(c) Postpartum care.
2. Infant and child care—
(а) Health center service by physician, nurse, and nutri
tional expert.
(б) Home visiting by nurse.
(c) Clinic and hospital service.
As practically every city had clinics, hospitals, and some form
of public health visiting prior to the new interest in the health of
children of preschool age, it is only practical to suggest that every
organization which undertakes this new form of service should con
sult with all other organizations which might legitimately consider
that they should share in the work and with other groups in allied
fields. Several cities where this plan has been followed have evolved
programs of continuous care for children which otherwise would
have been impossible. In one city the board of education agreed to
take over the records of the children as soon as they were of school
age. This solved the problem of caring for the records of children
discharged because they were “ over age,” and gave .them permanent
value.
It should be remembered, when planning case records, that speciali
zation of service requires a record carrying great detail which is
generally considered too great a burden for an organization giving a
variety of services.
I t should be recognized, however, that many of the foremost
believers in generalized service maintain that a complete record of a
case is as necessary when attended by a general nurse as when carried
by a special nurse giving the same service. Undoubtedly this should
be the aim of the organization giving general service, but at present
there exists great variety of records, illustrated by those which have
arisen for use in connection with maternity service according to the
part it plays in the entire program of service rendered by the organ
ization. At one extreme there is the excellent detailed system of
the New York Maternity Center Association,21®and at the other the
scant records kept by many organizations, some using plain cards
upon which is recorded the fact that the patient was visited by the
nurse and the condition of the patient at the time of the visit. Be2ia See: The Public Health Nurse. July, 1920.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

tween these two extremes lie all possible variations. Several of these
are shown in the records given in the manuals reproduced in the
Appendix22 of this report.
Case vccovd 'planning.—During the past decade great emphasis has
been placed upon the necessity for standardization of case work in,
public health nursing through the standardization of case records;
but to date little progress has been made in spite of numerous at
tempts to evolve so-called “ standardized records.”
At first the announcement of a “ standardized record form” for
any type of public health nursing was heralded with enthusiasm and
the record eagerly adopted without inquiry or investigation. As a
rule a short trial proved sufficient to demonstrate that the record did
not fit the needs of the organization. Accordingly it was discarded
and the old method of record making was revived.
Careful consideration of several of the “ standardized records
suggests two reasons for their failure to prove more satisfactory:
(1) No one record can be devised which can meet the varied needs
of organizations differing in type of organization and method of work.
(2) True standardization must begin with standardization of defini
tion of the terms used on the records.
Experience has proved that two organizations using the same
records may interpret them so differently that any comparison of
their results is impossible.
Record making and record planning are two very different things.
There is a great deal of the former and very little of the latter prac
ticed by executives in ah branches of work. The usual method is
for the executive of an organization to send to a number of adminis
trators doing similar work in other cities for copies of their records,
frequently receiving only part of the records and upon them basing
plans for her own work. That record which seems best suited to the
executive’s need is frequently adopted, without a single change.
Experience soon demonstrates that certain items are not applicable,
others are vague as to meaning, and still others are so worded th at
each member of the staff interprets them to her individual satisfac
tion. As a result the records are incomplete and the information
they contain is not comparable.
In order to avoid these difficulties at least 10 steps are to be ob
served when a ease record is planned:
1. Determine the field to be covered by the record; that is, is it
to be a general record, or is it to be used for a special type of care,
such as prenatal, tuberculosis, or the care of infants under 1 year
of age ?
, .
2. Study all available records covering the same field. This in
volves sending to organizations doing similar work for copies of their
22 See Appendix, p. 119.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING CASE-RECORD SYSTEMS.

record systems. They should also be requested to send instructions
for the use of the records and a statement of their criticisms based
upon their use. Careful comparison of all records received will show
a variety of forms for the same item and numerous shapes, sizes, and
colors of records.
3. List all the items the proposed record is to include, taking care
not to include an item merely because it appears on the records used
by other organizations. Items for case records fall into four classes:
a. Identification. This includes the name, address, serial number
(if one is used), district or ward, etc. These are the data
which control the filing of the record.
b. Social history. This includes such items as nationality, em
ployment, housing, etc.
c. Physical history of child or mother as the case may be.
d. Record of performance.—(Nurse’s, physician’s, or dietitian’s
record.)
I t should be emphasized that in selecting items under these four,
headings no item should be included merely because the subject is
interesting.
4. Discard every item considered for the record for which there is
not some definite use planned. For example, the organization may
have no use for the information regarding the registration of a child’s
birth or whether “ drops” were put in its eyes by the attendant at
birth, but the importance, of both to the child should be impressed ■
upon the mother. This may easily be done through the medium of
listing these items with others to be noted by the nurse. In other
words, at this point in record planning the executive should deter
mine the items upon which she desires information to be used as a
basis for treatment, and the items which are important for a com
plete picture of the work of the organization in reports to the board,
monthly and annual reports, and other forms of educational pub
licity and public information. I t should be remembered that each
item included means additional expenditure of the nurse’s time in
securing it, added clerical service in correcting and tabulating it,
and a corresponding loss of time to the mother who has to supply
the information a combination of facts which emphasizes the im
portance of securing only essential information.
5. Determine the source of each item and decide whether it will
be advantageous to plan separate records according to the source of
the information. Some organizations prefer to keep the physician’s
and dietitian’s records separate from the record of nursing. Under
certain circumstances this may be advisable but as few records
should be planned as are consistent with competent administration.
6. Give careful attention to the form of the item.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

(a) It is not necessary to give items in interrogatory form if in
structions are written for each item; e. g., the inquiry “ How many
rooms are there in the dwelling?” can safely be reduced to “ No.
rooms/’ or “ Rooms.” If possible, use only one word instead of
phrases.
(b) Do not include items to be answered by the mother which call
for expert knowledge, to which she might not give truthful answers,
or to which she might not reasonably be expected to know the
answer; e. g., mothers can not be expected to know the physician’s
diagnosis, ‘facts about her husband before marriage, and many other
items frequently appearing on records.
(e)
For items which are to be tabulated do not use those calling
for judgment or opinion, instead of fact, on the part of either the
nurse or the informer; e. g., whether a house is clean or dirty, the
health of the various members of the family, etc.
(d) On record forms to be filled out by the nurse supply answers
•to be checked (*/) when possible. This gives uniformity of answers
at a minimum of effort and time on the part of the person filling out
the record and also on the part of those who check and tabulate the
information. This’does not apply to records which are to be typed
from the nurses’ records. I t is difficult to strike out items on the
machine and records will be much more accurate and present a much
neater appearance if space is left for a typed answer instead of having
' the printing on the typed record a duplicate of the form used by
the nurses; e. g., the item, “ Cause of discharge,” would appear
printed upon the nurses’ record as, “ Cause of discharge: Moved from
city, Transferred to —, Died, Over ago, Lost, Noncooperative.”
Supplying all the permitted answers enables the nurse to check the
proper entry. For the record to be typed this item would appear,
“ Cause of discharge,” followed by a blank space sufficiently large to
contain the longest entry when typed, which is “ Transferred to,”
and a space for name of the institution or organization assuming
responsibility for the case. This entry may be read much more
easily than if the typist had attempted to cross out the inappropriate
words of the inquiry, and minimizes opportunity for error in this
connection.
(e) Items which can be answered by “ Yes” or “ No,” or by figures,
are preferable for tabulation. A little study of the information to
be secured will often make it possible to ask the question in such a
form that a simple answer can be obtained for entry. Conciseness
which is accurate should be the constant aim of every person who
either plans, keeps, or reviews case records.
(j) If items are abbreviated, care should be taken to use accepted
abbreviations only and not to use the same abbreviations for different
meanings; e. g., “ M” may mean male, mother, miscarriage, maternity,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING CASE RECORD SYSTEMS.

or month, but it should be used for only one of these on a given
record, and both the abbreviation and its meaning should be entered
in the instructions to nurses in the office manual.
7.
Decide upon the physical form for the record, paying special
attention to the paper stock for the various records, arrangement and
spacing of items, and to the various printers’ devices which will make
the record simple to use, both in the field and in the office. If left
to his own devices, the printer will generally use the type, spacing,
and ruling which will present the best appearance without regard to
the spacing required for entries. For this reason the spacing should
be indicated on the printer’s copy and it should be based on the
amount of room which the usual entry will require when written in
moderate size.
The practice of using heavy type of uniform size for headings of
equal importance, smaller, lighter type for subheadings, and the
liberal use of heavy and lighter ruled lines to mark off one section
from another—these and many other devices materially aid the
nurse and clerk in finding items on the record quickly and easily,
thereby reducing the difficulty and cost of record keeping.
One of the points especially in need of emphasis is the size and
shape of the record. Those responsible for planning it should be
certain it is of standard file size before sending it to the printer. Some
organizations have been obliged to discard records which have been
ordered because no files could be found to fit them. A brief visit to an
office supply house will suffice to inform the record planner regarding
available filing equipment.
If possible, records should be so planned that it will not be neces
sary to fold them when they are filed. Folding and unfolding records
consumes a great deal of time and is extremely wearing on the
records. However, if it is necessary to use a folded record, the front
sheet should be higher than the back. This permits all information
to be typed with only one insertion in the machine while two inser
tions are necessary if the back of the record folder is the higher.
(See Appendix, pp. 151-152.)
Too great emphasis can not be placed upon the necessity for
careful attention to the size of records to be used with the folder
system. The highest point of the record used as a folder must not be
higher than the standard size; i. e., 3 inches for the 3 by 5 size, 4
inches for the 4 by 6 records, etc. This necessitates having the rec
ords to be filed within the folder at least one-quarter of an inch lower
than the top of the folder; otherwise they will conceal the identifica
tion items on the following folder. When preparing proof for case records which will require continua
tion sheets, care should be taken to have them contain sufficient

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

identification material to place them when they become detached
from the face records.
Before sending the proof to the printer it should be reviewed care
fully to insure that the following points have been observed:
(a) The record must be of standard filing size when completed.
(b) Identification material (name, address, case number, etc.)
should appear at the top of the record, the top being defined as the
top when filed. This section should be separated from the remainder
of the record by a heavy line. This makes it stand out and facilitates
filing.
(c) Records should be ruled. Those which are to be typed should
be ruled for typewriter spacing. This can be done.easily if it is men
tioned in advance to the printer.
(d) The printing on the record should run parallel to the way the
record is to be filed; e. g., the items on a 4 by 6 inch record should run
across the 6 inch width of the record so that the identification items
will be parallel with the top of the file drawer.
(e) Each record should bear the name of the organization, city,
State, and the year the record was first printed in its present form at
the bottom of the record in small type. Some organizations prefer
to assign a number to each new form. This should appear at the
bottom of each record and may be followed by the amount and date
of the order, although this information is kept less expensively in the
record form order book, in which should appear a copy of every form
ordered, together with the date and number of each order. The
use of the record should be shown by its title in small capitals at the
top center of the record; e. g., “ Clinic Record.” The rather general
custom of placing the name of the organization in large capitals at the
head of the record is one of the reasons for the difficulties many
organizations encounter in maintaining proper filing systems. The
top of the record is the section which first meets the eye of the file
clerk, and for that reason should contain the information which is
needed most frequently; i. e., the filing guides, otherwise designated
as the identification items.
( / ) The judicious use of different sizes of type, different width
lines, box heads, and, if necessary, different colored rulings serves to
divide the record into sections, makes important items and headings
stand out, and makes the whole record simpler to fill out and read. It
should be remembered that all ruling adds materially to the expense
of the record, and only those rulings should be used which will justify
the extra expense. This is especially true of the colored ruling. The
use of height and weight charts as part of an infant’s record is justifia
ble only if they are used faithfully and no other cheaper device can be
substituted which will yield satisfactory results.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

P L A C I N G CASE EECOED SYSTEMS.

(g) Every item should be numbered. This separates the items and
makes it simpler to refer to them when giving instructions or other
wise mentioning them. Occasionally items are so numbered that the
numbering system becomes an additional source of confusion. This
is true of any attempt to show divisions by a set of Roman numerals,
with subdivisions set apart by Arabic numerals and further divided
by the use of capital and small letters. The simple Arabic numerals,
with the occasional use of small letters, will give the best results in
identifying a record’s items. For example, a record was divided into
three sections designated by the Roman numerals, I, II, and III.
Under each of these sections appeared subdivisions shown by the
capital letters A, B, and C. These subdivisions were further divided
into groups numbered with Arabic numerals 1, 2, 3, etc., and some of
these divisions had still other divisions lettered a, b, c, etc. I t was
found very confusing to refer to item II-A -2-(c), which was the six
teenth item on the record, and the second printing of the record forms
was seized as an opportunity to number the items more simply,
item II-A-2-(c) appearing on the new form as 16 (c).
8. Always require proof from the printer before ordering records.
It will show waste space, if any exists, and will suggest various
changes which will improve the form. Every office manager should
be familiar with proof readers’ marks. [These are given in the typo
graphical appendix of the standard dictionaries.]
9. The printer must be instructed in regard to the paper stock as
follows:
(a) The paper stock should vary in toughness according to the
amount of handling it will receive and the period for which it must
endure. Heavy stock is often more brittle than thin paper stock.
The lightest weight stock which will stand up in the files is most
desirable. The stock must be consistent with the method of entry
making to be employed; e. g., the finish for ink entries differs from
that which may be used for pencil entries and is much more expen
sive. Entries can not be typed unless the paper stock is of proper
weight and flexibility to be used on the typewriter and the finish
such that it will take and hold the typing.
(b) Stock of various colors may be used to distinguish the different
types of records in the same system.
10. Written instructions should be prepared for the guidance of
those using the record, both in the field and in the office. They
should be prepared before the record forms are ordered from the
printer, because the writing of instructions generally reveals incon
sistencies and omissions which would otherwise have passed unnoticed.
Every item which possibly might be interpreted differently by
different persons should be defined. This task can be made com
paratively simple if great care is taken to word the items properly, to

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

provide answers to be checked, when possible, and to make them
sufficiently explicit so that instructions ar.e unnecessary. For
example, if two nurses were filling in the item “ Born” and no instruc
tions were given, one might interpret it “ Born where” and the other
“ Born when;” if the item had been worded “ Date of birth” no
ambiguity would have been possible.
Written instructions should also be prepared for the routing of the
records. For example, there should be instructions for the nurse in
the field which tell her when to fill out specified records and what
should be done with them when they are filled out; instructions to
the supervisor who reviews the records to insure uniform and con
sistent supervision of the clerical work and nursing service; instruc
tions to the copyist, the clerk who. tabulates the items from the
record, and the clerk who finally files the record. These instruc
tions should be concise statements of what is to be done in each case
and the best way to do it. They should be incorporated in the
office manual and should be changed *as experience demonstrates the
necessity.
P r e p a r i n g I n s t r u c t i o n s . —Instructions should be given a general
introduction showing their purpose and emphasizing the need for
accuracy and completeness.
When writing instructions for the individual items give first the
number of the item, followed by the actual wording as it appears on
the record. If necessary, define the item; e. g., “ Stillbirth shall
include all issues over 7 months gestation dead at birth.” Give
explicit instructions covering cases which may require special entries.
This is especially important in connection with occupational entries.
If the item checks with any other item, the fact should be mentioned
in the instructions; e. g., the date of the child’s birth should be
checked with the date of admission tq determine whether the age at
date of admission has been entered correctly.
Whenever a case arises which demands new instructions, they
should be made in writing and a copy given to each person concerned
for insertion in her copy of the office manual. I t is obvious that
although the chief executive must be responsible for the instructions
as finally approved, she can not prepare them without careful con
sultation with all members of the staff. Group conferences which
include the -staff members, held for the purpose of considering pro
posed changes or new instructions, frequently yield practical sugges
tions which would not have occurred to those holding the executive
positions.
Points requiring special emphasis in record keeping.
Few records of performance give an adequate picture of the nurse’s
service. She may have given excellent instruction and demonstrated
methods, but if she enters merely “O. K .” on the record, neither her

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PLANNING CASE RECORD SYSTEMS.

supervisor nor her successors will have any clue to the type of care
received by the patient. Faithful and accurate recording of services
performed is a very important part of the nurse’s responsibility.
Unrecorded service in public health work is a service but half per
formed. Some of the most frequent omissions in recording service
for children of preschool age are due to thè inadequate or vague idea
held by many nurses and supervisors as to what constitutes a satis
factory visit to a well child. This should be defined in the manual,
as well as rules for making satisfactory entries for specified services.
In making these entries the following details should be observed if
the records are to attain their, fullest value.
Bates.—Every entry of service should be dated—month, day, and
year all being entered. Although it is customary to enter the month
and day, the year is frequently omitted, with the result that it is
often impossible to tell when consulting old records when cases were
admitted or discharged. I t is safest 'to enter the month in its
abbreviated form instead of employing figures, because some nurses
will reverse the month and day figures or become confused regarding
the number of the month toward the middle of the year.
Abbreviations.—If abbreviations are to be accepted as entries,
only standard abbreviations should be used unless the author of the
instructions prepares abbreviations for certain special entries.
Great care should be exercised always to give an abbreviation the
same meaning and never to use an abbreviation for more than one
meaning.
“ No reply.”—No item should be left blank. Enter “ Unk.”
(unknown) for replies which the informant was unable to give;
“ Fail” for information the nurse failed to secure through forget
fulness, or for other causes; and enter a dash if the item does not
apply to this case. All “ Fails” and dashes should be explained to
the supervisor before being entered on the history record. “ Fail”
should never be abbreviated to “ F ” unless “ F ” does not indicate
“ Father” or “ Female” or some other entry elsewhere on the record.
Notes.—Whenever the items and space provided are insufficient,
or do not fit the case, a brief but clear statement should be entered
in the space provided for notes. Each note should be numbered to
correspond to the item about which it is written and the number* of
the item should be encircled to show that additional facts will be
found in the space reserved for notes.
Changing items.—Notes provide the only method which should be
employed to show the inadequacy of items as printed on the record.
The printed form should never be changed; e. g., in some organiza
tions where a record calls for information about the father, no rules
are given about the proper form for entries for a step or foster father.
Frequently the record will not contain any information about the

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

ÌO

child’s fatherr but the word “ step” or “ foster” as the case may be,
is entered above the word “father” and all of the information on the
record will pertain to the step or foster father. The proper method
is to encircle the item number and enter the facts about both the
father and the foster or step father in the space for notes unless the
form of the record provides for some different plan.
Confining entries to proper spaee.—Care should be exercised to
make entries only in the space provided. Occasionally it is a tempta
tion, when the space is too small to receive the information to be
entered, to continue it in the blank space adjacent although this
space belongs to another item. This confuses the clerical staff and
makes the record inaccurate. If there is more information to be re
corded than the item space permits, the remainder should he treated
as a note and entered in the space for notes.
Cheeks.—All possible answers should be provided on the form to
be used by the nurse in the field. This permits the timesaving
device of checking the proper answer instead of writing it out. To
insure the accuracy of this method it is essential that every check be
made through the center of the proper word in a neat and careful
manner.
Defining items.
It is commonly contended that records do not need explanation,
hut the-examples of the instruction writing found necessary by a
number of organizations as presented in the appendix will show how
the work was standardized through careful definition of items ap
pearing on the records and illustrate the proper types of entries.
STATISTICS.
TABULATING FACTS FROM CASE RECORDS.

Elsewhere in this report emphasis has been placed upon the fact
that within the records of the service rendered by the organization
lies proof of its past performances, a sound basis for future plans
regarding either curtailment or expansion of its several activities,
and a true accounting to those responsible for its financial support.
In addition, within these records is concealed excellent material for
the education of the staff to a larger appreciation of their opportuni
ties for increased efficiency and community service. The records
also contain material for preventive work in the future; if the in
formation available is used to inform the public regarding existing
conditions, supplemented by instructions in methods of remedying
improper conditions and preventing their repetition. The objection
is made that the public health organization exists primarily for the
service of the sick: therefore visits and service to the sick must be

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

STATISTICS.

the first consideration of the agency. Securing statistics and keeping
them up to date is an expensive feature; therefore it must be omitted
or slighted if money is limited. This is true, but it should be borne
in mind also that without accurate and complete records of its
experience and performance, intelligently interpreted and acted upon
to prevent recurrence of disease, the modern public health organiza
tion fails to realize the major service it is privileged to render to
society; furthermore, in many instances, careful application of
efficiency principles to the office administration will reveal opportuni
ties for economies which will permit adequate record keeping and
reporting without additional cost.
Causes of failure to utilize case record material.
Failure to utilize the case records to their fullest capacity has
been due to (1) incomplete and inaccurate records, (2) a belief on
the part of many board members that clerical work is an unnecessary
expense and can not be justified to those supplying the funds for the
maintenance of the organization, (3) ignorance on the part of the
executives of the way to secure figures from the case records, and
(4) inability on the part of the executive to use the figures once
they have been secured.
Assuming that the board is progressive and fully alive to the
possibilities lying within well-kept records, that a competent staff
has prepared them, and that there is sufficient clerical assistance to
do the statistical work, the next step is to develop a simple method of
taking off the items which are to be tabulated or counted for pre
sentation in the monthly and annual reports.
Preparing statistics for annual report.
The usual system is to postpone the work until the last month of
the year, except for those items which are taken from the monthly
reports of the nurses and dispensaries. Any facts which are of inter
est, but which can not be verified by figures because they were not
planned for at the beginning of the year, are either omitted or given
in the form of impressions. Frequently an annual report is merely a
statement of the number of patients enrolled and dismissed during
the year, the number of visits made by the nurses and a general
statement by the superintendent of the personnel, needs for the
future according to the judgment of the chief executive, and some
additional facts about the financial administration of the organization.
Dr. Edwin D. Solenberger in his article.on “ The Essentials of an
Annual Report” 24 states that “ an annual report should be a labora
tory record of the life and growth of the society or institution and its
84 National Conference of Charities and Correction, Proceedings, Vol. X II, 1909, pp. 361-362. Fort Wayne
Printing Co., Fort Wayne, Ind., 1909.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

relation to the community it serves.” This implies the application
of laboratory methods—that is, scientific methods of gathering,
preparing, and interpreting the data.
Such methods are based upon careful planning of the records with
attention to the following points: They should contain material
which can be tabulated and which will be entered on the records in a
form necessitating no change before it is tabulated. All records
should be reviewed after each entry to insure completeness and
accuracy; the executive should plan at the beginning of the year
which items she will use for her annual report. The routing of the
records brings them in orderly and steady flow across the desk of the
recorder or the person who is responsible for the final verification of
the records for completeness just before they are filed. It is to her
that the task of tabulation most naturally falls. It is for the execu
tive to decide which items are to be tabulated and the record from
which the information is to be taken. A system of checking must be
devised which will insure that all records are tabulated but none of
them tabulated twice, and the work must move so rapidly that each
day’s work will be tabulated within 24 hours.
A simple tabulating scheme.
The following system is simple to comprehend and maintain and
has proved effective in the three organizations in which it has been
installed at the suggestion of the Children’s Bureau:
1. Make a list of all the items to be tabulated—e. g., the total
number of children enrolled during the year, the total number of
children dismissed during the year, the number of children enrolled
according to age at time of admission, etc.
2. After each item enter the title of the record from which the
information can best be obtained—e. g., the First Visit Slip, the
History Record, etc. If a time or day book is used, this list should be
scrutinized carefully to determine whether any of the data can be
secured more easily from the time book or from the monthly reports
as compiled from the time book.
3. Determine whether some of these items would give more illumi
nating information if combined; if so, revise the list combining those
items to be tabulated together. This is possible of .course only if
both items appear upon the same record.
4. Draft the statistical tally sheets and write instructions for their
use. The tally sheet may best be kept in a loose-leaf book for the
current month and filed at the close of the month. The forms may
be made by hand, typed, or mimeographed, according to the facilities
and preferences of the individual recorder.
Once the form is decided upon, it should be retained throughout
the year or dropped entirely. Changing the form so that the items

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

STATISTICS.

tabulated are changed means that the material is not consistent and
therefore should not be used. In the front of the loose-leaf record
book containing the tally sheets a typed list of the sheets should be
kept. A partial list used by one organization follows:
Titles of tally sheets—1921.
Sheet No.

1.
2.
3.
4.
5.
6.

Title.

Record taken from—

Age at admission..-....................................................................First visit slip.
Source of case............ , ............................................... ______ “
“
“
Father’s weekly wage and number in family...................... Child’s history record.
Number of rooms in dwelling and number of occupants.. “
“
“
Cause of discharge and length of time on ro ll.......................
“
“
“
Age at and cause of death......................................................Death certificates.

Each sheet number should always refer to the same title—e. g.,
Sheet 1 in the above example should always refer to “ Age at admis
sion.”
All recording should be done with reference to the date of admission
and not according to the day the record reaches the- desk of the
recorder. This is necessary if, for example, the July monthly report
is to contain only the cases admitted during that month. If any cases
for the month come to the recorder’s desk after the monthly report has
been completed, the cases may be added to the proper tally sheets
and included in the following monthly report as “ Late Cases for the
Previous Month.” In the annual report they will be included in the
total for the proper month.
The pencil tally sheets should be kept until the annual report is
completed and checked, when they may be destroyed. All sheets for
one month should be kept in a folder in the vertical files, marked with
the month, year, and the words “ Tally sheets,” e. g., “January,
1921.— Tally sheets.” Never erase on these sheets. If a mistake is
made, cross out the error with a wavy line which will distinguish it
from any line used in the tabulating.
Before commencing the day’s tallying, note the total number of
cases tallied on each sheet. When the day’s tally is completed, count
the records tallied and the entries for the day. If the totals agree, it
is safe to assume that the work has been* done correctly. If an error
is found, the records should be checked with the tally marks, a tiny
check being placed at the top of each tally mark as the record is
reviewed.
In order to make certain that each item to be tabulated has been
tallied, a tiny check should be placed over the item number on the
record, the bottom of the check just touching the number. The
tallying is done much more easily in pencil, but it is highly desirable
that only an indelible pencil With a sharp point be used.
57716°—22----- 6

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

In writing instructions for tally sheets care should be exercised to
make clear any points about the items which are not apparent from
the face of the record, e. g., unless the record had upon its face the
abbreviations for all sources of cases so that the recorder could copy
them onto her tally sheet, it would be necessary in the instructions to
enumerate the sources and explain their meaning and the abbrevia
tions which should be used, as “ The sources are: 1. J. C. (Juvenile
Court), 2. H. (Hospital) n a m e -------- , 3. U. C. (United Charities,
etc.).”
The first month should be used as an experiment period, during
which it is advisable to list all items for a given tally sheet. A t the
close of the month the executive can judge from the totals which
groupings will prove satisfactory for her report. This point is well
illustrated by a sheet calling for the nationality of the mother. A
complete list might include 35 or more nationalities, although the
main groups might be only five in number. Accordingly, after the
first month the executive might have the figures for the month grouped
and those for the following months tabulated to show only the five
main groups, including the others in a group entitled “ All other
foreign born.”
Organizations wishing to maintain a permanent monthly record
of statistics secured from tally sheets can do so easily by keeping in
a loose-leaf book the totals from the tally sheets according to months,
a single page being reserved for each item. For example, the page in
the tally sheet total book for the sheet entitled “ Age at admission”
might be arranged as follows:
Sheet 1. Age at admission, year 1919.
Age at admission, Jan. Feb. Mar. Apr. May, June, July, Aug. Sept. Oct. Nov. Dec. Total.
Under 1 month...... ....................................................................................................................
1 month to 12
m onths.................. ...................................................... ................................................... ..
Total under I year....................................... .......................... ...................................................
12 months to 18
months............. ...................., ....... .............. ............ ......... .................................... ......... .
18 months to 2
years................................................................................................... ................................
2 years to 3 years...........; ........................................., . ............................................... ...............
3 years to 4 years......................................................................... .............. ........ ....................
4 years to 5 years............................................................................ ............................ | ___
5 years to 6 years.........................................................................................................................
6 years and o v er ................................................................................................... i ..................
Not reported........................................................................... ............. ....................................
Total................................................................... ............................... .......................................

Forms 1 and 2 on the following pages demonstrate the different
forms necessary for showing single or double items.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

STATISTICS.
FORM

V, S H O W I N G

FORM

FOR

SAMPLE TA L L Y
SINGLE ITE M .

SHEET

FO R T A B U L A T I O N

OF A

Sheet 1. Age at admission.
MonthAge at admission.
Under 1 month.............
1 month to 3 months. .
3 months to 6 months..
6 months to 9 months. .
9 months to 12 months.

Number of children.

///...
Ml /III...

Ml Mi
ff.......

Total..........

10
2

31
[Size : 8 by 11 inches.]

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Total

mi—

Total under 1 year.
1 year to 3 years.
3 years to 6 years

-1921.

FO R M 2, S A M P L E T A L L Y S H E E T S H O W I N G F O R M FO R S I M U L T A N E O U S T A B U L A T I O N O F T W O I T E M S .

Cause of discharge and length of time on roll.
LENGTH OF TIME ON ROLL.

Cause of discharge.

Lost address.............................. ...................

Died........................... I ...................................
N oncooperative..............................................

®
/

®
0

III
©
III

3 years
to
4 years.

4 years
to
5 years.

5 years
to
6 years.

6 years
and
over. '

®
m m

III

7
©
0

■®m
Total................................................................

N ote .—The two columns “ Totals'! should add to the same number. The encircled figures are the totals for the squares in which they appear.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Total.

m m

112

OFFICE, ADMINISTBATIO

Moved out of city.................................. .

3 months 6 months 9 months 12months 18 months 2 years
Less than 1 month
to
to
to
to
to
to
to
1 month. 3 months.
6 months. 9 months. 12months. 18months. 2 years. 3 years.

RECORD FILING.
IMPORTANCE OF RECORD FILING.

In order to make records and other material readily accessible,
numerous filing systems have been devised. To the commercial
world is due the credit for working out systems of cataloguing and
equipment to contain the various types of records and other forms.
Many public health executives with no experience in administrative
work are unfamiliar with the modern methods for rendering their
material easily accessible. Records are permitted to lie on tables
or in desk drawers until so many have accumulated that it is difficult
to locate the desired one readily. t They are then generally trans
ferred to a bpx, but without any special arrangement.
I t is not advisable to recommend any one system for all organ
izations, for the system should be developed to suit the needs of the
individual organization. In general, the essentials of a record-filing ->
plan are: (1) The records must be found easily, (2) the system must
be capable of expansion with the growth of the work of the organiza
tion, (3) the plan must be simple, and (4) so far as possible, the system
must aid the nurse and others dependent upon the filing system to
render an account of their service.
PLANNING A RECORD-FILING SYSTEM.

The subject of indexing and filing has been developed in great
detail, and many public health nursing executives have asked how
they could easily work out a system which they could be certain
was the best for their needs. One method which has proved suc
cessful in several cities is to ask the aid of the librarian or one of
her assistants. Possibly the library board will donate the time of
one person for the period necessary to plan the files' for the public
health nursing organization. This does not mean that the executive
is to turn over to the librarian all material to be filed and expect
her to work out the plan unaided. The executive must be respon
sible for supplying the information as to how each piece of work
is carried on and she must decide whether the proposed plan will be
practical. The librarian can only suggest the available methods
and combinations which'might not occur to a person unfamiliar
with filing systems. The executive who would be prepared to
criticize intelligently must not only be familiar with her own prob
lems but. she should know something of the principles of filing.
This is best accomplished by consulting any of the standard publi-.
cations on this subject.25 But possibly the .following definitions of
terms and illustrations of how the different filing systems have been
26 See bibliography, p. 117.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

applied by several public health executives will prove of assistance
in interpreting the technical publications.
A complete discussion of record filing must give attention to the
filing methods appropriate to summary and index cards as differenti
ated from case records or histories and must include a description
of the three filing methods.
INDEX AND SUMMARY CARD FILING SYSTEMS.

Practically every public health organization maintains either an
alphabetical or a numerical index of all the cases it has handled.
The forms which these indexes take are three—(1) the book index,
(2) the vertical card index, and (3) the visible card index.
The book index.
Cases are entered in the book index alphabetically, as far as pos
sible. This old-fashioned method has many limitations to offset the
virtue of security from loss of a name once entered. The objections
to it include the impossibility of keeping a strictly alphabetical
ind'ex after the cases have once been copied into the book; names are
frequently missed in running down a column, and there is great
difficulty in cross indexing. If there are many cases and the work
continues over a long period, a second book, or even more, becomes
necessary, adding to the difficulty of locating names. The book
index generally contains no information beyond the name and
address of the patient and the date of admission and discharge—
an added reason for discarding it in favor of the second or third
method.
The vertical card index.
The second method, the vertical card index, involves the use of
records printed, typed, or written on cards of standard size which fit
into vertical filing drawers. This system permits either exact alpha
betical or numerical arrangement of the cards and at the same time
permits unlimited expansion and cross indexing.26 The use of the
cards also provides sufficient space for a summary of the treatment
given and other pertinent facts.
The visible card filing system.
The third method of filing index records is generally too expensive
for the usual public health organization. I t is called the visible
system of filing and is a patented system of which there are sev
eral varieties. All require special cards or devices for holding the
. records in place and are appropriate only for indexes or summaries
in public health work, because the device makes no provision for
records of several thicknesses being filed together, and it would be
26 For a discussion of cross indexing, also called “ cross filing” and “cross referencing,” see p. 79.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

impossible to file several records in the same place in case the medical
and health center records were to be kept together. Another ob
jection to the visible system of filing is its tendency to gather dust.
On the other hand, it does offer many advantages over the drawer
system, because the visibility of the records prevents duplicate
records being filed, records are found much more quickly and easily,
and records can be read without removing them from their place in
the file.
CROSS INDEXING.

A discussion of cross indexing is essential to a complete understand
ing of the use of either the vertical or visible system of indexing or
filing, when the alphabetical method of filing is employed. Cross
indexing means the provision of a separate card for each spelling of
a name, referring in each instance to the spelling which has been
adopted as standard; a similar procedure is followed for persons
having aliases.
Several organizations have found that it saves the time of file clerks
to have posted, where it is easily visible, a list of names with all
variations of spelling, showing where each will be found in the files.
The cross-reference cards are also used as a double precaution. Only
the names having more than one spelling are listed. Only names
commencing with the same letter are listed on a given page. This
permits the addition of names, but when several have been added it
generally means that the strict alphabetical arrangement has been
necessarily forfeited and the page should be copied. The following
samples from sheets 1 and 2 will illustrate the method of use:
Sheet 1.
Adam, Adams, Addams.
Adams, see Adam.
Addams, see Adam.
Alexander, Alexandre.
Alexandre, see Alexander, etc.

Sheet. 2.
Bailey, Baily, Bayley, Bayly.
Baily, see Bailey.
Barnard, Bernard.
Bayley, see Bailey, etc.

The New York Maternity Center Association which uses this system
has, in addition, the following rules posted:
File by surnames alphabetically. Different spellings of same name filed together, as
More, Moore.
1. Names spelled with and without the final e, s, or z, all filed together: Brown,
Browne, Adam, Adams, Swarts, Swartz.
2. Names ending in y, ie, or ey, or i, all filed together: Brody, Brodie, Brodey; or
Kumisky, Kumiski. Names ending in stein and stine all filed together: Weinstein,
Weinstine.
3. Names ending in dt, t, or tt, filed together: Smit, Schmidt, Schmitt.
4. Names ending in witz, weitz, wits, weits, all filed together: Leibowitz, Leiboweitz.
5. Names ending in berg, bergh, burg, burgh, all filed together: Bromberg, Brombergh, Bromburg.
6. File all Sch as though Sh when followed by vowel. File all Sch followed by con
sonant as though spelled without the ch.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

FILING METHODS.

There are many combinations of filing principles, but the three
general methods are: (1) Alphabetical—filing in strict alphabetical
order according to name; (2) geographical—filing according to
country, State, city, county, or some other division of government or
locality; (3) numerical—filing according to a system of numbers
assigned to the material to be filed.
Alphabetical filing.
The straight alphabetical system is most commonly used for
filing the majority of records of either index or case record systems
and will prove very satisfactory if care is taken to observe the prin
ciples set forth in the section on “ Cross indexing.” They may be
applied to straight alphabetical filing of case records as well as to
filing of the card index. I t should be noted here that many persons
unaccustomed to office work believe that “ alphabetical filing” means
placing the records for all names commencing with a given letter
together without further classification. For the benefit of these, the
following definition should prove helpful. Alphabetical filing con
sists of arranging names according to spelling—the sorting to be made
according to each letter as it occurs in the name; e. g., Baird, Bird,
Brown, Bell, Burns, Bowen, Black, Bailey, if filed properly, would
appear in -the following 'Order: Bailey, Baird, Bell, Bird, Black,
Bowen, Brown, Burns.
For filing case records the alphabetizing may be carried through
the first or given name of the father and also that of the child to
facilitate finding a given case.27 This plan keeps together all the
records for a family, which is helpful when planning the day’s work
in a district with which a nurse is not familiar, as on relief days, or
when transferred to a new district. I t also aids the file clerk when
checking new cases to determine whether all old cases in the same
family have been properly discharged. I t will happen occasionally
that this system will reveal information about an entire family
marked in the index “ Lost address,” whereas the other system of
fifing by name of patient only would correct but one record.
A phonetic system of alphabetical filing has been patented recently.
Through the utilization of phonetic principles it brings together
automatically the great majority of the misspellings and variations
of both English and foreign names. The Philadelphia Social Service
Exchange and the Child Welfare Association of New Orleans are
among the users of the system and, in their opinion, no other system
would enable them to handle their files with the accuracy and speed
procured by the use of this system.
37 See pp. 88.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

Some organizations keep the alphabetical index for active and
discharged records separate, but the objection to this is the fact that
it necessitates looking in two places whenever a case is to be checked
to ascertain whether it is a new case. Ii it is desired to make the
discharged cases stand out, the date of discharge may be written in
red, or a red marker may be placed on the card, always in the same
position.
Geographical filing.
Geographical filing is based upon the same principles as alpha
betical filing, except that in the former system first consideration is
given to the address instead of to the surname of the individual. In
public health nursing organizations serving a single city, a geographi
cal file of case records probably would be divided into the several
nursing districts, each of which would be further arranged alpha
betically according to streets and numerically according to each
house number, commencing with the lowest number on each street.
If there are several records to be filed for a single house number, those
records should be arranged alphabetically, according to surname.
The advantage of a geographical file lies in the ease with which
each nurse is enabled to handle her own district; she has only her own
case records before her; she knows just how much work she has to do
and her supervisor can tell at a glance whether the districts are
properly apportioned.
The disadvantage of a geographical file lies in the necessity of
having a control file of all case records arranged alphabetically
according to surname. The control file need be merely a 3 by 5 inch
card index bearing identifying items, the district in which the case
is located, and the date of opening and closing the case.
Another use of the geographical filing method is found in what is
commonly known as a “ street file.” This is the use of a single index
card for each house number, all the families at that address being
entered on that card. The street file is used as a supplement to a
straight alphabetical file of case records and is very valuable in
identifying foreign names which may have a variety of spellings.
For example, on a given day a nursing organization may have as
new cases the following families:
Marowicz, Wladyllaus, Marianna, 160 Warner Street.
Cling, Will, Lizzie, 180 White Street.

Consultation of the street file may reveal that at 160 Warner
Street there is a family Merowitz, Walter and Mary, which is doubtless
the same family as the first listed in the above example. In the same
way, the street file may show a Kling family at 180 White Street
having the names of Willard and Elizabeth, which will be identified
immediately with the supposed “ new” case. The street file is

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

invaluable to an organization in a town having a large foreign popu
lation, provided that the organization reopens its closed cases instead
of counting every illness a new case. If the town possesses a socialservice exchange which acts as a clearing house for the social
agencies of the community it can be depended upon to detect
and report back to the agency any duplicates caused by variations
in spelling; this would relieve the organization of the necessity of
maintaining a street file.
Numerical filing.
This form of filing is best known to public health executives as
filing by case numbers;
In order to have all the information about a child in one place,
it is desirable to file all his records together if possible. Some
organizations prefer to keep the record of physical examinations and
the physician’s notes separate from the nurse’s records. A few
organizations have, in addition, dental or nutritional records and
other records of examinations by specialists which are filed according
to the type of service given. The probability that, the names will
not always be spelled alike gives rise to the need for some more
definite method of identification. This is found in the assigning of
case numbers to each case as admitted, all records for a given case
being given the same number which appears a t the upper right hand
of the 3 hy 5 inch index card in the complete alphabetical file. The
added expense occasioned by maintaining this extra index is one
argument against the use of case numerals.
The case number is frequently adopted by an organization which
makes no real use of it, but keeps it because the nurses are familiar
with its use in connection with hospital histories or dispensary
records. Unless there is a definite need for the case number which
can not be met in a simpler way, it should be abolished. Many
organizations, upon giving thought to this point, have dropped their
case numbers on a given date with no loss to their efficiency and with
a decided saving in time and clerical service.
Combined filing methods.
Each of the three systems can be combined with one or both of
the remaining systems, and frequently must be iso combined to
obtain the best results. The file clerk or the person responsible for
the planning of the filing system in a public health nursing organi
zation should study the possibilities of each system and devise that
combination which will prove most effective and least expensive
in the expenditure of energy, time, and money. Although it will
not be possible to consider, in this report, the numerous combinations
which might properly exist in all public health nursing organizations
supervising the health of infants and children of preschool age,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

enough systems will be discussed to indicate the various points to be
considered when planning a system. It will readily be understood
that in the same office it may be necessary to employ a variety of
systems, one for the nurse’s file of history records, another for the
index file of all cases, another for the permanent or discharged records,
and still another for the correspondence file. But public health
executives will do well to take a hint from business executives who,
after long experience, are tending to discard the numerical file as
inconvenient and expensive, except in certain cases. They file
alphabetically, whenever possible, and use the geographical file
only when the straight alphabetical name filing proves too cumber
some.
Indexing.
“ Index” means that which points out, and. the index of a filing
system is the collection of guides or dividers which are inserted in
the filing equipment to point out the location of the desired material;
e. g., in an alphabetical file one naturally looks behind the guide
labeled “A ” for the record of Adams, John.
Few persons know that there is a scientific principle underlying
the preparation of the indexes which are purchased ready for use.
Executives frequently purchase them without realizing that there are
many varieties, one of which may be better fitted to their needs than
any of the others. Practically every office supply firm of national impor
tance publishes valuable handbooks on filing systems and supplies,
and in addition gives advisory service to organizations located near
their district offices. In view of the fact that information on this
subject is so easily available, it will not be given further consideration
here, although it is emphasized that the proper indexing of material
to be filed is the key to a satisfactory filing system; therefore it merits
the careful attention of every executive.
RECORD FILING EQUIPMENT.

In selecting a filing system careful investigation should be made of
the various styles of filing equipment, as there is a wide range of styles
and prices. Practically all of the well-known firms producing filin g
equipment have experts who will advise the proper equipment for a
given piece of work. Of course there is a tendency on their part to
recommend the most expensive equipment, but if their assistance is
asked in developing the best equipment at the lowest cost they are
generally able to work out a more efficient and less costly plan than
those inexperienced in handling office equipment.
One executive of an organization which handles several thousand
records annually devised an inexpensive and practical file consisting
of a long trough built to fit the records and placed across one end of

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

the room at a height convenient for use by a person seated in a
standard office chair. The trough was operated upon the same
principle as a vertical card file and possessed the added advantage of
making all records available without opening a number of drawers.
A cover built for the trough protected the records from dirt when not
in use. Similar files are for sale by several office supply houses and
are called “ open files.” If they are made locally, great care should
be exercised to have the height and width of the trough conform to
the standard file size for the record it is to contain. I t should be
built where there will be adequate light and air for the file clerks;
this involves attention to the shadows cast by both natural and arti
ficial light. Lastly, the height from the floor must be so gauged that
there will be no strain involved when filing records.
Filing aids.
Metal signals, or flags of various colors, and colored legal seals
are excellent supplements to a filing system, but there is danger that
their use may lead to a system too complicated to justify the expendi
ture of time necessary to carry it on. The metal signals may be
obtained in styles standing above the cards or fitting close to the top
of the record, in all colors, and with any printed words or letters
desired. In addition each position on a record may have a special
significance, a multitude of combinations thus being offered. These
signals are valuable to indicate conditions which change from time
to time. For conditions of a permanent nature, the lawyers’ seals,
or “ stickers” as they are familiarly called, are judged more satisfac
tory by some persons. For example, prenatal cases may be flagged
with metal flags bearing the month the delivery is expected. When
the case is delivered, the record may be made to show the fact by
the application of a seal pasted over the edge of the card, half on
each side, so that the edge of the card shows a line of color the width
of the seal.
Folders.
Realization that folders take up valuable filing space and are in
themselves expensive has led public health nursing executives to
search out a method of filing the records for children’s cases without
folders, even though several records for a child must be filed together.
One solution is to make one of the records in the shape of a folder and
file the others within it. Sometimes a family folder contains the
records of all the children in that fam ily29 and sometimes each child
has a separate folder, the family information being filled in for only
one child if more than one child is admitted at a time.30
25 Appendix. Case Record System 2, pp. 151-152.
80 Appendix. Case Record System 4, pp. 190-191.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

PROTECTION OF RECORDS.

Comparatively few organizations make any provision for protect
ing records from loss by fire, primarily because the cost of vault
room is considered prohibitive. The housing of the organization in
a “ fireproof ” building is a partial safeguard but is not considered
sufficient protection by commercial firms having valuable papers
and records in their possession. But even though it is impossible
thoroughly to protect records from loss by fire, there is no excuse for
failing to protect them from misuse or from destruction through
lack of filing facilities and a well thought out and faithfully admin
istered system of routing from the time they are made out until they
are filed in the discharged file. Records should not be permitted to
lie about where they may be looked over by persons not having
official connection with the cases. Parents are rightly sensitive about
having their private affairs, as revealed by entries on the records,
discussed, and in the case of defects found during the physical exami
nation it is exceedingly important that the findings be kept con
fidential.
DISCHARGED RECORDS.

The usual causes for discharging records for children of preschool
age are “ Overage/’ “ Dead,” “ Moved from the city,” “ Lost address,”
“ Noncooperative.” I t is appropriate to discuss the disposition of
these records in the filing section, for the reason that it is necessary
to clear the files of dead material periodically if they are to be kept
within reasonable bounds as to size and condition.
Overage.
There- is no point in keeping the records for a child who is too old
to receive further care from the organization, but it is wasteful to
destroy the record if it can be of use to the child or those concerned
with his future development. In cities where other organizations
take up the care of the child’s health when he reaches school age an
arrangement might be effected whereby the records could be trans
ferred to the organization which is to continue the work. This would
afford them an accurate fund of information regarding the child and
the care he had received during his preschool life which should prove
very valuable. The only record which would be retained by the
organization giving the preschool age care would be a 3 by 5 inch
index card upon which would be entered the date of the transfer of
records and the name of the organization to which they were trans
ferred. This transfer should be made annually unless some other
arrangement is agreed upon by the two organizations concerned. If
the transfer is made at any time except at the close of the first organ
ization’s year, a special record of the number of transfers should be

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

made in a manner which will permit a complete total for the year
to be given in the organization’s annual report. If there is no organi
zation willing, or able, to receive the records for the overage children,
they may be destroyed, an entry to the effect that they were
destroyed, and the date, having been entered upon the 3 by 5 index
card.
Dead.
Records for dead children have no further value after they have
been properly tabulated, unless there are important facts about the
case which might be of interest in connection with other cases in the
same family. These may be briefed and entered upon the 3 by 5 inch
index card. The record may then be destroyed, the date and fact
of the destruction being entered on the card, which is then returned
to its place in the files.
Lost address, noncooperative, moved from city.
It is the experience of many organizations that all children who
have been on the organization’s rolls are not kept under supervision
even though they do not leave the city. Some families move and
are not located, others move from the city and return without notify
ing the organization, and some refuse to cooperate and consequently
are discharged. I t is inadvisable to destroy these records until the
child is overage, because there is a possibility that he may again come
under the supervision of the organization, but it is possible to elimi
nate the children in these groups who die in the city. This is done
by periodically copying the death certificates for all children under
school age who have died since the previous date of death certificate
copying. These are checked with the 3 by 5 inch index file to deter
mine which children are enrolled. Those belonging in the discharged
group may have the appropriate information entered on the index
card and the records may then be destroyed. If death certificates
are secured for cases which have not been discharged by the nurses,
the fact should be brought to their attention. One organization does
this by means of the form here shown, which also brings to their
attention cases of children within their districts who should have
been enrolled but were not. This can be done only by those organi
zations rendering service to every child of preschool âgé in the district
served by the organization.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

D E A T H C E R T I F I C A T E RECORD.

To (Nurse). . . . — — ......................... in Field No. ............... D istrict...... .........................
_ during
mont^ o f . . . . .............., 192..., the following deaths occurred in your
held, but apparently these children were never enrolled in the association. Why?
Name.

Address.

Cause nonenrollment

The following deaths occurred among the children on your roll, but were not reported
to the mam office. W’hy?
Name.

Address.

Reason not reported.

Child Welfare Association, New Orleans—1920. Form M. 18.

SPECIAL INFORMATION FILES.

Frequently it is desirable for an organization to maintain a special
file which will show the cases having special treatments. This may
be done by keeping an index file in which each card represents a
special treatment; e. g., adenoids removed. On the card are listed
by date the case numbers or names of children who have received
this treatment. This necessitates careful checking of records daily
for special file items.
CHECKS ON FILING.

The most far-reaching method of preventing mistakes in the files,
once the staff has been carefully selected and trained, is to enforce a
ruling that only the file clerk shall place material in any file except
those assigned to the individual nurses. All material which has been
consulted and is ready to be returned to the files should be placed in
a filing basket kept on top of, or conveniently near, the files. This
should be appropriately labeled and nothing but file material should
ever be placed in it. In case the files are so extensive th at more than
one clerk is needed to keep the material filed, it is best to assign a

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

section to each clerk. This places the responsibility upon one person,
which is a cardinal rule in office control. This does not mean that
only one person shall understand each task connected with filing.
Here, as in every other position, a substitute must be ready to assume
the responsibility for the position next above to provide for vacation
periods, promotions, dismissals, sickness, or resignations.
The file clerk when filing a record or index card should always look
at the card preceding and following the one she has filed to be certain
there is no duplicate in the files. In addition, she should frequently
review, a drawer at a time, all the cards in the files in order to be sure
they are properly filed. A misfiled card may lead to duplicates which
are much more expensive than the time it takes to review the files
occasionally.
AN ILLUSTRATIVE FILING PLAN.

One organization finds it helpful to have the nurse’s cases filed so
that all the members of the family are filed in sequence and that all
the patients living on the same street are found in the same section
of the files. The reason for this is obvious; it enables the nurse at a
glance to select the cases she will visit the following day. Emer
gency cases are flagged with red flags or signals, meaning that they
must be visited before other cases. Such a system involves filing all
cases (1) alphabetically according to streets; (2) numerically accord
ing to house numbers on each street, commencing with the lowest
number; (3) alphabetically according to the surname of the child;
(4) alphabetically according to the father’s given name; and (5) alpha
betically according to the child’s given name.
For example, a nurse has the following case records for children:
Name of patient.

James Brown.
Bessie Brown.
Theodore Brown.
Frederick Chase.
Carrie Brown.
Esther White.
Nellie Brown.

Address.

61 Elm Street.
92 Ash Street.
61 Elm Street.
61 Elm Street.
81 Elm Street.
.91 Banning Street.
61 Elm Street.

Father’s given name.

William.
George.
Frederick.
William.
Arthur.
Thomas.
William.

Sorted according to streets, these records resolve themselves into
three groups: Ash, Banning, and Elm. Sorted numerically accord
ing to house numbers, Elm Street alone is considered, as there is
only one family on each of the other streets. For Elm Street the
arrangement is: 61 Elm Street followed by 81 Elm Street. Sorting
again according to the family or surname, the result for Elm Street
is all the records for Browns followed by that for Chase. The fourth
sorting, which is according to the father’s given name, is applied
only to the Browns living at 61 Elm Street. The result is: Frederick
followed by William. The final sorting, according to the child s

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

RECORD FILING.

name, is applied only to families having more than one child. In
this instance the family of William Brown is the only one to con
sider. The two records are filed with that for Nellie, following
James: Reading from the front of the file toward the back the records
as finally arranged appear in the following order:
• Street.

Ash.
Banning.
Elm.
Elm.
Elm.
Elm.
Elm.

Number.

92.
91.
61.
61.
61.
61..
81.

•

Surname.

Brown.
White.
Brown.
Brown.
Brown.
Chase. .
Brown.

Father.

Child.

George.
Thomas.
Frederick.
William.
William.
William.
Arthur.

Bessie.
Esther.
Theodore,
James.
Nellie.
Fred.
Carrie.

This system was further elaborated by an organization which did
not use a time or day book but which felt that there must be some
mechanical method for calling the attention of the nurse and super
visor to the cases which were not being visited at least once a month.
The following system was de.vised for this purpose: Four blue guides
were marked to show the weeks of the current month and four yellow
guides were similarly prepared to show the four weeks of the fol-.
lowing month, as follows:
Blue guides:
Curient month—1st week.
Current month—2d week.
Current month—3d week.
Current month—4th week.
Yellow guides.
Next month—1st week.
Next month—2d week.
Next month—3d week.
Next month—4th week.

Following each visit to a case or. family the nurse, decides when
the case shall next be visited and files it in its proper place according
to week, street, house number, etc. At the end of each week only
those cases remain in the week’s section which have not been seen.
I t will be noted that a case is not forwarded unless seen, although
the nurse’s record may show that the case was visited. This is also
noted on the record, but it is not forwarded until seen. The cases
not seen should be visited the first of the following week before the
new week’s work is begun. The efficacy of this system will be
greatly increased if a definite rule is made by the supervisor for the
frequency of visits to each type of case; e. g., infants under 1 month
of age shall be visited once a week, infants from 1 month to 1 year,
once a month, etc.
I t is immediately evident that such a system will need a comple
mentary system to enable the supervisor to tell immediately whether
57716°—22-;---- 7

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

a case is active, discharged, or new, and if active, in which district
it is to be found. This is accomplished by keeping an alphabetical
card index of 3 by 5 inch cards for all cases, whether active or dis
charged. The cards show the following information:
Surname—Child’s first name.
Father’s first name—Address—District.
Mother’s maiden name.
Date of child’s birth.
Date of admission—Age at admission.
Date of discharge—'Age at discharge.
Cause of discharge.
Length of time on roll.

As addresses change, the old address is lightly crossed out and the
new one and the new district are written below. This is possible
if, when having the cards printed, abbreviations are used and the
card is spaced to allow a clear space b elow A d d ress” and “ District.'”
If cases are readmitted, the date of readmission and all the additional
information secured when a child is admitted are added below the
date of the first discharge.
■ This file controls the case work of the organization; it is most
important that it be kept up to date, and it should be accurate
with regard to the information on the cards and also accurate in the
alphabetical arrangement of cards. AH new cases, before being
given to a nurse, are checked with this file in order to ascertain
whether the case has been discharged, whether it is an active or a
new case. Even though the file is in perfect order, there is danger
that duplicates will creep in through the different spelling of names.
This can be reduced to a minimum by cross-referencing.
I t is obviously impossible to use this system if the organization
maintains health centers or dispensaries to which the records must
be transported and used as the children are presented for examination
or advice. I t would be difficult to locate the cases quickly, and im
possible to refile them in the proper place. In such cases it is much
better to file the cases alphabetically according to surname,
father’s name, and child’s first name in the order given. The records
may be transported from the main office, if necessary, in locked tin
files having handles. Metal follow-up blocks can be secured which
will hold the records in plaee while in use at the center, so that the
tin file may be used in the same manner as the regular drawer file.
As the records are completed they may be placed in a section set
apart by a guide marked Center to-day.” When the records have
been returned to the main office all may be transferred to the nurses’
file except those for children attending the center that day. These
are placed on the supervisor’s desk for her attention and the records
are finally refiled by the office recorder when the proper entries have
been made on her records.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FINANCIAL ADMINISTRATION.

RESPONSIBILITY OF OFFICE MANAGER FOR THE FILES.

A well-established filing division in a public health nursing organi
zation need not necessarily have a file expert in charge of the group.
In many cases it will fall to the office manager to advise regarding
the filing system, and to keep constantly on the alert for devices
which will improve its effectiveness and new ways in which it may be
used to aid the- staff. This necessitates constant study of the cata
logues issued by the large office-equipment firms. Few of the
smaller cities carry a large or varied supply of filing devices, nor are
their catalogues so complete as those issued by the firm s from whom
they purchase their supplies. Upon request any of the officeequipment firms in a city will give an office manager the addresses
of the firms of national reputation. A request to be placed upon
their mailing lists will bring to the office manager all catalogues as
they are issued. The articles desired can then be selected and
ordered through local firms. The catalogues generally are divided
into two groups—office furniture or equipment and office supplies.
In the case of a firm specializing in some particular group of sup
plies there will be catalogues limited to that subject; e. g., filing
system supplies.
The recent tendency to give more attention to the planning of
records suited to the work of the individual public health nursing
organization will prove but an expensive experiment unless in every
instance equal attention is given to the selection and training of
those who are to be responsible for the maintenance of the files.
There must be frequent checks or tests of their accuracy and com
pleteness, and whenever the files fail to perform their functions the
cause must at once be discovered and remedied.
FINANCIAL ADMINISTRATION.
RESPONSIBILITY FOR FINANCES.

Public health nursing organizations supervising the health of in
fants and children of preschool age operate under a variety of arrange
ments with regard to their financial management, but all of those
financed from private funds, at least, have one or more committees
to handle the financial policies of the organization. No better delinea
tion of the duties of the committee on finance is required than that
given in the chapter of that title in “ Organization of Public Health
Nursing,” by Brainard. The sources of financial support and
methods of financing organizations of various types are clearly set
forth, directions are given for preparing and maintaining a card
index of potential subscribers, and the dangers of some types of
public appeal are pointed out. The responsibility for financing the
organization should rest not upon the executive of the organization
but upon the board of directors or managers, acting through the

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

committee on finance. But the entire expenditure of the funds so
secured rests primarily upon the executive of the organization, regard
less of the type of machinery planned to control the expenditures.
Even though the expenditures must be approved by the supplies
committee or by the administrative committee, the suggestion for
expenditures must come from some one in close touch with the field
and office staffs. This person is logically the chief executive of the
organization. As in other matters of office administration, many
public health nurses have had little opportunity to become familiar
with the technique of budget planning, bookkeeping systems, and
businesslike methods of financial control. For this reason it is im
portant that office managers be chosen in part for their knowledge
of reliable bookkeeping in all its phases.
ESSENTIAL ACCOUNTING PRINCIPLES.

It is impossible to offer a system of accounting which will apply to
the various types of organizations for which this report is prepared,
but there are certain essentials which every organization should
observe. These may be summarized as follows:
1. The system should be based upon the needs of the organiza
tion as shown by a carefully prepared budget.
2. The accounts should be audited at least once each year and
the auditor’s statement published in the annual report.
In this connection, executives who are planning the office
administration machinery for financial control will find it
helpful to call into consultation the auditor who is to be
engaged at the close of the year to review the organization’s
accounts. He can define the steps to be taken, the proper
division of accounts, and, if necessary, assist in planning
the system of bookkeeping which will enable him to audit
the accounts at the close of the year with a minimum of
difficulty.
3. Daily, monthly, and annual schedules of routine for each step
in the system should be clearly defined and entered in the
office manual, showing who is to perform each step, even
though some steps are performed outside the immediate
office of the organization.
4. All books, canceled checks, bank statements, check stubs,
petty cash, and petty-cash memoranda should be kept in a
safe when not in use. _
Bookkeeping.
Bookkeeping is a method of accounting for all the receipts and
expenditures of an organization or individual, according to a plan
which will permit classification of the same with reference to the
special interests or needs to be served.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FINANCIAL ADMINISTRATION.

The usual system of books consists of (1) cashbook, (2) journal,
(3) general ledger, (4) petty cash book.
This system can be varied to meet the requirements of the organiza
tion, but the functions of these four units must always be retained,
whatever the system adopted. One organization may find it expe
dient to combine the journal and cashbook, and may wish to elaborate
the system by adding a payroll book, a membership or donation file,
or some other form of special classification.
ILLUSTRATIVE SYSTEM OF BOOKKEEPING.

The following system which has been found satisfactory in the
administration of the Child Welfare Association of New Orleans, La.,
may prove suggestive to executives interested in comparing their
financial systems with those of other organizations engaged in the
same form of service.
Books.
The books include:
1. A combined journal and cashbook.
2. A general ledger.
3. Card catalogue combining membership and donation lists.
4. Petty cashbook.
The combined journal and cashbook is a large size 300-page ledger
printed especially for the Child Welfare Association. The entries
run across both pages when the book is open and the headings are as
follows, reading from left to right:
N o t e .— Headings in capitals followed by two or more headings in small type indi
cate a box heading with subheadings; e. g., an item written below as MEDICAL,
Service, Supplies, would appear in the book as

Medical
Service

Supplies

Headings, left-hand page:
Column 1. NURSES’ OUTFITS.
2. MILK.
3. SALARIES, Nurses, Office.
4. MEDICAL, Service, Supplies.
5. EQUIPMENT, Office, Stations, Medical.
6. INCIDENTALS, Office, Stations, Nurses.
7. RENT, Office, Stations.
8. STATIONERY and PRINTING, Office, Stations.
9. DUES.
.10. POSTAGE, Office, Stations.
11. MEMBERS.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Headings, right-hand page:
Column 1. SUNDRIES.
2. DEPOSITS, BANK.
3. DATE.
4. NAME.
5. LEDGER FOLIO.
6. CHECK NO.
7. WITHDRAWALS, BANK.
8. SUNDRIES.
9. DUES.
10. DONATIONS.
11. MEMBERS.
12. STREET DONATIONS.
13. NURSES’ OUTFITS.
At the beginning of the financial year the total sum that can be
expected from annual subscribers is entered in the column MEM
BERS on the debit side and in the column DUES on the credit.
When a subscription is received, the amount is entered on the
credit side under the column MEMBERS and also on the debit side
under the column DUES; in this way an even balance is maintained.
Contributions from individuals other than annual subscribers are
entered on the credit side under the heading DONATIONS.
Anonymous collections obtained by means of milk bottles, etc.,
placed in different parts of the city, are entered under the heading
STREET DONATIONS. These contributions and those men
tioned in the previous paragraph can not be entered on the debit
side, since they are occasional and by no means annual.
Money received from the nurses in payment for uniforms and ma
terial is entered in the eolumn NURSES’ OUTFITS on the credit
side, and purchases of such material are entered on the debit side in
a similar column. Thus a balance is obtained on this item also.
Under MEDICAL SERVICE on the debit side physicians’ fees
are entered.
Under SUNDRIES are entered items unclassified by the various
headings given.
In case it is found that further differentiation is necessary, two
blank columns are given on each side.
All receipts are to be deposited in the bank, and entered in the
column DEPOSITS, BANK, on the debit side.
All disbursements are to be made by check and entered in the
column WITHDRAWALS, BANK, on the credit side.
In this way an even balance will be maintained between the total
receipts and the deposits, and between the total disbursements and
the withdrawals.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FINANCIAL ADMINISTRATION.

I t will also be possible to obtain at any time the cash balance of
the association by taking the difference of WITHDRAWALS
BANK, and DEPOSITS, BANK.
From this book (a combined journal and cashbook) the ledger is
to be posted once a month.
The general ledger contains the monthly totals for individual items,
each item having a page reserved for its entries.
Membership and ledger cards kept alphabetically for all members
and donors are shown below. A receipt is given for every cent,
either check or cash, received by the association.
Petty cash. The first of each month the office manager will draw
a check to petty cash to bring the total petty cash on hand up to
$50.
This is kept in a separate cash box and all small miscellaneous
expenses are paid from this fund, a receipt being taken whenever
possible, and a memorandum made in all other cases, so that at the
end of the month every cent of the petty cash can be accounted for.
All the information given appears in the office manual of the
organization. If other organizations follow this plan, an exchange
of office manuals would doubtless prove of great assistance to execu
tives who are perplexed by the problems attached to the financial
accounting of the organization.
METHODS OF PREVENTING MISTAKES.

Some of the difficulties encountered by those unaccustomed to
handling funds and accounting for them is due to their failure to
comply strictly with the rules laid down for their guidance. One
cashier in a public health organization found great difficulty in
balancing her petty-cash account at the close of the month. This
was due to her custom of keeping the fees returned by the nurses
from their patients in the same compartment of the petty-cash
drawer with the money properly termed “ petty cash”—i. e., the
money set aside by the organization for that purpose and received
from a check drawn for petty cash. A lost receipt for an expenditure
from the petty cash or a mislaid memorandum of the amount turned
in for fees meant confusion in the petty-cash account and inaccuracy
in the fees account. The organization now prevents this difficulty
by having fees and petty cash kept separate and, in addition, using
a patient’s receipt, which is checked against the returns of cash made
by the nurses. This method protects the nurse from failure to receive
credit from the bookkeeper and also places the services of the nurse
upon a business basis. The form and the instructions for its use
follow.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

Patient’s receipt card.
PATIENT’S RECEIPT CARD.

P a t ie n t ..............................................................- - ........

Date
of visit.

A d d ress

Amount Amount
fee.
paid.

Service rendered.

Received by—

Mothers will please keep these receipt cards for at least one month after last payment.
Child Welfare Assn., N. 0 . 1920. Form 25.

I n s t r u c t io n s

for the

U s e (w

th e

P a t ie n t ’s R e c e ip t Ca r o .

These receipt cards are made in duplicate and bound in books. The original white
sheet is perforated at the left edge and should be left in the home of the patient.
The yellow carbon sheet should never be detached from the book.Patient: Write the surname of the patient first and then the given name. For
example, "Smith, John.” Write the address clearly and do not fail to use north
or south for streets that cross Canal and discriminate carefully between streets and
avenues. Do not guess at the numbers of houses; be as accurate as possible.
Date of visit: In this column enter the date of your visit in figures.31
Service rendered: Indicate here the form of service given to the patient.
Amount of fee: In this column enter the amount charged for this visit.
Amount paid: In this column enter the amount paid to you by the family.
Received by: Sign your name after each amount paid. This is your receipt to the
patient. On making a second call, ask the patient to give you the original white
sheet. Place this carefully over the yellow sheet in your book with carbon paper
between the two sheets and enter the record for your second, visit. Impress upon
the mother the necessity for keeping (not losing) the white sheet. At the end of the
month the yellow sheets in your book will be checked with the four columns for fees
provided on the calendar sheet on the time book.

Fee envelope.
Another organization simplified the office handling of fees by using
the envelope form here shown and checking it with the entries on
the nurse’s daily report. When the amount has been checked, the
amount and the date are crossed out and the envelope is returned to
the nurse’s desk for use the following day. Before this envelope was
used, the nurses laid the money collected upon the cashier’s desk.
3i This instruction would he improved if changed to read: “ Enter the date of your visit, giving the
month, day, and year. Use only the following entries for the months—Jan., Feb., Mar., Apr., May, June,
July, Aug., Sept., Oct., Nov., Dec. Never use figures to indicate the month.”

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY.

In c^se the amount upon the desk failed to check with the total fees
turned in by all the nurses there was no way to determine which
nurse was responsible for the error. The new system has resulted in
quicker tallying of the day’s fees and fewer inaccuracies on the part
of the nurses.
ENVELOPE FORM .
Name of Nurse:
DATE.

[Size: 3 by 5 inches.!
AMOUNT.

DATE.

AMOUNT.
1

------- ;
—

—

CAR TICKETS.

Car tickets, even when donated by the street car company, have
cash value and should be treated accordingly. If tickets are used,
it is advisable to determine by experience the number required for
each district for a given period, give out that number periodically
and keep a strict account of additional expenditures. If tickets can
be given out with the salary and expense checks it serves to empha
size that they have a distinct cash value and should not be used
carelessly by the members of the organization.
PUBLICITY.
FUNCTIONS OF PUBLICITY.

The function of publicity as used in connection with public health
nursing organizations supervising the health of mothers and children
of preschool age is fourfold: (1) I t is an accounting to the public;
(2) it presents the health facts of the community as it sees them; (3)
it suggests methods of improving conditions inimical to health and
preventing their recurrence; and (4) it furnishes a method of secur
ing financial support.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION".

MEDIUMS OF PUBLICITY.

Annual report.
The most usual form of publicity for public health organizations
is the annual report, which should bo published, regardless of its size.
If the organization can not afford to put out its annual report in the
form of a pamphlet, at least it can be presented in the local news
papers, which will publish it gratis in most instances. The impor
tance of this public accounting can not be stressed too heavily. The
public pays the bills for the maintenance of the organization, and
thus represents its stockholders. As stockholders, they have a right
to know what is done, how it is done, and how much it costs. The
annual report furnishes this information, which serves as a basis for
further or decreased contributions, according to the indications of
the report.
Size.—The organization which has sufficient funds to permit the
publication of its annual report should decide, at the time the first
report is published, what constitutes an acceptable standard as to
size and this should be adhered to for all future reports. This stand
ard size is desirable in order to- permit binding together the reports
for a number of years; it establishes in the mind of the public a
definite association between the appearance of the annual report and
the organization. This has a definite advertising value. The size
most generally approved is 6 by 9 inches.
Content.—Probably no better concise statement covering the
essentials of an annual report can be given than that made by Edwin
D. Solenberger in a paper read before the National Conference of
Charities and Correction in 1909.31
The following six points are brought out :
1. The report should be published annually and be a report of the
past year’s work, not chiefly a statement of what is proposed for the
future.
2. I t should show on the cover page—
The full corporate name of the organization.
The date established and incorporated.
The exact location of the office or offices.
The full post-office address.
The exact period covered by the report.
3. I t should state thé function of the organization in the com
munity, showing the classes dealt with, the terms of admission, and
the limitations as to age, sex, color, physical condition, religion, and
so forth.
(a)

81 Solenberger. Edwin D.: “ The Essentials of an Annual Report” in National Conference of Charities
and Correction, Proceedings, 1909, p. 361.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY.

4. I t should show—
The progress of the organization in work and methods.
New features.
Extension of old lines of activity.
The cooperation and affiliation with other organizations.
5. I t should call attention to—
Changing conditions in the community which affect the work
of the organizations.
New laws affecting similar organizations.
6. I t should present statistical and financial statements which are
clear, uniform, and frank.
In emphasis of the last point, it is well for executives to realize that
frankness includes statements of failures as well as successes, and
fairness entails explaining the reasons for the failure and pointing the
way to adjustments which will avoid similar failures in the future.
Text.—The text of the report should be simple and nontechnical,
but it should not be limited to a mere statement of facts and figures.
Such a report is uninteresting and fails of all purposes except that of
making a formal report to the public. The report which presents its
material in a popular manner, comparing findings with those from
other cities, using various forms of illustrative material, such as
stories, charts, photographs, etc., will win the interest of its readers
and thereby secure added support for the organization. At the
same time, it will serve as an additional method of public education
in matters of local health conditions.
Preparation of the text requires attention to four features which
add greatly to the effectiveness of a report, if presented properly,
i. e., (1) interpretation of statistical data, (2) use of photographs and
stories, (3) use of charts, (4) presentation of maps.
(1 ) I n t e r p r e t a t i o n o f S t a t i s t i c a l D a t a .— The executive who
attempts to interpret the statistics obtained from the various sources
at her command must be certain that she never states a conclusion as
anything but an opinion unless the figures justify it. The danger of
neglecting to do this is shown in the case of an executive who noticed
that the city’s infant mortality rate decreased at almost the same
rate as the number of visits by her nurses increased. At once she
drew the conclusion that the work of the organization was responsible
for the lowered mortality rate and a chart was prepared to point this
out to the public. However, analysis of the birth registration for
the period under consideration showed there had been a marked im
provement and at the same time there had been no decrease in the
percentage of deaths registered. As the infant mortality rate for the
city was obtained by dividing the number of infant deaths registered
during the year by the number of births registered during the same
period, it is at once apparent that the increase in registration of births

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

100

OFFICE ADMINISTRATION,

would cause a much lowered infant mortality rate in the city’s report,
although actual conditions among the infants remained unchanged.
Another organization in a city having a large Negro population
had selected for comparison with its report that of an organization
in a northern city, and the executive was at loss to account for the
fact that, although her nurses made as many visits during the year as
the nurses in the northern city, the infant mortality rate in the
northern city was very much lower than that of the city under con
sideration. Analysis of the figures prepared for the annual report
showed that the southern organization limited its supervision to white
children with the exception of emergency cases among the Negro
children, among whom the death rate was very high. The northern
city had practically no Negro population and its nursing service
supervised the health of all the children under 3 years of age through
out the entire city. Careful study of the vital statistics in the south
ern city showed a lower infant mortality rate for the white children
than that obtained in the northern city, but the infant mortality rate
among the Negro children was so high that it brought the rate for
the city above that for the northern city—a fact which had escaped
the executive, who was perplexed over the apparent failure of her
organization to accomplish the results obtained by the northern
organization.
Familiarity with reports of other organizations doing similar work
and with Government reports containing figures valuable for com
parative purposes will aid the executive who wishes to make the
fullest use of her statistical material.
(2) P h o t o g r a p h s a n d S t o r i e s .—Well-selected stories or photo
graphs illustrating points proved by statistics add great force-to the
points made and are much more effective than the statement unsup
ported by an illustration. In selecting stories, it is important to use
only those which can not be identified or to have in writing permission
from the persons mentioned. Failure to regard this rule has caused
damage suits against several organizations which used stories and
photographs which could be identified.
(3) C h a r t s .—Some of the points may be shown most clearly by
the use of graphs or charts which can be enlarged and placed among
the exhibit charts of the organization. (See charts in connection
with exhibits.)
(4) M a p s .—Organizations which maintain spot or pin maps, show
ing births and deaths as they occur according to location, or the
location of visits, might find a reproduction of such,maps an attractive
addition to the annual report.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY.

101

(b) Monthly reports.
The complete monthly reports as presented by the executive
should be a combination of the reports of all special groups; i. e.,
nursing, medical, office staff; and her own record of accomplishment
for the month. In addition, the facts must be interpreted and pre
sented in popular form, lightened in tone by case stories, disguised
as to name, but authentic in fact and typical of the points to be em
phasized. Because the form of the reports will vary according to
the scope of the organization, it is not possible to suggest a form
which would be found acceptable to all organizations; but each
organization can determine its own form and this should be entered
in the office manual in the administration section, under the heading,
“ Executive's routine duties."
(c) Exhibits.
Exhibits as a method of presenting results, forecasting needs, and
suggesting community needs have been in use for several years by
social agencies throughout the country. As the Russell Sage Founda
tion has published two volumes on the subject of exhibits, and several
publications on special phases of exhibit preparation have been
issued, it might appear that the subject should be omitted from this
report. But there are several features of exhibit planning which
belong particularly to the field of the public health nursing organiza
tions supervising the health of infants, mothers, and children of pre
school age. The main purpose of this type of health organization
lies in preventive work through education of the public. Exhibits
offer an unusual opportunity for this type of publicity.
Planning and preparing exhibits.—The planning and preparation
of exhibits consume a great deal of time, but it should be possible to
have most of the actual work of preparation done by volunteers
working under direction. They may be supervised by (a) a com
petent volunteer, (&) a paid supervisor who is an exhibit expert, or
(c) the chief executive of the organization. I t might be found profit
able to engage an exhibit expert to hold an exhibit demonstration
for the instruction of those who are to be responsible for future
exhibits. The executive of the organization should attend all these
demonstration lessons-in order that she may be competent to give
decisions on points of dispute when the expert is no longer available.
This demonstration should include all points of exhibit planning,
commencing with determining the purpose of the exhibit.
Before the services of a nonresident expert are engaged, a careful
survey for local candidates should be made. Many of the library
schools now include exhibit planning and preparation in their courses
of instruction. This enables their graduates to render this special
type of service to the communities in which they live, not only in

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

102

OFFICE ADMINISTRATION-.

connection with the library but in connection with any community
information which the library can display as part of its educational
program.
One public health nursing organization found th at it could utilize
the services of a number of interested young volunteers who were
attending art schools in the preparation of artistic panels for wall
display in their administrative offices and health-center waiting
rooms. Such service has many by-products of value to the organiza
tion such as winning loyalty from the volunteers, teaching them much
they would not know otherwise and securing local talent which adds
to the interest of the public in the exhibit when it is placed on display.
Charts*—One of the most popular forms for exhibit panels is the
chart. Its numerous uses and adaptations are well set forth by
Willard Cope Brinton in his publication “ Graphic Methods for Pre
senting Facts,” and the method is simply explained and illustrated
in Frank J. Warne’s u Chartography in Ten Lessons.”32
One child welfare association which made extensive use of the
suggestion contained in these two publications found a quick and
simple method of making bar chart panels. Gummed passe-partout
paper of various colors and widths was cut into the desired length
and applied to the chart with a minimum of labor and time. In
addition, the appearance of the chart was much neater than the bar
charts printed or sketched by inexperienced persons.
Location of exhibits.—Exhibits will not long retain the attention of
the public unless they are renewed or completely changed. This
means that they must be systematically planned for and inspected.
There may be some permanent places available for exhibits, such as
the library, schools, association of commerce chambers, waiting
rooms of health centers and dispensaries, etc., but there will be other
places where an occasional exhibit will be acceptable for a limited
period; e. g., during special conferences a t churches, at club meetings,
in store windows, at county fairs, etc. The alert director of the
exhibit committee will never miss an opportunity to reach the public
through this effective method of appeal. Many organizations now
use exhibits in connection with their annual campaign for funds, and
after the completion of the drive distribute the various parts of the
exhibits for display in health centers and settlements during the re
mainder of the year. Generally, they hang as originally placed,
where, undisturbed, they gather dust and soon lose their fresh and
attractive appearance. They are viewed largely by the same audience
week after week, and consequently, soon lose their appeal. This is
most unfortunate, as the audience which might be reached in such
■« Brinton, Willard Cope: Graphic Methods lor Presenting Facts. The Engineering Magazine Co., New
York, 1914.
Warn®, Frank J.: Chartography in Ten 'Lessons.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY.

103

exhibit rooms is one of the most desirable from the standpoint of
public health.
As the publication “ The A B C of Exhibit Planning”33 points out,
it is very helpful to have persons on duty where exhibits are stationed,
who will answer questions, distribute literature, and give other
helpful service.
Sources of exhibit material.—Several national organizations have
prepared sets of wall panels and other exhibit material which may be
obtained upon request, generally for the cost of shipment. Informa
tion concerning these organizations and the material available may
be secured upon request from the National Organization for Public
Health Nursing and the Federal Children’s Bureau. I t is customary
for organizations to set up exhibits, regardless of their suitability to
local needs, and they are seldom supplemented by eharts or panels
showing local conditions, although this comparative presentation is
extremely valuable in setting forth sharply the excellencies and de
ficiencies of the local health situation. National exhibits form an
instructive and sound foundation for local exhibits but they are not
intended as the sole display in any community exhibit.
The best methods of planning, preparing, and distributing exhibits
have not been completely standardized, but enough has been done to
be well in advance of the use made of them by p ublic health nursing
organizations. Those executives interested in developing this
feature of publicity will find increasing opportunities for exhibit
display, and a resulting popularity with the public which few other
forms of publicity can secure.
(d) Library cooperation.
In return for the varieties of service which the librarian can render
to the public health nursing organization in matters of office organiza
tion, and the planning and preparation of exhibits, the public health
nursing executive can supply the librarian with the necessary in
formation regarding public health publications which should be on
the shelves of the public library. In addition, she should encourage
the use of these books by all those who come under the influence of
the organization. The public health exhibits could be so planned that
at least one panel would inform the public of the health material
available without cost in the local library.
(e) Newspaper articles.
The newspaper holds first place as a medium of publicity, but
it is used comparatively little by most public health nursing organi
zations engaged in preventive work. This is due partly to the
33 Routeahn, Evart G., and Routzahn, Mary Swain: The A B C of Exhibit Planning, p. 101 S . The
Russell Sage Foundation, New York, 1918.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

104

OFFICE ADMINISTRATION.

fact that nursing executives do not know what constitutes “ news,”
in the newspaper sense, nor do they know how to prepare copy which
will appear without radical changes. I t is the common complaint
among reporters that the copy turned in to them with the injunction
that it must appear without change or not he printed is often poorly
prepared and dull in style, a combination which prohibits its appear
ance as “ news” and dooms it to failure as a publicity feature.
This does not mean that the executive should not prepare the
copy for the reporter—quite the contrary. The oral interview is
pretty definitely foreordained to an inaccurate presentation by the
time it has gone through the hands of the reporter and the city editor.
This does not mean that they are intentionally inaccurate or unin
terested, but they are not trained in the public health field, its terms
and work are unfamiliar to them, and they are unable to see in a
given statement the news value that appears to the nursing executive.
The responsibility for giving them the news in a form which will
insure accuracy and make it command sufficient attention to secure
its insertion in the newspaper as a prominent news item lies with the
executive of the public health nursing organization. She must
guard against supplying sensational material, using facts which she
can not prove, giving opinions which do not have their foundation
in fact, and avoid many other pitfalls which await the careless news
giver.
Newspaper reporters are, as a rule, inclined to be friendly to socialservice organizations, and if their assistance and cooperation are
enlisted they will do much to point the way to utilizing the newspaper
fully in behalf of the public health nursing organization. In order
to make unnecessary a great deal of instruction on their part, the
executive of the organization should read some of the standard
publications on newspaper writing.34 In addition, it may be possible
to secure from the newspapers copies of the style books, which many
newspaper offices maintain for the guidance of their employees.
It is essential that all newspapers in a community should be treated
with fairness in regard to news, which sometimes presents a difficult
problem when both morning and afternoon papers must be considered.
One of the most important features of fairness in this connection is
the matter of sending material to the papers in time for the edition for
which it is intended. All papers will give the executive a statement of
the hours covered by their editions, although, in general, it is the rule
that events up to 2 o’clock in the afternoon belong to the afternoon
paper, while all following that hour, through the evening and night,
belong to the morning paper.
Another reason for the refusal to print manuscript as submitted may
be traced to the rule of the newspapers that they are conducted in the
» See Bibliography, page 117.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY.

105

interest 6f news. u News is what interests readers; it includes any
thing and everything that has such interest; it must be new, current
and timely.” 35 Although some propaganda can be made to take
on the appearance of news, most editors will rule it out on the grounds
that it is argument and not news. I t is, therefore, one of the difficult
but interesting duties of the public health nursing executive to be
constantly awake to opportunities to educate the public by means of
“ news” which has propaganda value. Some editors are willing to
reserve a special column certain days of the week for articles which
are clearly propaganda, provided it is of the type which interests all
or certain classes of readers. Information about the care of babies
is always welcomed, because it is of great interest to the mothers of
the community. Other subjects, designed to reach special groups,
might well be prepared for reserved space if the executives were
aware of their opportunities in the newspaper field.
A publicity campaign which gave special attention to the newspaper
publicity aspect is admirably described in an article by Eleanor
Taylor Marsh.36
( / ) Public meetings.
Public speaking is one of the arts but little practiced by public
health executives, although it is one of the most effective publicity
vehicles at their command. Such speeches can be largely propa
ganda, illustrated with material from the experience of the local
organization, comparisons with conditions and accomplishments in
other communities, and definite recommendations and appeals upon
which action can be based. These talks should be carefully pre
pared according to the type of audience to be addressed. Many
speakers become so used to the vocabulary of their profession that
they do not realize that many points fail to reach the intended mark
because'the terminology employed is unfamiliar to the audience.
The executive who can present her facts to business men in the
language of the commercial world, to social workers in terms of
social service, and to other groups according to their experience
and interest, will find that she has at her command a publicity
medium which will yield immediate results in support of the program
she is endeavoring to develop. The executive who speaks con
vincingly and entertainingly will find the club programs open to
her, not only in her own city but elsewhere. I t should be the desire
of the board that such community service be considered one of the
very important duties of the executive and it should therefore
stand ready to bear the expenses attached thereto, whenever, in
35 Bleyer, Willard Grosvenor: Newspaper Writing and Editing, p. 18. Houghton, Mifflin Co., Boston,
New York, etc., 1913.
36 Marsh, Eleanor Taylor: “ Telling the Public About the Public Health Nurse, ” in Public Health Nurse,
Vol. X II (March, 1920), pp. 218-222.

57716°— 22-----8

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

106

OFFICE ADMINISTRATION.

its judgment, the community service will not interfere with the
work of the organization. Occasions for giving public addresses,
like membership upon committees, must be carefully considered,
and the choice made should be governed by the amount of time the
executive can take from her duties connected with the administra
tion of her organization.
(gr) Educational classes.
There is a wide divergence of opinion regarding the extent to
which public health nursing organizations should maintain educa
tional classes. As it is an effective method of preventive work,
there seems to be no reason why it should not be included in the
program for educational publicity. These classes will vary accord
ing to the needs of the community and the teachers available.
(1) Little Mother's Classes.—So-called Little Mother’s Classes
are perhaps the best type of educational elasses. In these the
children learn a great deal about the care of the infant and in the
case of children of foreign-born parents this instruction as taught
through them often is more effective than the same instruction given
the mother in demonstrations or through an interpreter.
(2) Women’s dub 'programs.—Club programs often give an entire
period to a selected subject and if that subject, is public health, the
executive of the nursing organization will probably he requested to
assist in planning and executing the program. Some of these
programs have included special classes of instruction in the home
care of the sick, emergency* care or first aid in case of accidents, and
other information which every mother needs to have as p art of her
equipment for caring for her family.
Even the fact th a t no teacher could be secured did not daunt one
group of women who desired to be better informed upon public
health subjects. They appointed a committee which worked out a
program with the assistance of the public health nursing executive.
I t consisted of reading on suggested subjects, occasional lectures,
and preparation of papers on matters of local health interest, the
information for which could be secured only through interviews
and visits of inspection.
(7b) C o n te s ts .

Contests may be made an interest-compelling feature in a publicity
campaign, although, unless they are carefully planned to guard
against such difficulties, they are apt to arouse injured feelings
which may overbalance the good they have done. Refusal to per
mit the award of any prizes, sufficient classification to permit the
award of numerous ribbons, and other safeguards should rob a
contest of its dangers.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PUBLICITY,

107

(1) Baby health conferences.—Special emphasis should he laid upon
the undesirability of holding baby contests a t which prizes are
awarded to the fattest babies or to those who possess some other
quality in a superlative degree. Experience has demonstrated
beyond dispute that it is much more satisfactory to hold baby-week
campaigns or other health demonstrations, the purpose of which is
to supply parents and the community with scientific facts about
the health of the babies and children presented for examination.
Complete descriptions of the methods and means for planning and
carrying on such campaigns will be found in- the publication entitled
“ Baby-Week Campaigns,” which is issued by the Federal Children’s
Bureau.
(2) Poster contests.—One community which held a poster contest
persuaded the school board to permit the art teacher to devote one
week to assisting the children in preparing posters on subjects pre
sented each night in the local newspapers. The material appearing
in the newspapers was carefully prepared by the contest committee
to supply the children with a mass of information which would inter
est and a t the same time instruct them upon matters of public health.
Local merchants were asked to hold window displays showing special
features of child care, and in many other ingenious ways the subject
of infant and child care was brought effectively before the public.
The posters were hung in the public library assembly hall, and at
the end of the week first, second, and third prize ribbons were
awarded according to the school grade and the first prize posters
were later exhibited in the health center.
(f) Motion pictures.
The educational films on child-welfare subjects are as yet few in
number and comparatively little use has been made of them. They
are expensive to produce and therefore the small public nursing
organizations can not buy films, but it is possible for special occa
sions to borrow or rent those films produced by national or special
organizations, such as the Children’s Year film of the Children’s
Bureau.
The New York chapter of the American Red Cross has issued a
list of 221 motion pictures on health, among which are a number on
child-health subjects. The list, which may be secured upon appli
cation, contains information covering title of film, description of
subject matter, name of distributors of the film, terms upon which
it may be secured, and the number of reels.
These suggestions may serve to give the public health executive a
point of departure for securing information regarding films and slides
suited to her subject. More detailed information is not given here
because the lists are changing constantly.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

108

OFFICE ADMINISTRATION.

Distribution of literature.
Every public health nursing executive should keep for distribution
standard publications on the subjects which her nurses are endeavor
ing to teach the mothers and children in the districts. Many such
publications can be secured in quantities from various Federal,
State, city, and private organizations. A word of warning should be
given in this connection. Each executive must be responsible for
the publications issued through her organization; therefore she
should read carefully each publication before placing it on the list
of printed matter to be distributed. This will give her an oppor
tunity to select material which is consistent and which sets the
standard she wishes maintained by her organization. Even though
there are two accepted ways of dealing with a given situation in a
specified health matter, it is not wise for an organization to distribute
two publications, each setting forth a different method. To do so
will confuse the mothers and destroy their confidence in the instruc
tions issued. I t is possible, also, that the method followed by the
organization may not coincide with that recommended in all litera
ture for free distribution. As a measure of self-protection the execu
tive should make such a situation impossible by reading earefully all
literature before it is sent out from her office. The office manual
should contain a list of the publications available for distribution,
directions covering when and to whom they are to be distributed,
and instructions added to the effect that no member of the organiza
tion may give out any literature nor recommend it unless it appears
on the list in the manual. If any member of the organization knows
of any desirable literature not on the list she should report it to thè
executive in writing, giving the title of the publication and the
address of the organization from which it may be secured. If the
executiye approves it, she will secure a supply for distribution and
the name of the publication will be added to those previously listed
in the office manual.
(j)

THE OFFICE MANUAL.
PURPOSE OF THE OFFICE MANUAL.

Progressive public health organizations are rapidly following the
precedent established by modern commercial offices in preparing, for
the guidance of all employees, a manual of procedure which is gener
ally known as “ The Office Manual.” Within this manual are pre
sented the policies of the organization, the duties of the board, the
committees and all employees, and the best method of performing
every routine task. Business houses generally find it more expedient
to divide their manuals into : (1) The policy book, designed to acquaint
new employees in a general way with office rules, regulations, and

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE OFFICE MANUAL.

109

customs; (2) the manual of procedure, which gives definite instruc
tions as to the best way to perform the office operations found in
each department.37
The public health organization generally can combine both of these
in one manual.
NEED FOR OFFICE MANUALS IN PUBLIC HEALTH NURSING ORGANIZA
TIONS.

The usual method of introducing a new employee to either the
nursing or the office staff is for the chief executive or one of her assist
ants to give oral instructions regarding the organization’s rules and
the procedure for the special tasks to be assigned to the new em
ployee. In the majority of cases this oral instruction is incomplete
and superficial. The details of procedure, which are important in
maintaining a well managed office, are frequently omitted; the em
ployee is told in general what she is to do but not how to do it, and
she spends the first few days or weeks learning by asking questions
or by making mistakes, both of which methods are time consuming
and expensive to the organization. When Several employees are
engaged to perform the same duties, but are interviewed separately,
it will usually be found that the oral instruction was not the same in
all cases, a fact which later complicates the office routine, and may
cause misunderstandings and unpleasantness among those perform
ing the tasks.
To obviate all this waste and inefficiency, executives are preparing
office manuals. As Galloway says of the commercial manual, “ It
contains in black and white all these regulations, expressed in terms
clearer and more concise than any one individual can command on
the spur of the moment. I t eliminates the excuse of ignorance of
house rules, because every member of the organization has them at
immediate command.”38
FORM OF THE OFFICE MANUAL.

The manual may be typed or multigraphed and should be bound
in loose-leaf form. One copy, that used by the chief executive,
should be kept in a standard loose-leaf cover, as it must be referred
to frequently, and should be kept in excellent condition. The man
uals used by members of the staff may be bound between press board
covers which are protected at the back with a binding or passe-partout
cloth. This gives a durable and inexpensive cover which may be
renewed as occasion demands.
Some executives believe that each member of the organization
should have a complete copy cff the manual, some maintain that a
37 Galloway, Lee: Office Management, Its Principles and Practice, Ch. XLII, p. 637.
38 Ibid., pp. 637-638.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

110

OFFICE ADMINISTRATION.

single copy of the manual will suffice for the entire office, while
others are of the opinion that each employee should have only those
portions of the manual which deal specifically with her duties. If
this last policy is adopted it is advisable that every employee be
required to read the entire manual at least once and th at she be given
access to a complete copy whenever she is interested in procedure
or routine other than that in her own department. Comprehension
of the entire program of work often reveals the reason underlying
certain rules whieh might otherwise seem arbitrary and unfair; fur
thermore, this complete knowledge of the system obtaining in an
office and in the field should lead to an attitude of cooperation
between the field and office staffs. That this is true, a t least in some
cases, is shown in several organizations where the nurses have evi
denced greater interest and care in making out their reports as soon
as they realized the steps in the office which depended for speed and
ease of performance upon the clarity and accuracy of the nurses’
record keeping. In another instance,- the office force, which had
criticized the nurses for their poor writing, their careless methods,
and their unwillingness to do more of the clerical work, changed its
attitude to one of sympathetic cooperation as soon as they appre
ciated the responsibilities attached to the nurses’ field service. This
assistance took the form of discovering ways whereby more of the
clerical work could be assumed by the office staff, leaving the nurses
free to give that service which no one else in the organization could
render;!, e., nursing service. The change was brought about by the
presentation to the office staff of the duties of the nurses with em
phasis upon the fact that the office existed not as a separate activity
but as a tool whose main function is to expedite every activity of
the nursing staff and to aid the executive in obtaining any informa
tion she might need for the furthering of the work of the organization.
PREPARATION AND DEVELOPMENT OF THE MANUAL.

The manual is not written at one sitting nor is its first form perma- *
nent or final. The initial draft will be incomplete, and as it is reviewed
probably many inconsistencies will be revealed which might pass
unnoticed if the instructions were given orally. I t may be. that
before the preparation of the manual can be undertaken it will be
necessary to make a survey of the office, in order to determine
whether there is orderly procedure in all its functioning. Many
executives have no definite idea of exactly how the work in their
offices is proportioned, whether the methods employed are wasteful
or inefficient, or whether one employee is overburdened while another
has too little work to keep her fully engaged. In such cases the exec
utive should have the work of the organization surveyed and analyzed
as the first step in preparing material for the manual.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE OFFICE MANUAL.

I ll

No one person can prepare a manual solely from theory. The plan
may be made by the executive, but when the time arrives to outline
the duties of each member of the organization the persons performing
the duties should be Galled into conference. I t will, frequently be
found that they are able to suggest improved methods or divisions of
work and that their interest will be greatly increased if they are asked
to write out their own duties and what they consider the best arrange
ment of their time.
When all the material has been gathered for the initial draft of the
manual, it must be put in order by some one able to observe the fol
lowing rules:
1. The language throughout must be simple enough to be compre
hended by all of the employees. If it is necessary to use technical
terms they should be defined.
2. Every statement must be so worded that it can be interpreted
but one way. A vague order is no better than no order. Often the
failure of an office manual to accomplish what is claimed for it is due
to the careless wording of its contents.
3. Orders should be accompanied by careful explanation of the
reason for giving them in order that they may not seem unfair and
arbitrary.
4. The entire manual must be prepared so that its effect is one of
dignity and at the same time one of helpful guidance, rather than a
set of rules to restrict the activities of the staff. In this connection
the manual should emphasize the fact that it can remain helpful only
if every employee is constantly on the alert for inconsistencies and
needed changes by which the contents may be improved.
As soon as the manual is put into use, a multitude of omissions and
incorrect or incomplete statements not apparent when reviewed pre
viously will probably be revealed. This calls for immediate and pains
taking investigation upon which new material can be based or the
old revised. In making changes in a manual great care must be exer
cised to review every section of the manual which may be in any way
affected by the change. Failure to do this will result in contradic
tions and inconsistencies which are bound to cause confusion.
Suggestions for changes should be made in writing to the chief
executive. If they ase approved, a dated copy of the change should
be given to each employee to insert in the proper place in her
copy of the manual, crossing out the supplanted section. Manuals
should be considered part of the office equipment of the library
division, as are all of the books and publications belonging to the
organization. They should be charged out to employees by number.
The employees should be required to return them at the close of their
term of service with the organization, in as good condition as is con
sistent with constant use. Manuals in use should be reviewed

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

112

OFFICE ADMINISTRATION.

periodically by the office manager to ascertain whether they are up to
date. All discrepancies should be brought to the attention of the
employee who has failed to keep her manual corrected to date and she
should be required to put it in proper form at once.
CONTENTS OF MANUAL.*

The initial draft of the manual should include the policies of the
organization, the duties of all members, board of managers, the nurs
ing and office staffs, and volunteers, and any instructive material
of a general nature but of permanent value which can more easily be
emphasized in an impersonal fashion. For example, one public
health nursing organization found it necessary to insert a section on
“ Office etiquette” in its manual. This included a number of matters
which might give offense if specifically mentioned to the offending
individuals; among these were humming, whistling, conversing in a
loud tone, and other unnecessary actions which tend to disturb
other members of the staff; appropriate dress for the office, eating
during working hours, and other points which might properly be
termed “ office etiquette.”
Detailed instructions regarding the contents of a manual for public
health nursing organizations supervising the health of children of
preschool age can not be given because of the varieties of forms of
organization in the different associations, but perhaps the following
list of subject headings taken from the manual of one such organiza
tion will prove suggestive. This organization has a staff of 30
nurses, 2 senior nurses, 1 supervisor of nurses, an office manager, a
recorder, a file clerk, and a chief executive. Their service includes
the care of both well and sick children throughout the city, from
birth to 6 years of age. In addition, they give complete maternity
care, including prenatal supervision, confinement service, and post
natal care of the mother.39
Co n t e n t s

Manu a l.

1. Organization (Board of managers, committees, staff).
2. General information^ (Aim, scope, field, hours, fees, location of district and
main offices, location and hours of health conferences.)
3. General duties of administrators and staff.
a. Board of directors.
b. Committees.
c. Executive secretary'.
d. Office manager.
e. Recorder.
/ . Stenographer.
39
Since the preparation of this manual, the organization has added a number of services necessitating
many changes in the manual. Additions have been made to the office staff, requiring a reassignment
of duties, and a field clerk has been engaged who relieves the senior nurse of practically allher clerical duties.
Child Welfare Association, New Orleans, La.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE OFFICE MANUAL..

113

3. General duties of administrators and staff—Continued.
g. Supervisor of nurses.
h. Senior nurses.
i. Staff nurses.
j. Staff physicians.
Division on Nursing:
4. Instructions to supervisor :40
a. Triple responsibility.
Responsibility to the family.
Responsibility to community and association.
Responsibility to the nurses.
b. Principles of supervision.
Encouraging initiative.
Democratic discussion.
Development of nurses.
c. Procedure with new nurses.
Initial interview.
Assignment of equipment.
Supervision during first two weeks. (Includes various kinds of experience
and instruction by demonstration for training the nurse in the technique
of the organization.)
Weekly written report on nurses’ work during probation.
Routine of enrollment or dismissal at completion of probation.
d. Procedure with staff nurses.
Weekly home visits with nurses.
District office hours.
Daily duties (of supervisor).
Weekly duties of supervisor according to day of week performed.
Monthly duties of supervisor.
5. Instructions to senior nurses.
a. Conduct of district office.
b. Daily reports to main office.
c. Clerical supervision.
d. Supplies and equipment.
6. Instructions to nurses.
a. Circular of information (application, probationary period, salary, vaca
tions, resignations, absences, hours of duty, half days, telephones,
residence, uniforms, supplies and equipment).
b. Daily routine.
c. Standing orders.
d. Procedure at health center.
Records:
e. Use of time books.
Patient’s record.
Summary record.
Loan closet record.
Monthly report from time book.
/ . Use of child-receiving slip.
Routing.
Filling out.
Definition of items.

Appears in rewritten form in the Public Health Nurse, July, 1920.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

114

OFFICE ADMINISTRATION.

Division on Nursing—Continued.
6. Instructions to nurses—Continued.
Records—Continued.
g. Use of street-book child record.
Routing.
Filling out.
Definition of items.
. ■ .
•
h. Use of matemity-reCeiving slips.
Routing.
Filling out.
Definition of items.
. ■
‘
•
i. Use of maternity street-book record.
Routing.
*
Filling out.
Definition of items.
j
■
Medical Division:
7. Instructions to physicians.
:
, :;:v
а. Procedure at health center.
б. Uniforms.
c. Medical-history record.
Use.
Filling out.
Definition of items.
Administrative D ivision:
8. Instructions to office manager.
a. General outline of duties and responsibilities.
b. Financial duties.
Bookkeeping.
Combined journal and cashbook.
General ledger.
Card catalogue of membership and donation list.
Petty-cash book.
Financial record of individual nurses.
c. Inventory taking and keeping:
Supplies.
Equipment (covers taking inventory, additions, subtractions, transfers,
use of requisition slips).
d. Correspondence files.
Contents.
Filing plan.
Annual revision.
e. Administrative files.
Contents.
Filing plan.
Annual revision.
/ . Library.
Contents (books, pamphlets, maps, charts, photographs, slides, manu
scripts, magazines, clippings, films).
Routing.
Office forms and circulars.
/
Application blank for nurses (mimeographed).
Circular of information for nurses (printed).
Diet slips (for each age group), etc.
Filing methods according to type (i. e., book, chart, clipping, etc.).

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

THE OFFICE MANUAL»,

115

Administrative Division—Continued.
8. Instructions to office manager—Continued.
/ . Library—Continued.
Developing material.
Loaning material.
Borrowing material.
Destroying or otherwise permanently disposing of material.
9. Instructions to recorder.
a. General outline of responsibilities and duties.
b. Daily routine.
e. Semimonthly record of deaths.
d. Statistical work.
Tally sheets.
Total book-tally sheets.
e. Filing records.
General rules.
Child permanent records.
Medical records.
Maternity records.
Prenatal.
Confinement.
Postnatal.
Checking methods.
10. Instructions to stenographer.
a. Correspondence.
Form.
Routing.
Filing.
b. Typing records.
General instructions.
Child permanent records.
Maternity records.
Prenatal records.
Confinement records.
Postnatal records.

In preparing the manual it is important to insert in each section
copies of all forms referred to. Any forms which may not fit into
the body of the report may be saved for a special section at the
close of the manual where each form is entered and its use described.
This section will gradually be absorbed as the manual grows, but is
practically always necessary when the manual is first drafted.
INTERCHANGE OF OFFICE MANUALS.

Because of their changing form it is not good policy to print office
manuals, and because they are not printed no organization has a
supply large enough to make it possible to give copies to all appli
cants from other organizations. But there is a distinct value in the
interchange of office manuals among organizations giving the same
types of service, and each organization might have one or two copies
which could be loaned for short periods. The knowledge that manuals
will be subjected to comparison and critical inspection would do

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

116

OFFICE ADMINISTRATION.

much to .stimulate accuracy, completeness and clarity of expression.
Business firms, as a rule, do not loan copies of their manuals, but
they are very generous in arranging for persons interested to study
them. I t might prove helpful to office managers or public health
nursing organizations to look over the manuals, if there are any,
maintained by the local chamber of commerce, the Young Men’s
Christian Association, and business firms. Of course, much in their
manuals would not apply to the administration of the nursing organi
zation, but many excellent ideas as to office equipment, arrange
ment, methods of performing clerical work, and taking and keeping
inventories would be found in them.
The local librarian or executive of the social service exchange
should prove a Valuable adviser to the executive in preparing the sec
tions of the manual devoted to filing either records or correspond
ence. In addition, the librarian is particularly qualified to advise
concerning the portions devoted to collecting, keeping, and using
books, pamphlets, maps, and all other articles which may properly
be termed “ library material.”
OBJECTIONS TO OFFICE MANUALS.

‘One of the most frequent objections to the preparation of an
office manual is the time required to prepare and continue it. Ex
perience will soon demonstrate that this amount of time sinks into
insignificance when compared with the amount of time lost through
the repetition of orders, mistakes made because orders were not
understood, and confusion resulting from overlapping and poorly
planned methods.
A second objection to office manuals is the inability of the execu
tive and members of her staff “ to write well enough” to prepare a
manual. This is not a legitimate excuse, because the manual is not
intended as a literary production. Its chief requirement is clarity,
and it has been repeatedly proved that if an executive is unable to
express her orders clearly, either in writing or orally, it is due to the
fact that she has not clearly defined in her own mind just what she
wants done and how she wants it done. The demand for a clear
expression as called for by the office manual often serves to clarify
and sharply define in the mind of the. executive the duties of the
various members of her staff. Surely this should be sufficient
argument for the preparation of an office manual.
VALUE OF THE OFFICE MANUAL.

The carefully prepared manual, once installed, will never be dis
carded, for it will enable the executive to establish a more intelligent
control over the office routine, and she will have, as a result, a care
fully standardized office which is the foundation of sound and efficient
organization.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

BIBLIOGRAPHY.
Many readers will doubtless wish to consult the sources of quota
tions given and will find additional helpful suggestions in the maga
zines and books used as references throughout this report. There
fore, the following list is appended in the belief that it may encourage
the search for further direction in methods of office management in
all its phases on the part of public health nursing executive^.
This list should be developed by the interested executive, who
will find the latest books on office administration and its problems
in public libraries, the libraries of associations of commerce, and in
the commercial departmental libraries of high schools and colleges.
OFFICE ADMINISTRATION.
Barrett, H. J.: Modern Methods in the Office. Harper and Brothers, New York and
London, 1918.
•
Carr, A. M., and Bradley, Florence: Reading Lists on Organization, Administration,
and Development of Public Health Nursing. National Organization for Public
Health Nursing, New York, 1920.
Galloway, Lee: Office Management, Its Principles and Practice. The Ronald Press
Co., New York, 1919.
Gowin, Enoch Burton: Developing' Executive Ability. The Ronald Press Co.,
New York, 1919.
— — ------ The Selection and Training of the Business Executive. The Macmil
lan Co., New York, 1918.
Purinton, Edward .Earle: Personal Efficiency in Business. Robert M. McBride &
Co., New York, 1919.
Scott, Walter Dill: Increasing Human Efficiency in Business. The Macmillan Go.,
New York, 1911.
Schulze, J. William: Office Administration. McGraw-Hill Book Co. (Inc.), New
York, 1919.
Shaw, A. W., Co.: How to Manage an Office. A. W. Shaw Co., Chicago, 1914.
-------------- Making the Office Pay. A. W. Shaw Co., Chicago, 1918.
Shepard, George H.: The Application of Efficiency Principles. The Engineering
Magazine Co., New York, 1917.
Administration (monthly). Ronald Press Co., New York.
Office Appliance (quarterly).. Office Appliance Co., Chicago.
System (monthly). A. W. Shaw Co., Chicago.
Statistical Manual for the Use of Institutions for Mental Diseases. The National
Committee for Mental Hygiene, New York City, 1920.

PUBLICITY.
Bleyer, Willard Grosvenor: Newspaper Writing and Editing. Houghton, Mifflin Co.,
Boston, 1913.
Harrington, H. F., and Frankenber, T. T.: Essentials of Journalism. Ginn and Co.,
New York, 1912.
Marsh, Eleanor Taylor: “ Telling the public about the public health nurse,” in The
Public Health Nurse, Yol. X II (March, 1920).
117

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

118

OFFICE ADMINISTRATION.

National Juvenile Motion Picture League Bulletin. New York.
Routzahn, Evart G., and Routzahn, Mary Swain: The A B C of Exhibit Planning.
The Russell Sage Foundation, New York, 19'18.
Sampson, E.: Advertise. D. C. Heath & Co., New York, 1918.
Shaw, A. W., Co.: How to Write Advertisements that Sell. A. W. Shaw Co., Chicago,
1912.
Solenberger, Edwin D.: “ The essentials of an annual report” in National Conference
of Charities and Correction, Proceedings, 1909.
Tipper, Harry; Hollingsworth, Harry L.; Hotchkiss, George Burton; and Parsons,
Frank Alvah: Advertising, Its Principles and Practice. The Ronald Press Co.,
New York, 2d edition, 1919.
-------------- Principles of Advertising. The Ronald Press Co., New York, 1920.

GRAPHS.
Brinton, Willard Cope: Graphic Methods for Presenting Facts. The Engineering
Magazine Co., New York, 1914.
Warne, Frank J .: Chartography in Ten Lessons. Frank J. Warne, Washington, D. C.,
1919. .
Whipple, Geo. Chandler: Vital Statistics. John Wiley Sons (Inc.), New York, 1919.

INDEXING.
Amberg, Arthur J.: Applied Indexing, 1918. (May be secured gratis upon applica
tion to the Amberg File & Index Co., Chicago, Cleveland, Pittsburgh, New York,
Boston, or Philadelphia.)
Hudders, Eugene Russell: Indexing and Filing. The Ronald Press Co., New York,
1916.

PUBLIC HEALTH NURSING.

Brainard, Annie M.: Organization of Public Health Nursing. The Macmillan Co ,
New York, 1919.
Carr, A. M., and Bradley, Florence: Reading Lists on Organization, Administration,
and Development of Public Health Nursing. National Organization for Public
Health Nursing, New York, 1920.
Foley, Edna L.: Visiting Nurse Manual. The Visiting Nurse Association, Chicago,
1919.
Gardner, Mary Sewall: Public Health Nursing. The Macmillan Co., New York, 1916.
Public Health Nurse (magazine). National Organization for Public Health Nursing,
Cleveland, Ohio.

COMMUNITY SERVICE.

Byington, Margaret F.: What Social Workers Should Know About Their Own Com
munities. Charity Organization Department of the Russell Sage Foundation,
New York City, 1912.
Sears, Amelia: The Charity Visitor. Chicago School of Civics and Philanthropy,
Chicago, 1918.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.
Four record systems are presented here in an effort to show how
the same problem is solved by organizations offering different types
of service. In each case instructions for the use of the records, and
definitions of the items, have been given as examples of the way to
prepare for an office manual that section dealing with the case record
system. These records were planned by the executives of the four
organizations represented, in cooperation with the organization ad
viser of the Children’s Bureau, who advised regarding form and ar
rangement of the items selected and defined by the public health
nursing executive.
RECORD SYSTEM L
Ch i Ed W e l f a r e A s s o c ia t io n , N e w O r l e a n s , L a ., 1 9 19.

Scope.—Service to all children under 6 years of age during sickness
and health in a selected section of the city. Its system comprised:
1. Call Book.
2. Child Receiving Slip.
3. Street Book (child record).

4. Time Book.
5. Medical History Card.
6. Child Permanent Record.

1. The Call Book.
The call book was a blank book which was used as described on
page 56. The instructions for its use follow:
Call book.—The call hook is a daily record of (1) the calls recorded at each district
office, and (2) the nurse’s presence at the station for the noon horn. Every call
received at the district office, written, telephoned, or oral, should be entered in the
book under the date it is received. The nurse who is to make the call (this may be
the relief nurse) indicates that she has taken it upon her notebook by signing her
initials in the dotted space in the call book.
On the following noon a receiving, slip should be turned in for every call that
appeared on the call book the previous day. The exception to this is a call marked
“ O. C.” (old cases). Only in exceptional cases should the slip be delayed 48 hours.
Prompt attention to receiving slips insures prompt, attention to calls.

2. Child Receiving Slip.
Routing-—This slip is used for all city board of health cases and
for all cases admitted from sources other than the birth records. The
routing is as follows:1
The city board of health case is copied in duplicate from the birth records at the city
hall by the child welfare association recorder. The carbon copy is retained by the
recorder and filed, according to date, in the main office. This file is kept as a tracer
for the original call slips, each move made by the original slip being entered with
the date upon the carbon. The copies are districted according to the four districts
and mailed from the city hall. The district senior nurse puts these slips in the proper
mail boxes. The nurses visit the cases and return all slips, filling them out in accord
ance with instructions. The sendbr nurse verifies these slips and returns them to
the main office, where the recorder checks them to see whether they are readmit
cases; the stenographer types the permanent record form for new cases; and the slip
is sent to the social-service confidential exchange, where information about other
agencies registered on the case is entered on the back. The slip is returned to the
main office where the new information is typed on the back of the permanent record
card. The carbon is then destroyed and the slip is sent to the proper district office,
where the nurse enters the information on her street book record. The slip is then
filed alphabetically in the proper station as a reference blank for the physician.
The carbon slips in the main office are reviewed once each week in order to trace slips
which may have been held up in some other office. The office that has failed to send
on the slip is so notified.
1 See Chart I, p. 122.

57716°—22

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

121

122

OFFICE ADMINISTRATION,

CHART SHOW ING TH E ROUTING OF TH E ORIGINAL CHILD RECEIVING SLIP.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1—Family Name................................................ ....................... 2—Address.......................... ................................... ..3 —Field No...................... ...............
4—Name............................................... 5—Col. W............ 6—Bom ..............................192.. .7—Birth registered Y. N. 8—Time book page.. . . ___
9—Father’s Name......................................................................10—Admitted...................... 192___ 11—Age at admission___ yrs........ mos........ days.
12—Mother’s Name..................................................................13—Not Admitted (cause)................................. : ................... .. .14—Reg. Aff........... .
MOTHER: 15—Age............... '.yrs. 16—Country birth.....................................17—Nationality................................ ......... 18—Spks. Eng. Y. N ___
19—Reads Eng. Y. N. 20—Reads other Lang. Y. N. (specify)................. 21—Refd. by CBH, Phyn., Canv., Mwf., Ind., Org. or Inst...............
22— Present Occupation (a) Lodgers Y. N. (b) Other (specify)....................................... (c) Seasonal Y. N. (d) Weekly earn. $......................
23—Issues (a) Live born.............. .(b) Died..................... (c) Age at death......... f (1)___yrs........
mos. (d) Cause r l
(1).. . .yrs.. . .mos.
(e) Stillborn..........(f) Miscarriages...........(g) Total............................. .............

(2).. . .yrs..

* 2

*24—Case pregnancy (a) Urine.......................................................... ....................
(3).. ..y r s ...
S.3
(b) Bowels, reg. irreg. (c) Yag. discharge Y. N. (d) Nausea Y. N. (e) Instruments Y. N. (f) Lacerated Y. N. (g) Temp. Y. N...................
(h) Attendant: Phyn., Mwf., Other (specify).........................................’. . .......... ... .(i) C. W. A. Maternity Y. N. (Prenatal Y. N. Post Y. N.)
(j) Mother ceased work................................. „ .d a y s before confinement, (k) Resumed w o r k ............................. ........ days after confinement.
FATHER: 25—Age..................... yrs. 26—Country birth......................................... .........................27—Nationality................ ....................... ..........
28—Occupation: (a) Kind.................................................................................................(b) Seasonal Y. N. (c) Weekly earnings $ ..........’. . . ...........
CHILD: 29—Sex M. F. 30—Leg’t. Y. N. 31—Term..............mos. *32—Eyes at............ .days of age. (a) Normal, discharging............... ......
(b) Have drops been used ?............... 33—Illnesses: (Diseases and ages)........................................................... •.............................................. ................
HOME: 34—Type........................families. 35—No. rooms................. 36—No. in (a) family................. ..(b) Others.............. (c) Total....................
37—City water (a) Y. N. (b) Location, in dwel. out bldg, (specify)........ ........................................... 38—Date 1st v is it ...........................................
39—Nurse. ................... .40—Senior Nurse.............................41—Physician..............................Fam. Soc. 42—Sent to M. O .................................

APPENDIX,

Child W elfare A ssociation, N ew Orleans, L a ., 1920—Form 6.

C HILD RECEIVING SLIP.
[Size: 5 by 8 inches.]

N ote.—Starred items (*) need not be answered for children over 1 month of age.

fcO
to

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

124

OFFICE ADMINISTRATION.

Instructions for filling out child receiving slips.
General —Every item must be answered for all city board of health
cases, and for all other cases of children under 1 month of age.
For children 1 month of age and over, the following items need
not be answered: Numbers 24, a, b, c, d, e, f, g, h, i, j, k; 32, a, b.
For cases not admitted only the following items need be answered:
Numbers 1, 2, 3, 4, 5, 6, 7, 9, 12, 13, 38, 39.
Whenever possible, answers have been supplied, making it un
necessary for you to write in an answer. Check through the center
of the appropriate word or letter to indicate your answer.
Take great care to write the names and addresses plainly; print
the first letter of every word, and the remainder, unless your writing
is better than your printing. Be especially careful to distinguish
between e and i, f and s, a and o, n and u, 1 and t, m and w, r and e.
When there is insufficient room on the face of the slip for the entry,
encircle the number of the query, enter the same number on the back
of the slip, and give the additional facts there.
Whenever possible, make the entries on the receiving slip in the
home, as this will prevent the necessity of a second visit to obtain
items omitted. Mothers will not often resent notes being made in
their presence if you explain that you have more than 200 children
to visit and that it is impossible for you to remember all the facts
about each one unless you write them down. You can also say that
you are required to send a report to the main office about every child
you visit and it is therefore necessary that you have every item exact.
When you are unable to secure the facts at the first visit, consult
with your senior nurse about making a return visit.
INSTRUCTIONS FOR ITEMS.

(1) FAMILY NAME.—Enter the family name in plain printing.
Try to obtain the correct spelling as this is essential when the various
records for a child are matched in the main office. Slips should be
marked in the upper right-hand corner to show plural births, as,
“ Twin of Robert.”
(2) ADDRESS.—Enter the address of the family at the first visit.
If they live in an apartment, indicate the floor, as 2 FI., immediately
after the street. If the apartment or house is difficult to locate,
encircle the item number, enter the same number on the back of the
slip and give additional facts there.
(3) FIELD NO.—Enter the number of your field.
(4) CHILD’S NAME.—Enter the child’s name. If the child has
not been named enter “ Not named” and the slip will be forwarded
to main office where the case will be held. As soon as the child is
named, turn in to your senior nurse a slip bearing the serial number

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

125

of the slip, if it is a city board of health slip, the father’s full name,
the address, and the words “ Child has been named,” followed by the
name.
(5) COL., W. — Check Col. for colored and W. for white cases.
(6) BORN
192—.—Enter date of birth. A safe method of
securing the correct date is to see a copy of the birth certificate if
the mother has one. If the date is entered from the city board of
health record ask the mother if it is correct, as it is possible the
attendant may have made a mistake in registering the case.
(7) BIRTH REGISTERED, Y. N.—This query is known as an
“ educational query.” Its purpose is to teach the mother the value
of registering the child’s birth. If the birth is not registered you
should urge her to have it done and explain its value. If you have
not attended the lectures on this subject you should secure a pamphlet
on birth registration published by the United States Children’s
Bureau, by applying to your senior nurse who will send your request
to the main office. Check Y if the birth was registered; check N if
not registered. Enter N. R. if the mother does not know whether
or not the birth is registered.
(8) TIME BOOK PAGE.—Enter the page of the time book upon
which this case appears.
(9) FATHER’S NAME.—Enter father’s first name. If he has
a second name this should be entered also. Do not enter initials as
they are not sufficient for identification.
(10) ADMITTED
192—.—Enter the month and day and
supply the last figure of the year. I t is much better to write out
the month or to use the usual abbreviation, as figures entered
instead of the names of the months often lead to mistakes, especially
for the months in the middle of the year.
(11) AGE AT ADMISSION
YRS.
MOS.
DAYS.—
Enter exact age of child on date of admission as indicated. Check
with date of birth.
(12) MOTHER’S NAME.—-Enter the mother’s full maiden name.
(13) NOT ADMITTED (CAUSE).—If the case was admitted,
dash this query to show it does not apply. If the case was not ad
mitted, check the word “ N ot” and enter the cause.
(14) REG. AFF.—This item must always be checked for all ad
mitted cases. Check Reg. (Regular) if the case is in the district
and the child is under 6 years of age. For all others, check Aff. for
affiliated.
MOTHER.—Items 15 to 24, inclusive, apply only to the mother.
(15) AGE.—YRS.—Enter the mother’s age at last birthday in
years.
(16) COUNTRY BIRTH.—Enter name of country in which
mother was born; U. S. A. for United States; Russia, Germany; etc.
(17) NATIONALITY.—The country of birth does not always
indicate the nationality, therefore enter here the nationality of the

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

126

OFFICE ADMINISTRATION.

mother. She will be native born if born in the United States.
Always indicate for all countries when the person is Jewish.
(18) SPKS. ENG. Y. N.—Check Y if she speaks English; check
N if she can not speak it well enough for you to carry on your con
versation with her.
(19) READS ENG. Y. N.—Check Y if the mother can read in
structions about the care of the baby; if she can not, check N.
(20) READS OTHER LANG. Y. N. (specify)—If the mother
can not read English but can read in some other language, check Y
and enter the language she reads. I t may be possible to supply
her with pamphlets on the care of children, written in her own
language.
_ ___
(21) REFD. BY C. B. H., PHYN., CANV., MWF., IND. ORG.
OR INST.—These are the only sources to be entered. Check ap
propriate one. C. B. H. is city board of health; Phyn. is physician;
Canv. is a case you have found in your district, a canvass case;
Mwf. is midwife; Ind. is an individual—it may be a relative, neigh
bor, etc.; Org. or Inst, check Org. if the case was reported by an
organization, check Inst, if it was reported by an institution, and
enter the name of the organization or institution.
(22) PRESENT OCCUPATION:
(а) Lodgers Y . N.—Check Y if the mother has any lodgers the
day of admission. A lodger is a roomer; it does not m atter where
he takes his meals. Check N if there are no lodgers in the family
the day the child is admitted.
(б) Other (specify): If the mother has no occupation except house
work enter Hwf. for housewife; if she has another occupation check
Other and enter the nature of the occupation.
(c) Seasonal Y . N.: Check Y. or N. to show whether the occupa
tion, other than housework, is done only at certain times of the
year.
(d) Weekly earn. $ : Enter None if the mother is not employed.
Enter the appropriate amount for the week preceding the child’s
admittance; include the amount received from lodgers for this
period.
(23) ISSUES:
(a) Live Born: Enter the total number of children that have
been born alive to the mother.
(b) Died: Enter the number of children who were live born but
have since died.
(c) Age at death:
Yrs.
Mos.: Spaces have been provided to
enter the age at death for three children; if others have died enter
the information on the back of the slip, following the usual proce
dure for notes.
id) Cause: Enter for each dead child the cause of death as given
by the mother. If you note that the children all died of “ stomach
trouble” or other diseases closely related to diet you should give
especial attention to this point in instructing the mother how to
care for the child just admitted.
(e) Stillborn: Enter the number of issues of seven or more months
gestation born dead.
(f) Miscarriages: Enter the number of issues of less than seven
months gestation born dead. Stillbirths and miscarriages indicate
the need for instruction of the mother in prenatal care, even though
she has no immediate need for it.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

127

if) Total: The total number of issues will be the sum of {a), (e),
and (/). If any of the issues were multiple births, twins, triplets,
etc., indicate this in a note on the back of the slip.
(24) CASE PREGNANCY:
(a)
Urine: Enter O. K. if there was no abnormality throughout
the entire pregnancy. If there was abnormality present at any
time enter the facts, using back of slip if necessary.
Q>) Bowels, reg. irreg: Check irreg. if there was. any irregularity
during pregnancy.
(c) Vag. discharge Y . N.:. Check Y if there was a discharge at
any time during pregnancy.
(d)
' Nausea Y . N.: Check Y if the mother suffered any nausea at
any time during pregnancy.
(e) Instruments Y . N.: Check Y if any instruments were used in
the delivery.
i f ) Lacerated Y . N.: If Y is checked, enter in a note on the back
of the slip whether the laceration has received medical attention.
(g) Temp. Y . N.: If Y is checked, enter the highest temperature
if the mother knows it.
(h) Attendant: Phyn. Mwf. Other (specify): Check Phyn. Mwf.
or Other as the case may be, and enter the name of the attendant.
(i) 0. W. A. Maternity Y . N.: Check Y if the mother received
any nursing or medical care from a Child Welfare Association nurse
or physician either during pregnancy or the two weeks following
confinement.
(Prenatal Y . N. Post Y . N.): Check both of these according to
whether any care was received from a Child Welfare Association
physician or nurse during the specified period.
(j) Mother ceased work:
days before confinement: This inquiry
applies only to work outside the home. If the mother did not work
outside her home, dash the inquiry.
(k) Resumed work
days after confinement: This inquiry ap
plies only to work outside the home. If the mother did not work
outside the home, dash the inquiry.
FATHER: Items 25 to 28 inclusive, apply to the father only.
For these items follow the same procedure as for items 15, 16, 17,
22 (c), d.
.
CHILD:
(29) SEX M. F.—Check F if child is female; M if it is a male.
(30) LEG’T. Y. N.—Check Y if the child is legitimate; N if it is
illegitimate.
(31) TERM
MOS.—Enter the number of months gestation.
(32) EYES AT
DAYS OF AGE:
(a) Normal, Discharging.—Enter the condition on the day of
admission and enter the age of the child on that day.
(b) Dave drops been used? Enter Yes only if the drops were put in
the child’s eyes by the attendant.
(33) ILLNESSES (DISEASES AND AGES).—Enter all the ill
nesses for the child’s lifetime, entering the disease followed by the
age, e. g. scarlet fever, 5 years; measles, 5 years.
HOME:
(34) TYPE
FAMILIES.—Enter the number of separate
family dwellings in the building. If it is a cottage that has been
converted to be used by two families, enter 2, but enter 1 if two
families live together, sharing the rooms.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

128

OFFICE ADMINISTRATION.

(35) NO. ROOMS.—Enter the number of rooms in the household
even though they are used by lodgers.
(36) NO. IN FAMILY:
(a) This applies only to the mother, father, and children.
(b) Others: Include all members of the household not members of
the family as defined under (a) ; this would include lodgers, relatives,
etc.
(c) Total: This will be the sum of (a) and (6).
(37) CITY WATER, Y. N.:
(a) Check Y if the family has the use- of city water on the premises.
(b) Location: In dwel.; out bldg, (specify): Check appropriate word,
dwel. for in dwelling and bldg, for out of building. If it is in the
budding but outside the dwelling encircle (b) and enter facts in a note
on the back of the slip.
(38) DATE 1ST VISIT.—Enter date of first visit.
(39) NURSE, (40) SENIOR NURSE.—Both the nurse and senior
nurse will sign as indicated at the bottom of the slip.
(41) PHYSICIAN, FAM. SOC.—Enter name of physician and
check whether family or child welfare physician (Soc).
(42) SENT TO M. O.—This refers to the date the record is sent
to the main office which is to be entered by the senior nurse.
If any of these instructions is found to be faulty or incomplete
you are urged to take it up with your senior nurse who will send your
suggestions in writing to the main office. New instructions covering
the points raised will be typed and supplied to each nurse who will
then paste the new instructions on the page facing the old and cross
out the old instructions.
3. Street Book.
INSTRUCTIONS TO NURSES FOR USE OF STREET BOOK.

Arrange the street book sheets alphabetically according to street;
e. g., Baronne, Charles, Second, etc. Under each street arrange the
time book sheets and station cards according to house numbers,
starting with the lowest, e. g., 2116-2210-2300, etc. Use the back
of one set of alphabetical dividers and print the street names on the'
tabs. If you have more dividers than you need, return the unused
dividers to your senior nurse in order that they may be given to those
who need them.
Routing.—The street book records are made out in'the district and
kept there until the case is discharged, one sheet (not page) to be
filled out for each case submitted. The front side of the sheet is to
be used first. All the sheets for the day’s calls must be turned in to
the senior nurse of the district unless the case needs to be revisited
the following day, in which case the senior nurse will O. K. the nurse’s
entry on the date of last visit and the sheet will be turned in the
first day the case need not be visited. When the case is discharged
the street book record for the case will be turned in to the senior
nurse. I t is then sent in to the main office where the recorder verifies
it and if there is no indication of illness, the visits are summarized
and entered on the face of the permanent record. If the history
indicates illness, improper care, or other irregularities under No
nursing visits, enter “ See street record.” These street records will
be filed alphabetically.’ Those copied onto individual child perma
nent record will be destroyed.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

STREET BOOK—CHILD RECORD
[Size: 5 by 8 inches.]

1—District No...................... 2—Nurse.................................... ...................... . . . . . . I 3—Name...................................................................................B. W.
FI............

7—Admitted.........................,1 9 .. 8—Discharged (date)................ 19.. 9—Cause......................(2nd. . . . . . .................................................. FI.............
10—Readmitted_______ 19.. 11—Discharged..................19.. 12—Cause: Over 6; Lost; No co-op.; D ied; Out city; Out dist.; Trans, to
13—Exclusively breast fed through ___month.
15

(a)
Year 19
Month
Day

(b)
Diagnosis

........... .

14—Receiving slip sent to Main Office (date)................................ .................. - ..........................

(c)

Physician

N U R S E S N O T ES

\Mv ,

- ,v

_„ . ; ,

I, cx

Cl w x WI S. N.

APPENDIX,

Child W elfare A ssociation, N ew Orleans, L a . F orm 7.

4—Time book page............ 5—Classification (a) 1; 1—3; 3-6; (b) Reg. Aff..............6—Addresses f is t . ......... ...........................................

Irl
1
. 1
1

■

1^
N ote.—The reverse side of the record bears only items 1,6, and 15, a, b, c, d.

fcO

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

130

OFFICE ADMINISTRATION.

Regular 'procedure.—When planning your work for the next 24
hours take from your file the station cards for all cases upon which
you intend to call. In addition take one extra street book sheet upon
which to enter notes for old cases seen unexpectedly. Insert accord
ing to street and number all of the receiving slips sent to you from the
main office and take a few blank ones to use for cases found and
admitted in the district.
When a case is discharged, enter on the street-book record on the
line following your last visit the date and cause of discharge. Admis
sible causes for discharge are (1) over 6 years of age; (2) lost address;
(3) no cooperation; (4) died; (5) moved from city; (6) moved from
district; (7) transferred to district
(specify district number);
(8) discharged to other organizations or institution.
Lost address.—Every effort should be made to secure the address of
a family which has moved. If you are unable to learn the family’s
address, try to learn the address of a relative or neighbor and enter
this information immediately below the cause of discharge. I t is
especially important to keep on the rolls the children of families of
migratory habits, as their mode of life is especially conducive to a high
infant mortality rate.
No cooperation.—This cause of discharge generally indicates lack of
understanding on the mother’s part of the purpose and value of the
child-welfare association’s work. A brief but clear explanation of the
record of failure to secure the mother’s cooperation should be entered
under the cause for discharge. These cases will not be considered
discharged until O. K ’d and initialed by the supervisor. If the lack
of cooperation is due to the instructions of the family physician, state
this clearly and give the full name of the physician.
Died.—When death is the cause of discharge do not fill out one of
the individual death records which is to be discontinued, but imme
diately below the cause of discharge enter the following information: 1. Name of physician.
2. Number of days physician has been in attendance.
3. Number of days child-welfare association nurse has been in
attendance.
4. Length of child’s illness (in days).
5. Length of time the child has been on roll.
6. Alleged cause of death.
7. The nurse’s own opinion of the cause of death.
Moved from city.—Enter the name of the city to which the family
has moved, if possible. This will be a check on the information
secured, as families moving to another part of New Orleans are fre
quently said to have, moved out of the city.
Moved from district.—This does not mean moved from your district,
but that the family has moved outside the section of New Orleans
served by the child welfare association. Never enter this cause of
discharge unless you can follow it with the approximate new address
of the family. If you do not know the new address even approxi
mately, the cause of discharge should be “ lost address.”
Transferred to.—Always follow this by the number of the district to
which this case is transferred.
Discharged to.—Give the name of the institution or organization to
which the case is discharged; e. g., Poydras Asylum.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

131

When you report to your district office, proceed as follows:
(1) Go over your street-book records carefully to see that—
(a) All records for old cases are complete.
*
(b) All records for new cases other than city board of health cases
have receiving slips attached.
(c) All records for new city board of health cases have receiving
slips sent from city board of health attached.
(2) Transfer your notes from your extra street-book sheet to the
proper individual street-book records.
(3) Clip together all the city board of health receiving slips not
admitted, making sure that the cause for not admitting the case is
entered after comment at the bottom of the page.
(4) Make the proper entries in your time book and leave all your
work in the book as you are doing at present, to be checked by the
senior nurse. You will find all your incorrect and incomplete work
in your mail box the following day. Incomplete and incorrect
records will have slips attached. Those ready for filing will bear
O. K. in the extreme right-hand column of the page and remain in
your time book. The incorrect sheets are to be corrected and, with
slips still attached, left in your time book for a second inspection by
the senior nurse.
Instructions for filling out items:
(1) District No.: Enter the number of your field.
(2) Nurse: Print clearly your last name.
(3) Name: Print the name of the patient putting the last name
first , as Brown, Nellie. Check B. or W. according to whether the case
is Black or White.
(4) Time Book page No.: Enter the number of the page in your
time book upon which this case appears.
(5) Glassification (a) 1; 1—3; 3—6; (b) Reg.aff.: Check the proper
classification under (a), and under (b) check to show whether it is a
regular or affiliated case.
(6) Addresses, 1st FI., 2d FI.: Enter the address, and if it is a two
or more family house enter after FI. the floor. If it is a one-family
house, enter Cot. for cottage after FI.
(7) Admitted {date)—19—: Enter the date case was admitted.
(8) Discharged (elate)—19—; Enter the date case was discharged.
(9) Cause: Enter cause of discharge, using only those causes ap
pearing under item No. 12.
(10) Readmitted—19—(11) Discharged—19— and (12) Cause: Over
6; host; No. coop.; Died; Out city; Out dist.; Trans, to — are to be
used for readmitted cases and (12) is to have the proper cause
checked.
(13) Exclusively breast fed through
mos.: Be sure this entry
is made before the case is discharged.
(14) Receiving slip sent to main office (date) : The senior nurse will
enter this date.
Column 15:
(a)
Year 19—, month —day—: Enter at head of column the year
—on each line enter month and day of month of visit. If the case
is carried on into another year skip a line before the first visit in the
new year and enter on that line in the date column the year only.
Then proceed as before.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

132

OFFICE ADMINISTRATION.

(&) Diagnosis' Cases being carried for observation and not receiv
ing any medical treatment should be entered as Observ. For cases
under medical treatment by a family physician, the nurse should
telephone the physician and secure the diagnosis, which should be
entered. This diagnosis must always be received from the physician
himself if medical treatment is being given. Never leave this space
blank.
(c) Physician: Enter the name of the family physician or the child
welfare association physician. If theTattei, enter C. W. A. after the
physician’s name.* If the family has a society physician enter Soc.
after his name.
.
.
,
Even though Observ. is entered as diagnosis, the physician s name
should appear if the family is in the habit of consulting him.
(d) Nurse’s notes: Enter your record of your visit. Tell what you
did and the condition of the patient. Try to write these notes so
that they would be helpful to a new nurse who might be called to
take over the case. In the column headed, O—X—I—CX—Cl—
w x —W I2, put a check in the column which will indicate the kind of
visit you made. These headings correspond to those in your time
book. The last column, S. N., is reserved for the senior nurse’s
initials when she approves the day’s entries.
If you need a second sheet for case entries use another street book
record, marking it sheet No. 2 in the upper right-hand corner, and
on the first line under “ Nurses’ notes” enter the word continued..
(16) Date of birth: Enter date of child’s birth; month—d a y year. Check this entry with Item No. 7 and Item No. 5, to be sure
your classification is correct.
4. The Time Book.
.'
General.—The time books are kept in the four district offices.
They contain:
(1) The family history sheet, which is the left-hand page ol the
record 01 cstses*
(2) The daily report checkerboard sheet, which is the right-hand
page of the record of cases.
(3) The summary sheets.
(4) The loan closet sheet.
Sheets 3 and 4 are kept in the back of the book.
Before entering cases in the time book, be sure that they have been
separated according to classification. Do not enter cases of different classification on the same page. Leave part of the page blank
if necessary. The right-hand sheet can be used for only one month’s
record. As soon as the monthly report has been completed, look
over all the left-hand sheets and transfer to a new sheet the names
of all active cases on pages having more than half the names crossed
out. When this is done, write copied across the old sheet and leave
it in the time book. The senior nurse will verify your transfers and
destroy the old sheet.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

A PPEN D IX .

133

When the checkerboard sheets are full and the monthly reports
have been completed they will be filed by districts in a book kept in
the district office by the senior nurse.
Items:
(1) Every patient seen by the nurse in her district (this does not
include relief calls in other districts) should be entered on her time
book.
(2) Patients over age, colored patients, and affiliated cases, should
be entered on a special page marked “ affiliated.”
(3) Print all entries in the time book, abbreviating where possible,
and reserve space for corrections or second entries.
(4) Name: In the column headed “ Name” enter patient’s sur
name first—‘thus: “ Jones, Arthur” ; always write the given name
in full. When a number of patients from the same family are being
carried, it is advisable to enter them consecutively.
(5) Address: The address should be entered in pencil.
(6) Date of birth: Enter date of birth.
(7) Referred by: This is to indicate the source of the call. For
cases entered through canvass of district enter C. W. A.; for cases
referred by relative, physician, midwife, hospital, board of health,
etc., enter “ individual,” “ physician,” or “ midwife,” etc., using the
following abbreviations: Individ., Phyn., Mwf.
(8) Physician: In all instances where a patient has private or
society attendant, enter physician by name, even though patient is
a conference attendant, if a patient is receiving treatment at a
dispensary or hospital, enter the name of the institution.
(9) Diagnosis with date: Where cases are being carried for observa
tion and no medical treatment is necessary, enter as “ Observ.
1/1/19,” where “ observ.” is entered and pneumonia or any other
condition develops, the entry should be read: “ Observ. 1/1/19—
Pneumonia 1/11/19;” or, “ Observ. 1/1 /19—Adenoids 1/16/19.”
“ Pregnancy 5 months 6/4/18. D. Maty. 10/1/18.” 3
(10) Contagious or infectious diseases in family: At time of admis
sion.
(11) Date of first visit: Enter date of first call on patient. This
date must not be changed when patient’s name is forwarded in
time book.
(12) Number of visits forwarded: In this column enter the total
number of visits to patient from enrollment to the present quarter.
At the end of each month add the total number of visits made
during that month to the total number of previous visits and for
ward new total.
(13) Termination—Date—Cause: Any entry in this column indi
cates that the patient has been dismissed or transferred to another
district. Write briefly but fully date and cause—thus: “ Moved—
address unknown 1/11/19;” or “ Died 1/11/19;” or, “ Transferred
dist. 3—1/11/19;” or, “ Over age—1/11/19.”
(14) When entering a case that has been transferred from another
district-make note of this transfer with date in red ink in column
“ referred by;” thus, a case originally referred by the physician and
transferred from one district to another is entered in the column—
“ Physician—transfer No. 3—1/11/19.”
* It would be preferable to use abbreviations for the names of the months rather than numbers.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

134
O FFICE AD M INISTRATIO N.

[Left-hand page,l

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

TIME BOOK.

ö
M;

[Right-hand page.]

135

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

136

(15)
The checkerboard page represents a daily calendar for a
period of one month. Enter visits according to date on the line
corresponding with patient’s name. _As all lines are numbered it is
a simple m atter to identify the patient by the line number, lhe
symbols for calls, are as follows: *
.
' .
*
O is any call which did n ot perm it nurse to interview the

mother.
X is any call n o t a working call.

I is a working call.

. . . .

CX is any clinic v isit n ot a working clinic visit.
C l is any clinic v isit at which the physician gave the child
m edical attention.
W X is a visit of the child to the station when some nursing
service was given.
W I is a visit of the child to the station when only instructive
care was given. •

(16)
At the end of the month the page should be totaled as follows:
Begin with line one ; starting with the first of the month read to
the right for the number of X ’s, placing a small check above each
as you count it. When you have checked all on line one, enter
the total number of X ’s in the column headed X under the totals
section of the page. Follow this same procedure for each of the
five remaining classifications of visits. Then look back over the
line to see that every entry has been checked. As a final check,
count entries on line 1 from the 1—31st of the month and be certain
it is the same as the sum of the visits entered under the six headings
in the totals sections.
___ . T
Times seen.—This will be the total of the first two columns X and 1.
In totaling this column from the top to the bottom of the page,
check cases seen once only and enter the number a t the bottom of
the page in ‘the totals column; thus “ once 17” meaning 17 cases
visited only once during the month—next check the cases seen only
twice during the month and enter in the totals column just below
the first total; follow the same procedure for cases seen three or more
tin i6 S i

Important.—I t is intended that the new system will make it unneces
sary to copy the names and addresses of your cases so frequently.
When a caseis discharged, draw a pencil line from left to right through
all the items for the case. Each month when you have completed
your monthly report, copy onto new sheets all names appearing, on
pages having more than one-half the cases discharged. Write
Copied across the old sheet and turn it in with your monthly report.
Before starting to make your monthly report total the individual
sheets in your time book, using the form shown on pages 134-135.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

A PPEN D IX .
TOTAL SHEET FOR NURSE'S MONTHLY REPORT.

137
[Size: 8 by 11 inches.]

^ urse.......................... - .................................... Field....................... ..............Month............ ...........................1920*

5. Medical History Card.
Use. -This record will be k ep t b y the conference physician for
every child attending the station conferences. U pon the first v isit a
com plete physical exam ination will he m ade b y the conference
physician. U pon succeeding visits the child will be weighed and the
physician s notes entered on the back o f the card in the space indi
cated. These records will be kep t at the individual stations until
the case is discharged, w hen th ey w ill be forwarded to the m ain
office where the recorder w ill file them alphabetically.
W hen a case is dism issed because over age, all records pertaining
to the child should be forwarded to the school authorities. A cardindex file of these cases w ill be k ep t b y the recorder.
Instructions for use of m edical history card.— The surnam e should
be printed and great care should be taken to write the nam es of father
and child and the address plainly, in order th a t th ey m ay be properly
m atched w ith the n u rse’s records w hen th ey are sen t to th e m ain
office. The date at the top of the card is the date of the com plete
physical exam ination.
General.— E very question m ust be checked. For exam ple, A b
normal; if the case is abnormal check this word; if norm al check N ,
m eaning N o. Care should be taken th at the check is in the m iddle
of the word intend ed . A n y item for w hich inform ation can n o t be
secured should have an R entered after the printed N . This indi
cates N R or no report; if there is no N after the query enter N R .
57716°—22-----10

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CHILD: 1. M. F. 2. Born....... 19... 3. Age..yrs..mos.
4. Entered (a) Kinderg’t ’n, N., at..yrs. (b) First Grade,
N., a t . .yTs.
PHYSICAL E X A M IN A TIO N .

18. Diseases

N R L Diseases

(b) stye .

(f) Conjunctivi
tis: N.

N R L

SKIN: 43. Pediculosis: (a) body, N. (b) scalp N.; insects
N.; nits, N __
44. Eczema, N. (loc.).............................. 45. Acne, N ..........
46. Impetigo, N ................47. Infected sores, N ....................
48. Scabies, N __ 49. Ringworm: (a) scalp, N .. . . (b)
body, N __
50. Other conditions................................ .G..........................

A ssociated
in fe c tio n
(spec.).

ABDOMEN : 51. Distension, N ..........................................
52. Tenderness, JN. (loc.)................................................... .
53. Enlarged liver, N ..............................................................
54. Enlarged spleen, N ...........................................................
55. Hernia,N.;umbilical;inguinal, R., L.,double;...........
femoral, R., L., double. 56. Other defects...............

GLANDS: 37.

(a) Occipital
(b) SubmaxUlary.
(c) Cervical.. . . .
(d) Axillary.......
(e) Epitrochlear.
(f) Inguinal........
(g) Other............

Palp
able
Y
Y
Y
Y
Y
Y
Y

En
larg’d

NY
NY
NY
NY
NY
NY
NY

Gr’tly
enlrg.

NY
NY
NY
NY
NY
NY
NY

N
N
N
N
N
N
N

N ...................
N ...................
N ...................
N ...................
N ...................
N ...................
N ...................

CIRCULATORY SYSTEMr 38. H eart:............
(a) Apex beat displ., N _cm. (b) Enlarged, N .
(c) Murmur, N. (loc.)............................... ...........
Transmitted back, axiUa, sternum, N .............
39. Heart disease N., Diagnosis:.............................

Phlyctenular
(d) Corneal opac
(g) Strabismus..
ities.
19. Glasses, N .....................
(e) Corneal ulcer..
20^ Other abnorm.................................................. ................
21. Diagnosis of Sp................................................................ RESPIRATORY SYSTEM: 40. Chest: (a) Exefirsion:
EARS: 22. Hearing: R ............ ft. L ...........¿..ft................
23. Otorrhea: (a) Acute, N ., R., L___(b) Chfonie, N.,R.L.
normal, abnorm. (spec.)................................................ - - 24. Other abnorm...................................................................
25. Diagnosis of Sp......... ..................................................... . (b) Fremitus: normal, deer., in c r ........... ..........................
(c) Dullness, N. (spec.)..........................................................
MOUTH: 26. Teeth: (a) Temp. No__ Decayed No—
(d) D ’Espinessign, N ...........................................................
FiUed No.......
(b) Perm. N o .. Decayed N o .. FiUed N o.. 27. Malocclu (e) Rales- N., kind............ loc................................. .............
41. Other defects....................................................................
sion, N ..
28. Alveolar abscess, N ........... 29. Other abnorm............ 42. Respiratory dis., N., Diagnosis:....................................

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

.1 9 ..,

NASOPHARYNX: 30. Mouth breathing, N. 31. Nasal
discharge, N ....... .
32. Nasal obstr., N ............ 33. High arch palate, N .........
34. Tonsils: Rem. (a) enlrg., N. (b) greatly enlrg., N. (c)
dis. N.
35. Other abnorm........................................ ..........................
36. Diagnosis of Sp.................................................................

BONY and MUSCULAR SYSTEM: 57. Beaded ribs,
N ........ ..................................................................................
58. Harrison’s groove, N ........... 59. Enlarged epiphyses,
N ...............
60. Round shoulders, N. 61. Winged scapulae, N. 62.
Scoliosis, N.
63. Lordosis, N. 64. Kyphosis, N . (loc.)....................... .
65. Knockknee, N ........ 66. Bow legs, N ........ 67. Flat
foot, N ........
68. Pigeon toe, N ........ 69. Club foot, N. (spec.)....... ........
70. Arthritis, N. (spec.)..................................... ............ ......
71. Paralysis, N. (spec.)........................ .— .. — ............. .
72. Other defects (cong. and acq.)........................................
NERVOUS SYSTEM : 73. Speech defects, N ........ (a)
Stuttering, N ........
(b) Stammering, N .................... 74. Tic., N. (spec.).......
75. Chorea, N'. (spec.).................................................... ........
76. Other defects.......................... *.......... — ................/- - - - 77. Nervous dis., N., Diagnosis............................................
Child Welfare Ass’n, New Orleans, La., 1919. Form 3.

OFFICE ADM INISTRATION,

GENERAL: 5. Weight__ lbs..........oz. 6. Height— in 7. Anemia, N ....... 8. Nutrition excel., G., P ., VP..........
9. Temp... ° 10. Vaccinated, N. (a) Age. .yrs. (b) Scar,N..
HEAD: 11. Size: normal, large, small.................................
Circumference............ in ......................................................
12. Shape: normal, abnorm. (spec.)................. ...........- —
13. FontaneUe: closed, open............ cm........ .......................
14. Craniotabes, N ....... 15. Abnormal condition, N .......
16. Diagnosis:.................................................................
EYES: 17.,Vision (a) R ............(b) L........(c) Imposs. to
test...................

138

MEDICAL HISTORY CARD.
[Size: 8 by 10 inches.]
Surname...........-......................................................... Father................................................... ............... Address............................................................... Child.
Clinic.................................. ..................... Examined b y............................................................... M. D. Nurse......................... ......................................Date..

APPENDIX.
MEDICAL HISTORY CARD (REVERSE).
GENITALIA: 78. Male: Prepuce adherent, contracted, normal.....................
79. Female: Vaginal discharge, N ........................................................................
MENTAL CONDITION: 80. (a) Normal, N . (b) Defect app. (spec.)........
(c) Abnormality susp. (spec.)........................................
81. LABORATORY F IN D IN G S:................................." " " " " "
82. PREVIOUS ILLNESS: (a) Contagious:.....................................................
(b) Respiratory:................... . , ......... ............................__________ . . . . . . . . . . . . .
(c) Digestive:................................................................................................. .........
(d) Other:............................. ........................................ •; ■
;1
. BAD H A B IT S :......................................
. SUMMARY of DEFECTS and DISEASES: ...
: RECOMMENDATIONS:.......................
86. Name of family physician................ .............' ’ 87.’ Med. Sup.’ Desired, Y . N,
Weight.
Date.

Physician’s notes.
Lbs.

Oz.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

139

140

OFFICE AD M INISTRATIO N.
ITEM S.

N o t e .— Instructions are presented only for those item s which,
m ight perm it more than one interpretation.
CH ILD .
'
,
„
,
1. M. or F.: Check M for m ale and F for fem ale.

Born —— 19—: Enter month and day of year of child s
.
3 . A ge----- years------ months:
Enter age as indicated.
4. Entered (a) Kindergarten, N., at — yrs. (b) First grade N., at
----- yrs.: E nter the age at w hich the child began to attend kinder

birth; e. g., June 6, 1919.

garten or the first grade. If the child is now attending either, the
nurse w ill report the case to the supervisor, who w ill report it to the
m ain office. If the school wishes the case transferred to the school
nurse, the case will be discharged b y the child welfare association.
GENERAL.
. '
,
. ,

5. Weight----- lb s.-------oz.: Weight is to be taken without the

child’s clothes.

6. Height ----- in.:

...

Height is to be taken without the child s

shoes. A djust the measuring board so th at the horizontal part just
touches the child’s head, while the perpendicular part is pressed
against the wall. As m ost m istakes are m ade in reading, take the
m easurem ents twice to insure accuracy.
7. Anemia, N.: This is to be determ ined b y the color of mucous
membranes.

8. Nutrition, Excel., G., P., V. P.: Check P. (poor) if the case
requires medical supervision; check V. P. (very poor) if the case
requires medical treatment. Either condition should be mentioned
under Summary and Recommendations.
9. Temp. ----- °: The temperature is to be taken only if the
symptoms indicate that it is important.
Unless the
10. Vaccinated, N. (a) Age----- yrs. (b) Scar. N.
mother is with the child you may not be able to ascertain the age
at which child was vaccinated; in this case enter R. after the first N.
HEAD.
11. Size, normal, large, small: If the size is abnormal, measure and
record the circumference.
12. Shape, normal, abnorm. (Spec.) — — If the shape is abnor
mal specify “ square head, hydrocephalic, oxycephalic, or scaphocephalic. ”
' _
.
15.
Abnormal condition, N.: Note here abnormal conditions of
scalp, features, hair, etc.
EYES.
17. Vision (a) R . ----- (b) L . ----- (c) Imposs. to test----- : The
vision is to be tested by one person using Snellen’s cards.
20. Other abnorm.: Note here such abnormal” conditions as
nystagmus, etc. Any child found with defective vision or any eye
diseases is to be listed for consultation with specialists.
EARS.
22. Hearing R .-----1t., L . -------it.: The hearing is to be tested
by one person using “ whispering voice” at a distance of 20 feet.
Ii hearing is defective or if there is a discharge, list the child and
refer to a specialist to look for cerumen, retracted drum, and adenoids.
MOUTH.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

A P P E N D IX .

141

27. Malocclusion, N.: This term includes any condition for
abnormal bite.

29. Other abnor.: Note here such abnormalities as general conditions
of uncleanliness and types of teeth, such as syphilitic, rachitic, and
those devoid of enamel, which may have been caused by contagious
diseases.
NA SO PH A RY NX .

30. Mouth breathing, N.: Test by closing the mouth to see if child
can breathe easily through nostrils.
32. Nasal obstr., N.: Test each nostril by closing the other side.
34. Tonsils—Rem. (a) enlrg., N. (b) greatly enlrg., N. (c) (Lis. N.:
Rem. means removed; greatly enlarged are those nearly filling the
throat; diseased tonsils are those showing (1) cheesy plugs, (2) local
ized infections of the surrounding vessels. Enlarged maxillary glands
afford corroborative evidence.
Indications for recommending
removal of tonsils shall be: (1) those so enlarged as to nearly fill
the throat, causing difficult breathing; (2) history of repeated attacks
of tonsilitis, that is—four or five attacks within a year.
35. Other abnorm.: Note here abnormal conditions of gums, badly
coated tongue, offensive breath, mucous membranes, uvula, or any
malformation such as harelip, cleft palate, etc. All abnormal
conditions of the nasopharynx may be listed and the case referred to
a specialist for absolute diagnosis.
G LANDS.

37. Enlarged glands are those over one-fourth inch in length;
greatly enlarged glands are those 1 inch in length or over. In looking
tor infection associated with enlarged glands look for bites on the
body, and if possible examine the clothing for pediculosis and the
head for nits.
37. (g) Other: This term includes thyroid, etc.
CIRCULATORY SYSTEM .

38. (b) Heart-enlarged, N.: This is to be determined by axillary
border if apex beat is below the 4th or 5th interspace (in 5th between
7th and 13th years), and outside mammary line.
R E SP IR A T O R Y SYSTEM .

41. Other delects: Note here assymmetry, abnormal shape, poor
development, etc.
S K IN .

50. Other conditions: This term includes general condition of the
skin su.ch as clean, rough, dry, clammy; also birth marks, furunculosis,
urticaria, etc.
ABDO M EN.
53. Enlarged Liver, N .: The liver is enlarged if more than 1 inch
below the border of the ribs. Specify in inches.
54. Enlarged Spleen, N.: The spleen is enlarged if palpable;
m oderately enlarged if 1 inch below border of ribs; greatly enlarged
if felt as tum or m ass, nearly half filling abdomen.

56. Other defects: Make note of distension due to tympanites as in
rickets, or ascites, etc.; take measurements at a level of the umbilicus,
if the abdomen is, greatly enlarged from any cause.
B O N Y A N D M USCULAR SYSTEM .

67. Flat foot, N.: Examine the child as he stands in stocking feet
or barefoot, and record height of arch in inches. This is to be
measured with ruler held perpendicularly from floor to head of
acaphoid bone, which is the top of the arch.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

142

OFFICE ADMINISTRATION.

70. Arthritis, N. (Spec.): If arthritis is present, try. to secure a
history of previous infections.
72. Other defects (Cong, and acq.): Note flabbiness of muscles,
clubbed fingers, tuberculosis bone affections, etc., both congenital
and acquired. Record here also in every case whether or not pro
nation of the foot is present and whether it is inward or outward; l. e.,
if the line of the foot is not in a straight line with the tibia.
NERVOUS SYSTEM.
76. Other defects: Note extreme nervousness, etc.
MENTAL CONDITION.
80. (c) Abnormality susp. (Spec.): Note sluggish or active men
tality.
81. Laboratory findings: In this space record results of urinalysis,
cultures, or smears, if it is possible to cooperate with the local labora
tory.
PREVIOUS ILLNESS.
82. (d) Other: This term includes general diseases such as rheuma
tism, malaria, intestinal, parasites, etc.
83. Bad habits: Enter here habits such as finger-sucking, mastur
bation, nail biting, perverted appetites, etc.; information in regard
to such habits probably can be obtained only through the mother.
84. Summary of defects and diseases: Include here all marked defects
found in general examination.
85. Recommendations: Enter recommendations which, if acted
upon, will correct or improve defects found.
86. Name of family physician: This should be secured at the first
visit to the conference if possible; if not, the nurse should obtain it
upon her next visit to the family and enter it on the medical record as
soon as she revisits the conference station. At the close of each
conference hour the nurse will enter on the back of the physician’s
daily report card under the heading: “ Family physician's name—
child's name—child's address" the items specified for all cases for
which there is a family physician.
87. Med. Sup. Des. Y . N.: This means: Does the family physician
desire the child welfare physician to supervise the case? A letter
should be sent from the main office to the family physician to learn
whether or not he desires the child welfare association to continue
medical supervision of the case.
The remainder of the card is to be used by the physician for his
record of the condition of the child, his directions as to treatment,
etc.
N. B.—No case having a family physician shall be permitted to
attend child welfare conferences without the knowledge and consent
of the family physician.
6. Child Permanent Record.
This record is to be typed by the stenographer from the receiving
slips after they have been reviewed by the recorder and cleared with
the files to insure that they are new cases and not readmitted cases.
Instructions for typing—Be careful not to let entries run beyond
the space provided. Take pains to spell the family’name correctly
and to have the card free from errors. In general the items are so
worded as to call for only one entry. But for the following observe
these rules:

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

143

APPENDIX.

Item 4. Father's name: Enter the father’s first name or first two
names, or first name and second initial. Do not accept initials only.
Never enter the last name of the mother here except for illegitimate
children.
Item 7. Mother's name: Enter the mother’s full maiden name or
her first name, but never her husband’s last name.
CHILD.
Item 8. Sex: Enter M for male or F for female.
Item 9. Legit. Enter Yes or No.
Item 11. (a) Eyes at birth: Enter normal or discharging. Other
entries should be referred to the executive secretary before typing.
(b) Drops: Enter Yes or No.
MOTHER.
Item 15. Speaks Eng.: Enter Yes or No as checked upon first visit
slip.
Item 16. Reads Eng.: Enter Yes or No as checked upon first visit
slip.
Item 17. Reads other language: Enter name of language or the word
none.
Item 18. Occupation (a) lodgers: Enter Yes or No. Never enter
number.
(c) Seasonal: Enter Yes or No.
Item 19. Children (a) live born: Enter number in figures.
(6) Dead: Enter number in figures.
(e) Stillborn: Enter number in figures.
(f) Miscarriages: Enter number m figures.
(g) Total: Enter number in figures.
For other entries see instruction for child receiving slip except for
Item SO, Agencies on Case.
Under Item SO,, Agencies on Case, enter the date the receiving slip
was sent to the confidential exchange; e. g .:
Date.
Feb. 2,1919

Agency.

Remarks.

Conf. Ex.

Sent.

Below these entries enter the information returned by the confi
dential exchange.
^
Enter on all cards for all members of family: Confidential exchange
entries for
J. F.
CHMD
LATL
KD
BB
JC
COS
Refer to recorder, who is to write for fuller information, slips show
ing registration with (LATL) (LIHS) (CH) (SSDCH) (TI) (SSDTI)
(CHMD) (HL).
•
When replies are received, they are to be briefed and entered on
the child permanent record. The letter can be given to the nurse,
who will enter the information on the proper street-book record.
The letter then can be destroyed.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

144

OFFICE ADMINISTRATION,

When the entry has been O. K ’d by the recorder, she puts the slips
in envelope for the nurse and puts the cards in the stenographer’s
filing basket. After the nurse has made an entry on the proper streetbook record, she destroys slips or takes them to the station for filing,
according to the decision of the executive secretary. All slips must
be matched, as no cases are referred back to C.W.A. unless they first
were registered by C.W.A.
N o t e .— Since the record system described was planned, the child welfare associa
tion has added complete maternity service to its program.' This necessitated a revision
of the record system, affecting every form except the child permanent record.
CHILD PERMANENT RECORD.
[Size: 4 by 6 inches.]
I—Family Name.............................. 2—Child’s Name.......................... 3—Born.................
4—Father’s Name....................................... 5—Addresses (a).................... 6—Districts (a).
7—Mother’s Name.................. ............................................ (b ).............................................. (b).
CHILD: 8—Sex__ 9—Legit___ 10—Term___m os.(c)....................... , ......................(c).
II—(a) Eyes at birth.......................(b) Drops......................... 12—Illnesses: (disease, age).
MOTHER: 13—Age............ yrs. 14—(a) Country birth............................(b) N ationality...,.......................
15—Speaks Eng........•.................... 16—Reads Eng......................... 17—Reads other language.....................
18—Occupation (a) lodgers................(b) Other..................... (e) Seasonal.............. (d) Weekly earn.$ ...........
19— Children: (a) Live born..... (b) Dead......... (c) Age at death] 1____yrs. (d) Cause] 1......................
____ (g) Total........ .......12— yrs................... 12......................
(e) Stillborn................... (f) Miscarriages
20—Case pregnancy: (a) Urine.......................'................... ....................|3 — yrs............... ...1 3 .............. .
(b) bowels.......... (c) Vag. discharge.............(d) Nauseau.............. (e) Instr................ (f) Temp..................
(g) Lacerated............ .
(h) A tten d an t...,.............(if C.W.A. Mat. (Pre..................... Post..................)
(i) Ceased work.............. mos. before confinement, (k) Resumed work...............mos. after confinement.
FATHER: 21—Age............ yrs. 22—(a) Countnr birth.......................... . (b) Nationality.......... ........ .
23—Occupation (a) kind................................. (b) Seasonal................................. (c) Weekly earn. $...............
HOME: 24—Type__ families. 25—No. rooms___ 26—N o.in (a)fam ily___ (b f Others___(c) T o ta l....
27—City water (a)................................. (b) In dwelling................................... (c) In building.............. : ............
28—Ad
Dis
Age at
Referred charged
Cause of atAge
admission
dis Mos.
mitted
by.
(date). discharge. charge. on roll. 0
(date). yrs. mos. days.

Visits.
X

Child Welfare Association, New Orleans, La., 1919. Form 1.
CHILD PERMANENT RECORD (REVERSE).
29—Died (a) Date........................................ .
19
(b) Age at death......... yrs.
(c) Death certificate cause:...................................................................................
(d) Signed b y ..........................................................................................................
(e) On C.W.A. roll at death............................. (f) Discharged............ m o s...
Agencies on Case.

30Date.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Agency.

Remarks.

mos............ days
days before death.

APPENDIX.

145

RECORD SYSTEM U.

1920.
Scope.—Generalized service, except school nursing and conduct of
health centers.
B

1.
2.
3.
4.

r id g e p o r t ,

C o n n ., V

Call slip.
Nurse ’a daily report.
First visit slip.
Family folder.

is it in g

5.
6.
7.
8.

urse

s so c ia t io n —

Child’s record.
Maternity record.
Medical record.
Tuberculosis record.

Form 1. Call slip made in pads4—Sources.—1. Telephone calls in
office. 2. Personal calls at office. 3. Metropolitan Life Insurance
postals.
Use.—A call slip is made out for every case reported to the main
office.
Routing.—When filled out the slip is checked with dismissed files;
if it is found to be an old case the original record is attached to the
call slip and they are put on the assistant superintendent’s desk.
She distributes these to nurses. The nurses sign the call slips, put
them on spindles on their desks, and file the records in their active
files on their desks. The following morning the clerk collects daily
reports and first-visit slips, which are together on the assistant super
intendent’s desk, and the call slips of the previous day and checks
them against each other. If the case is not an old one, the call slip
is put on the assistant superintendent’s desk.
Instructions for filing out call slips.—Secure all possible information
called for by the slip and make entries in proper place. Secure the
full name of the patient, if possible, and the proper spelling of the
family name.
The nurse makes out a call slip for each Metropolitan Life In
surance postal which she receives in the morning.
CALL SLIP.
Name...........................................................
Address................................................................................................................................ Floor. . . . . . . . . .
■X.-....... :- .-s ......................................................................................... *..............Social History on File, Y N
Diagnosis.................................................................................................................................. .
’
Orders.................................................... I .! ! ! " ! ! " " ! ! ! ! ! " ............................................... ... ....................

------ . . . .
................................. ..........................................Physician................................... ...,[
Case reported b y ............................... ......................
Call slip made b y ...................................................... " ! ! ” " ! ! ” " D ate” ! : ! " " I i i & / " H o u r . ! "
Visiting Nurse Assn., Bridgeport, Conn., Form 1, 1920.
[Size: 3 by 5 inches.]

2. Nurse’s Daily Report.
.
These are to be made up into pads with a sheet of carbon for each
pad. The original will be taken into the field and completed there
by the nurse, and the carbon will be placed upon the assistant super
intendent’s desk as a record of where the nurse will work during
the day.
Items—
Age: In the case of children, enter yrs. or mos. after the age, to
avoid confusion.
Type: P ut a check under the appropriate heading for every case
to show whether it is a new or an old case.
* Cases picked up in the district have first visit slips made out for them but no yellow slips.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

146

OFFICE ADMINISTRATION.

Work done: Enter here when a case is discharged* and always give
cause of discharge and condition of patient at the time of discharge,
if known; if not known, so state.
NURSE’S DAILY REPORT. [Size: 8J> by 11 inches.]
Date.......................... 192 .
Addresses.

Nursing District.........................................N urse...,.................

Names of patients. Age. New. Old.

Dis. A.m. P.m .

Work done.

Fee.

Instructions to nurses for 'planning work: All cases are filed by
streets, the streets being arranged alphabetically. Under the streets,
the families are arranged according to house numbers, beginning
with the lowest number. In order to locate any case quickly, use
the street district directory, which gives an alphabetical list of streets,
showing after each street which numbers on it belong to each dis
trict; e. g.—
.
Street.
Wilmette.

Numbers.
1-700 inclusive.
701-1000 inclusive.
1001-7000 inclusive.
Etc.

District.
3
5
2

The list begins with streets commencing with the letter A. This
eliminates the necessity of having an alphabetical list containing a
separate card for each person.
Flags.—The following flagging system will be adopted:
Red flag—Emergency case, to be visited at once or on next trip
out of office.
Green flag—Current month.
Yellow flag—Next month.
Blue flag—Prenatal case.
The green and blue flag will bear the figures 1, 2, 3, 4, and the
blue flags will bear the monthss of the year.
Take from the filing case all folders for families in which there is
a new sick case or an old sick case to be visited (these would have red
flags on them). Include well children and children to whom birth
certificates are to be delivered in these same families. If time will
permit, add cases of well children and prenatal cases in the same
building find on the same street or in the same neighborhood. Well
children should be visited once edch month. Prenatal cases should
be visited once each month the first seven months and weekly there
after. Prenatal cases will bear a signal or flag having on it the month
the case is to be delivered and also a signal to show when the next
call is to be made. The same system that is used for the cases of
well children will be used for prenatal cases. The cards for well
children will bear a flag showing when the next visit is to be made,
for example, suppose this is the third week of the month. All. cards
for well children to be visited this week bear a green flag numbered 3.
These must be visited before those having a green number 4 are vis
ited. As soon as they are visited the clerk will exchange the flag
for one showing when the next visit is to be made.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FIRST VISIT SLIP.
[Size: 4f by 8 inches.]
2. Name...................................................... 3. Address..............................................................
4 N D
1. S u r n a m e ............... .
xre*A>ri?A J?Xo' *: x*v ; * - : •* • • •; v ............................... 6- Sex, M. F. 7. Negro, Y. N. 8. Nativity of mother..................... .’.’.’ .’_’.".’_".’ .’ .’ .T.’
9. Date of birth.’. " " ............
^^‘.A* ^ASES. io. Metropolitan (a) N o .. . . . . . . . . . . . . . . . . . . . . (b) Date of I s s u e . . . . . . . . . . . . . . . . . _________ . (cl Avp.nt or riphit. na
n
r /i/i v'xr*
12. Diagnosis (give stage ana location of T B ).......................................................- ........................................ ............
^' °
................................ l l . in Bed, X . N.
??• 5 r:
......... ................................... ................................. 14. Doctor’s orders............................ ..................
'
r~............ *...................................
15. Brief history with length of illness to date
................... .................. .............................................................
......... *...................................................................... ...........**

APPENDIX.

TUBERCÙLÒSIS:l6.Reported
to
Health
(datej.-.---......-...-.--.17. Oeased work.. .. . .yrs.. .. .. .. *mos.........wks...........
io
ai
. .. . . XT. . j *
- ■-Dept, of
------—
—\-----V
.days before admission.
ota l......h
rs. (d)
18. Sleeps daily (a) Night......... hrs. (b) D ay....h rs.s. (c)
(c) T
Total..
. . . .hrs.
(d) Remarks..............
Remarks
19. Exercise daily (a) Regular, Y. N. (b) No. hrs........... (c) Ty pe........................ ............
......................................... ‘on ' iSrini-V.......................................teA**tàlj; l
..............................? ,
daily
21. Sanitorium History (Dates, Institution, Location, Cause of departure)....................................................................................................
*"
MATERNITY AND CHILD: 22. No. mos. pregnancy at admission..... ..................
24. Ceased work............mos................w k s ..... ........ days before confinement___
Month of pregnancy.
25. Confinement (a) date........................................(b) Normal, Instr., Caesarian.
23. Prenatal c a s e Total.
(c) Injury of mother (specify) ............ ....................................................... .
fa) Visits to phy’n ..........
(b) Nurse’s visits............
26.
Remarks.............................................
(c) Visits to clinic...........
fd) Urine exam s............
(e) Blood pressure taken.
CHILD: 27. Injury of child at b irth ......................................... 28. Bom in .................................. ! ............................
oq Birth rpgistprpA v xr
S ) S s nofbott?erf ^ s ° nly.........m0‘ t0*-v - mo- (b) Breastand bottle..........mo. to..........mo. (c) Bottle only...' ..'.m'o.'to.'.'.'.'.'.'mo:' (d) Table ^¿d first at.
..m o.
.(f) Feeding regular, Ÿ. N.
31-W glked first a t . . .. .mo.
32. Talked first a t .. . . .'.’. ' . m o . ' 33.’F i r s t t o o t h a t * . m ’o.*’' ‘ ”3*4.’ Sleeps alone,’Y.’ N*
35. Bedroom windows open (a) Winter, Y. N.
(b) Summer, Y. N. 36. Out of doors daily, Y. N. 37. Institution history: (Name of institution, dates, cause.)
in. a .
unua section items 2« to 36, inclusive,
(c)
(e)
(f)
38. (a) Date. A.(b)
m(d)
(g) Nurse’s notes.
m. P. m. Temp.
(h) Nurse.
Pulse. Resp.
(i) Fee.
•
$............
Visiting Nurse Association, Bridgeport, Conn., Form F. V. 3. Oct., 1920
[See page 148.]

147

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FIRST VISIT SLIP (REVERSE).
[Size: 4f by 8 inches.]

42. Period
gestation.

41. Names of family.

Husband............................. .......................
Wife........................
- ........... ......................
Pregnancies.

43. Date
of birth.

44. Place of birth.

45. Health.
If dead give age at death and cause.

46. Years 47. Speak 48. Read
in U..S. English. English.

• ...........

................... I........................

49. Religion: (a) Church.

m’

................ .........................................

50. Relatives (a) name.................................................... (b) Address

(a)Hist.

(b) Kind.

51. Occupation.
(c) Name of firm.

N. B. Items 39, 40, 51
through 56 must be answered
for every case admitted unless
a previous record is on file and
there has been no change
in conditions. If items are
not answered enter “ Same”
across them.

52. Housing (a) Rooms (b) Rent per mo. $ ............... (c) occupants a u . . . . . ^ u .
W weeKiy 53. Toilet (a) Type, WC., P . (b) Location home, yd. (c) No. families using.
earnings.
04. KemarKs.
$ ...................
55. ""Milk (a) IDatìy quantity. - - - - - - * - • - - "(b) Firm’s name....................................................... .
(c) Kept
56. General r

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

(b) Faith.
3 ............................................... .................... - - - - - -

A PPEN D IX .

149

Before the nurse starts to make out her daily report slip, she has
before her all the new cail slips arranged by streets and addresses, all
of the emergency cases arranged the same way (run in with the call
slips) and the cards of the well children she thinks she can see. Theii
she copies them onto her daily report sheet. She leaves the records
on her clip board and on top of them places the carbon of her daily
report sheet.
N o t e .— The flag is not changed on a case until that case is visited
and given attention. If the case is not seen, the visit will count as
a visit on the record but the flag will not be changed. This is an
important part of the clerk’s duty.
3. First Visit Slip.
For all cases requiring only the first visit no medical record will
be made out. Statistics will be taken from the first-visit slip which
will then be filed alphabetically in a file drawer marked:
FIRST-VISIT SLIPS
NO RECORDS IN FILE.

New call slips will always be checked with these filed slips to be sure
the case has not been seen earlier. If it has been visited previously,
a note to that effect will be made on the call slip. If a slip for the
same person is entered later, as a first visit for another illness, another
first-visit slip should be made out and treated as follows:
If only one visit is necessary, do not make out a medical record,
but staple the second first-visit slip to the first in the files. In this
way, cases such as absentees who are frequently absent but who need
no nursing care will stand out in the file. The first time the person
needs two consecutive visits a medical record should be made out in
full, as much of the family folder should be made out as possible,
and the facts on the first-visit slips in the file should be entered
under Remarks. When the entry has been checked the recorder
should destroy the slip.
Instructions to nurses.
N o t e .-— Instructions for all items are not given here, but would
appear in the organization manual.
The slip has been planned to cover all types of cases and whenever
possible the probable answers have been supplied in order that you
may check the proper word instead of being obliged to write it out.
For all cases fill out section 1, items 1-9, inclusive. Item 4 N. D.
Enter your district number. For all V.N.A. cases for which will be
made out a medical, tuberculosis, or maternity record, fill out items
10 to 15, inclusive.
If the case is one of tuberculosis, fill out, in addition to sections
1 and 2 (items 1 to 15, inclusive), section 3, items 16 to 21, inclusive.
For maternity cases, fill out sections 1 (items 1 to 9, inclusive),
2 (items 10 to 15, inclusive), and 4 (items 22 to 26, inclusive).
For all children, fill out sections 1 (items 1 to 9, inclusive), 4 (items
22 to 26, inclusive) and 5 (items 27 to 37, inclusive).

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

150

Item 38 is to be a record of the nurse’s report of the first visit.
Several spaces have been left for use in cases returned for second or
third visits, because the information was not secured at the first
visit.
REVERSE SIDE.

All of the items on this side of the record apply to the family as a
unit. All should be answered at the admission of the first member
of the family. Items 41 to 45 will not change except as the family
is increased or decreased, but such changes should be noted in their
proper places as they occur.
Item 51 should be verified at least once a year, and if any great
change in the family income occurs, it should be noted in this sec
tion, even though it was filled out at an earlier visit.
Items 52, 53, and 54 should be answered only when the family has
moved.
/
, .
Item 55 should be answered each time a member of the family is
admitted.
Item 56 is to be used for any remarks for which room has not been
left elsewhere.
4. Family Folder.
INSTRUCTIONS FOR U SE .

1. Name.—Enter the family name first and the first name of the
head of the household with the initials of other names following;
e. g., Smith, Allen A. Initials alone are insufficient identification.
2. Negro.—Enter Yes or No after Negro, according to fact.
3. Addresses and Districts.—Enter house number, street, location
of dwelling and ward, numbering each successive address; e. g.,
(1) 541 Green Street, 2d floor, District 6. (2) 6 Black Rock Street,
1st floor, District 3, etc.
.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

FAMILY FOLDER.$
(1) Name...........................
(3) Address and districts:
(7) Names of family.
Husband.
Wife........

(2) Negro..
(h) Period
gestation.

(9) Date
of birth.

------------(ii)' M L -----------

(10) Place of birth.

If dead give age at death and cause.

(12) Years I (13) Speak (14) Read
in U. S. | English.
English.

Pregnancies:

1..........

2 ...........

5 ..........
6 ...........

(a) Date, ^ ¿ t i t y " (e) Name of firm.
....................

.............

7................

(19) (a) C h u rch ...... . . . . . __ . . . ...... ............................foV Faith,
Wkly.
earnings.
Total 8.

(20) Housing.

(a)

Date.

(b) Address (c) No.
number.
rooms.

(17) Later earnings:
(is|) ¿elafives^SlH ^am eT

(d) Kept Winter.
Summer.

(d) Bent
per mo.

Total.

(e) Occupants.
Ad.
Childm.

Type.

(f) Toilet.
Loc. Fam. using.

A P P E N D IX .

(16) Occupational history (date)
(a)
(b) Occupation.
Hist. No.
Kind.
Name of firm.

.kemarks:
(t>!) Address.

N. B.—Check in red ink at left of column No. 7 for each member of family for whom this
folder contains a record.
- 6
Î ^ r i s m a d e of heavy manila paper. The front flap is 5 by 8 inches in size. Upon the face of the front flap are printed items 1 ,2, 3, and 7 through 20. The back
flap of the folder is 4Jby8 inches m size. Upon the front of the back flap are prmted items 4, 5, and 6, thus bringing these items on the inside of the folder.
[See page 152.]

151

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

152

FAMILY FOLDER (PAGE 2).

."'.'.'.'.■.'.■."r.”.'.'.”.'............................................................

(a) Date referred, j (b) Date returned.

[See page 151.]

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADM INISTRATIO N.

Department of Health, Bridgeport, C,onn., Division of Child Hygiene.

A PPE N D IX .

153

4. Dates.—(1) Enter the dates of residence at the address entered
nnder item No. 3, numbering the dates to correspond with the
addresses; e. g., (2) Jan. 1, 1920-Jan. 1, 1921 would mean that the
family lived at the second address entered under item No. 3 from
Jan. 1, 1920, to Jan. 1, 1921.
5. Notes.—Whenever there is insufficient space provided for an
entry, encircle the item number, enter the same number under
Notes and complete the entry. Always commence each note on a
new line.
6. Report of work being done by social agencies:
(a) Date referred. Enter the date the slip is sent to the confi
dential exchange. If the inform ation is secured directly
from an agency, enter the date the V. N. A. requests the
information. B e sure when entering the dates to enter
the year.
(b) Date returned. E nter date slip is returned from the confi
dential exchange. I f inform ation is secured directly from
an agency, enter the date the agency gives the inform a
tion to the V. N . A.

(c) Entries. Enter the source of information and the information
secured, using the following abbreviations for sources:
C. C. B .— Catholic Charitable Bureau.
D . P . C.— D epartm ent of Public Charities.

D. H.—Department of Health.
C. O. S.— Charity Organization Society.
St. V. H .— St. V incent’s H ospital.
D o n ot use any abbreviations un til approved b y the superintendent
and entered in the instructions. A lw ays use only the approved
abbreviations. W rite in full, sources for which abbreviations have
n ot been approved.

7. Names of family. Enter the first names of the father and mother
in the space indicated. Enter the mother’s maternity history below,
giving m order every pregnancy, commencing with the first, on the
line numbered 1. For all cases of pregnancy not resulting in live
births, enter SB for still birth and MISG for miscarriage. A still
birth is the result of a pregnancy of seven*or more months gestation;
a miscarriage is the result of a pregnancy of less than seven months
gestation.
If the mother has had more than eight pregnancies, enter the
word over after the eighth pregnancy, make headings under Item 5
Notes corresponding to items 7, 8, 9, 10, and 11 and complete the
information.
8. Period gestation. The X following the nam e of the father and
m other indicates th at no entry need be m ade for them . E ntries
m ust be m ade for all pregnancies. All entries should be in m onths.

9. Date of birth.—Enter month, day, and year.
10. Place of birth.— E nter country of birth for an y one b o m out
side the U n ited States.
U n ited States.

E nter city and S tate for those born in the

11. Health (■if dead, give age at death and cause).—Enter here any
evidence of chronic disease or deformity for living members of family,
giving first the date of the entry. For all cases of death, enter age
at death in years and months and state cause briefly.
57716°—22----- 11

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

154

OFFICE ADMINISTRATION.

12. Years in U. S.—Give this information for the husband and
wife only, and for them only if they were born outside the United
States. For those born in the United States enter a d ash ----- .
13. Speak English.—Enter yes only if the person can carry on a
simple, ordinary conversation in English. For all other cases enter
No. This inquiry must be answered for every case as some persons
born in the United States do not speak English.
14. Read English.—Enter yes only for those who can read an
English book or paper. For all others enter No.
15. Milk supply (a) Date, (b) Daily quantity, (c) Name of firm,
(d) Kept winter or summer.—This item refers to the quantity of
milk being taken on the date of entry.
(c) Enter the name of the firm which supplies milk for distri
bution.
(d) Give separately for winter and summer whether milk is
kept on ice. Specify method of keeping it.
16. Occupational history:
(a) History No.—Enter H for Husband, IF for Wife, and the
proper pregnancy number for each of the children working.
(5) Occupation.—Enter lodgers as mother’s occupation.
Kind.
Enter the exact occupation as carpenter, chauffeur, etc.
For day work, lodgers, etc., enter as place, Home, or
Private family, as the case may be.
(c) Weekly earnings total $—. — Enter here the total earnings
as shown in the remainder of the column. The weekly
earnings should be secured for the week preceding the
first visit of the nurse.
17. Later earnings {dates and amounts).—Enter here total family
earnings only at intervals frequent enough to show marked
changes in the family’s economic status.
18. Relatives: (a) Name, (b) Address, (c) Kinship.—Enter hefe the
names of relatives living with the family described in the family
folder, their kinship, and under address enter Same.
Enter also the names, address, and kinship of relatives who
may be depended upon for assistance if needed. Be sure to enter
city and State as well* as street under address.
19. (a) Church.—Enter the name of the church attended by the
majority of the family; e. g., St. Rose’s.
(b) Faith.—Enter the religious denomination of the church
named under 19a; e. g., Catholic.
20. Housing.—This section should be filled out every time the
family moves.
(a) Bate: Enter here the date of the nurse’s first visit after the
removal of the family to the new address.
(b) Address Number: This is the number of the address appearing
at the top of the folder.
(c) No. rooms: Enter the number of rooms for which rental is
paid, as shown in {d).
{d) Rent per Mo.: Enter amount paid per month for number of
rooms shown in (c).
(e) Occupants: Include all persons residing in the rooms. An
adult is a person over 16 years of age. A person aged 16
years or younger is a child.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

155

(/) Toilet:

Type.—Center P for privy vault—always located in yard.
Enter W. C. for flush toilet.
Location.—The usual entries would be dwelling, hall, cellar,
yard, porch—use these abbreviations: D., H., C., Yd., P.
No. Families.—Enter here the number of families using the
toilet.
If any insanitary conditions are found, they should be reported on
the health department slips and the date of the report and the facts
reported should be entered under Remarks immediately below the
Housing section. The clerk will be responsible for securing and enter
ing the action taken.
5. Child’s Record.
N o t e .—Use only the abbreviations given in the instructions for
filling out the first visit slip. If cases are reported by sources not
provided for in the list, refer the case to the superintendent.
8. Admitted (date).—Enter the date the child was first seen. This
will be the date of the nurse’s first visit to the child in the home or of
the child’s first visit to the health station, according to which was
first.
9. Age at admission. — yrs. — mos. — clays.—Subtract the date
of birth from the date of admission and enter the result in years,
months, and days.
10. Prenatal care.—In the square under the proper month of preg
nancy enter (a) the number of visits the mother made to the physician ;
(b) the number of visits the nurse has made when she saw the mother;
(c) the number of visits the mother made to the clinic; (d) the number
of urine examinations made each month; (e) Y or N for Yes or No,
according to whether or not the blood pressure has been taken.
Enter the total for each type of prenatal care in the total column at
the right of the section.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

156

CHILD’S RECORD.
[Size: 4f by 8 inches.]
1. Surname..................................... Name........................................ 2. Father........... ...................
Surname first.

4. District

3. Addresses:

5 . Sex........................................6. Date of birth.......................................... 7. Reported by.............................................

8. Admitted (date)............................................................... 9- Age at admission........... yrs. . . . . . . mos.

Birth: 11. Attendant (a) Nam e.

10. Prenatal care: Month of pregnancy.
1

Total.

................................. .............. - — - - -M-

(b) Address.................-...............12. Pregnancy No...............13. Registered.................
14. Delivery: (a) (Normal, instrumental, Caesarian)................................................. .
(b) Injury at birth (specify)............................: ; ; • ^ v : • y • v • y - : ........... *•
15. Feeding: (a) Breast only........ mo. to-----mo. (d) T ablefoodfirstat......m o.
(b) Breast and bottle............... mo. to ___ mo. (e) Bottle foods (specify kinds).
(c) B ottleonly................... ....m o .t o ----- mo. .....................................................

History of child: 16. Sleeps alone..............................17. Bedroom windows open (a) Winter................................ (b) Summer..............................18. Out of doors daily.
19. Walked first at.. ..m o.
20. Talked first a t... ..m o.
21. First tooth a t ... ..m o.

22. Institutional history (a) Name.

23. Family history........................ ..................

(b) Dates.

.Physician’s record.

24. Physical examination................................
(Signed)..................
(c) Cause............................................................(d) Condition.
.(b) to.
25. Discharged (post natal) (a) Date.
(c).Cause............................................................ (d) Condition.
.(b) to
26. Discharged (well child) (a) Date.
'28!'Death7a)Date.*.’.’ .'.’.'.'.’.’ .’.'.'.’’.'.'. . . . . . . . ......... (b) Age......... yrs.............mos. d. (c) Cause.
27. On roll . ....... yrs.Department of Health, Bridgeport, Conn., Division of Child Hygiene, Form 972, Sept., 1920.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

....M . D.

OFFICE ADMINISTRATION.

Type.

days

CHILD’S RECORD (REVERSE).
Surname..................................................................................... Name.
Age.

Weight.

Height.

Feeding.

Date.

Remarks.
Yrs. Mos. Days. Lbs.

Ozs. Inches.

Kind.

. Nurse.

Interval.

APPENDIX

1 .

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

158

OFFICE ADMINISTRATION.

11. Attendant, (a) {Name — M. D., Mwf; (b) Address —).—
Enter the name and draw a line through mwf. (midwife) if the at
tendant was a physician ; cross out MD if the attendant was a mid
wife. For cases where the attendant was neither a doctor nor a
midwife cross out both MD and mwf. Enter the name and address
of the attendant, and enter Nbr. for neighbor, Daught, for daughter,
Hush, for husband and Rel. for all other relatives. If the attendant
lives outside of Bridgeport, dash — the space after Name and enter
the city and State after the address. If the child was born in a
hospital with a private doctor in attendance, enter the name of the
doctor, and enter the name of the hospital after Address. If the
birth occurred in a hospital with a hospital physician in attendance,
enter the abbreviation Hos. M. D. after Name and the name of the
hospital after Address.
12. Pregnancy No. This figure should agree with the number to
the left oi the child’s name in the family folder.
13. Registered. Enter Yes, No, or Unk. (unknown). All children
born in Bridgeport should be registered. For those not registered
the nurse will nil out the birth certificate slip and turn it. in to the
assistant superintendent with the daily report. The clerk will
check with the Family folder all cases for which births are marked
not registered to be sure that the nurse turns in a birth registration
slip for the case. When the birth registration slip is sent to the
board of health, the clerk will enter immediately beneath item (13)
“ B R S” (birth registration slip) and the date; e. g., BRS 2/3/20.
When a birth certificate is made out and delivered to the family
the nurse must be sure to change the entry. The clerk should watch
the entry and report to the assistant superintendent cases which
have been overlooked.
N o t e — When the board of health clips the VNA birth registra
tion slips to the birth certificates made out for them, the VNA clerk
should take these out and make the proper entry on the records,
leaving the BBS attached to the record for the nurse’s information.
When the nurse delivers the birth certificate, she should destroy
the BBS.
14. Delivery.—
(а) (Normal, instrumental, Caesarian) : Check the proper entry
and enter any important facts in the space following.
(б) Injury at birth {Specify).—If there was none, enter None—
otherwise specify the nature of the injury.
15. Feeding-—
(a) Breast only — mo. to — mo.
(b) Breast and Bottle -— mo. to — mo.
(c) Bottle only — mo. to — mo.
(d) Table food first at — mo.
(e) Bottle foods {specify hinds).
'
\ 11
.
This is the history of feeding up to the date of admission only.
The remaining history will be shown on the reverse side of the record.
Enter the chad’s age in the space preceding the abbreviations mo.
(month); e. g., Breast only B. (Birth) to 6th mo.
Breast ana bottle 6th mo. to 9th mo.
Bottle only 9th mo. to 11th mo.
The age'at admission (item 9) should be the same as the last age
entry under feeding. Dash the remaining items, under feeding to

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

159

show that they do not apply to the case, (e) Bottle Food (specify
kind) : Enter cow's milk or condensed milk 'and some patent food,
etc., as the case may be. Do not attempt to give a formula. If
the child had several kinds of bottle feedings enter all of the foods.
History of child.
16. Sleeps alone.—Enter Fes or No. This applies to the child’s
custom at the time of admission.6
17. Bedroom window open (a) winter (b) summer.—Enter Yes or
No, according to the custom of ventilating the child’s bedroom at
night.
18. Out of doors daily. Enter Yes or No, according to the custom
of the child. Daily should be interpreted to mean “ except in stormv
weather. ” 7
19. 20, 21. Walked, Talked, and First Tooth at.—Enter the age of
the child for each item specified just before the abbreviation mo.
22. Institutional History (a) name (b) dates (c) cause:
(a) Enter here any hospitals (except for birth) boarding homes,
day nurseries, orphanage, etc., which have cared for the child.
(&) Give the dates of entry and departure for each in stitu tion
separately.

(c) Enter the cause of the child’s having been cared for in an
institution, such as death of the mother, illness of the
mother, illness of the child, etc.
Physician’s record.
23. Family history.
24. Physical examination.—These items are to be filled in by the
physician who will sign his name in the space indicated.
25. Discharged (Post Natal), {a) Date —■\b) to — (c) cause —
(d) condition —. When the infants are admitted during the post
partum care of the mother, they (the infants) must be discharged
to the well-baby service of the VN A. as soon as the cord is healed
and the child is in good condition. The entries under 25 a. b. c.
would be (a) date■-— (6) To well child V N A — (c) Cause — new
baby — id) Condition cured —.
26. Discharged (well child) :
(а) Date.—For cases “ unable to locate,” “ lost address,” “ moved
from city,” or “ died,” enter dash —.
(б) To -—.—-If the case is transferred to another district or in
stitution, enter the name of district or institution to which
child is transferred. If there is no cooperation, discharge
to the family. If the child is over age, discharge to the
school nurse.
«If Y. N. had been printed on the record the proper answer could have been checked—a saving of a
little labor.
1 See note for item 16.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

160

OFFICE AD M INISTRATIO N.

26. Discharged (well child)—Continued.
(c) Cause.—Use the following abbreviations or words:
Cause.
Proper entry.
Died.
Died.
Moved from city.
Moved from city.
Moved from district. .
Moved from district.
Transferred.
Trans.
(This applies to a transfer either to another district to
to an institution.)
No cooperation.
No coop.
(This includes cases discharged because they have nor
come to health station within five months of nurse’s first
visit.)
Unable to locate.
Wrong address.
Over 5 years of age.
Over age.
.
id) Condition.—Enter here dead, well, or a definite statement of
the defects or physical condition of the child when he is
transferred to the school nurse.
27. On roll—yrs.—mos. (This item refers to the well-child service.)—Enter the difference between the date of admission and the
date of discharge. In the case of a baby which had postnatal care
the date of admission to the well-child service will he the same as
the discharge from the postnatal service.
28. Death (a) date— (b) age—yrs.—mos.— (c) cause.—This infor
mation will be secured by the clerk from the hoard of health for
children who have died in Bridgeport, but the nurse should always
note deaths to be certain the entry has been made on her record.
REVERSE OF RECORD.

This side of the record is for the nurse’s record of home visits and
the physician-nurse’s health station record. When children are dis
missed from the postnatal service to the well-child service, draw a
heavy line beneath the last postnatal entry and repeat the date m
the following line, following it by u admitted to well-baby service under
'Remarks.1 ’
6. Maternity Record.
^
This record is to be filled out for every prenatal case. Items 21
and 22, Prenatal care, is a summary of the care received by the
mother during the entire pregnancy. I t will be most accurate if
filled out monthly.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

MATERNITY RECORD,
[Size: 4f by 8 inches.]
1. Surname................................................................. 2. Name..
5. Family folder........................................ 6. Date of birth..
9.
12.
13.
15.
17.

— ............ ......................... 3. Address.
..............
7. Reported by...................

Met. Policy No...................................... 10 . Date admitted
Employment: (a) Occupation................................................
Diagnosis..............................................................................
Doctor’s orders.........................................
Brief history, with length ofilUness to date..........................

18. Dismissed (a) date................................ (b) T
o
1! ”
19. No. v isits....... . 20. Enrolled____ __m o s... ...........wks.

....... : .. 11. Age at admission...........
(b) Firm......................................... .

8. Reported back
....................... yrs..........
__ (c) Stopped___mos.
14. Doctor.........................

4. District.
(Date)................
.m o s._____ ........d a y s
w k s.. . . . ds. before conf.

.16. In bed.
days.

(d) Condition.

APPENDIX.
161

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

162

MATERNITY RECORD (REVERSE).
Name.

Surname.
(a) Date.

(b)
A. M.

(e)
(d)
Temp. Pulse.

(0
Resp.

(g) Nurse’s notes.

(h) Nurse.

(i) Fee.
$............

OFFICE A D M INISTRATIO N.
\

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

7. Medical Record.
records18 Te°°T^ 1S t0 be made 0ut for eveTJ case of illness not provided for by the tuberculosis or the maternity
MEDICAL KECOBD.
1. Surname..........................

2 Name

5. Family folder............................ .7.7.7.777' 6.' Date of birth
9.
12.
13.
15.
17.

Met. Policy No.
............................ io. Date admitted__
Employment: (a) Occupation...................
Diagnosis................................................................
Doctor’s orders........................... 7 7 ..........7 . ...........................
Brief history with length of illness to date.7.7.7.7.7. 7. . 7. 7. 7. .

18. Dismissed: (a) Date............................ ....... 7.7."7.7"(b)"To.".""
19. No. visits............... 20. Enrolled................mos.7..............wk's".

]Size: 4j by 8 inches.[
............ ............-Address........................................-— .•.......................... . ............... 4. District.
....................... "• Reported b y....... *............. ........................... 8. Reported back...................
(Date
............................................................. 11. Age at admission.............yrs.........
mos
(b) Firm...............................
. . . 14. Doctor.......
16 In bed
______ (c) Cause.
days. 21. Remarks.............

(d) Condition.

APPENDIX.

22. RECORD OF NURSING CARE.

.days.

163

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

164

MEDICAL RECORD (REVERSE).
[Size: 4f by 8 inches.]
Surname............................................................................................................................... .......................... Name..
(a) Date.

(b)
A. M.

■(e)
(d)
Temp. Pulse.

(0
Resp.

(g) Nurse’s notes.

(h) Nurse

(i) Fee
$............
-

OFFICE ADM INISTRATION,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

8. Tuberculosis Record.
N o t e .—Instructions are not given for filling out the maternity, medical, and tuberculosis records, as they are
sufficiently clear to be intelligible to the reader for’illustrative purposes. The instructions to the nurses and office
'clerical staff cover the technical definitions, define when and how the various sections of the records are to be filled
out, and give other information similar to that presented in connection with the remaining records in this system.
TUBERCULOSIS RECORD.
[Size: 4J by 8 inches.]
1. Surname................ ..................................... . ...... 2. Name..................................................................... 3. Address................
5. Family folder................................................ 6. Date of birth......................................................... 7. Reported by...............
9.
12.
13.
15.
17.

.............................. 4. District.
8. Reported back.................. .
(Date)
Met. Policy N o.............. , ................................. 10. Date admitted....................................................... 11. Age at admission, .......................... yrs............................ mos...............days
Employment: (a) Occupation....... ......... ...................................... (b) Firm............................................. ..................... ...... ,(c) Ceased work........ .........................before admission
Diagnosis: (a) Disease............................................. .
(b) Stage..................... ................................ ......... (c) Location... — ...................................... 14. Doctor................... ..
Doctor’s Orders........................................................................................................ ........................................................................ ........................................ 16. In bed..............................
Briefhistory withlength ofillness to date................ .......................... .................... ........................................... ........................

23. SANITORIUM HISTORY.
(a) Dates of residence.

(b) Name of institution.

24. Dismissed (a) Date................................. (b) To..................................................................... (c) Cause....................................................
25. No. visits...............................................20. Enrolled.....................mos....................wks....................days.
Visiting Nurse Association, Bridgeport, Conn. Form 33—1920.
[See page 166.]

APPENDIX.

18. Reported to Dept, of Health (date)...................................... 19. Sputum examined (a) Date.................................................................................. (b) Result.
HABITS: 20. Sleep daily
(a) Night................... hrs. (b) Daytime....................hrs. (c) Total....................hrs. (d) Remarks......................... „..........
21. Exercise daily (a) Regular....................... (b) No. hrs............................
(c) Type........................ .......................... .......................... ...........
22. Milk daily
(a) Drinks..................pts. (b) How kept winter.......................................................................... ................... Summer...........

(d) Cause of departure.

(d) Condition.

165

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

106

TUBERCULOSIS RECORD (REVERSE).
[Size: 4J by 8 inches.]
Surname
(a) Date.

(b)
A.. M.

•
1
(e)
(d)
Temp. Pulse.

(f)
Resp.

(g) Nurse’s notes.

■

(h) Nurse.

(i) Fe<
$............
......

......
.........
......
.........

.......
.............. . . . . .
[See page 165.]

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADM INISTRATIO N.

.........

167

A PPEN D IX .

RECORD SYSTEM III.
D e l a w a r e H e a l t h Ce n t e r s —
1. Call Book.
2. Nurse’s Daily Report.
3. Family History Record.

1920.

4. Child’s Record.
5. Maternity Record.

Use.—This system is used by both the city and rural nurses of the
State reconstruction commission throughout the State of Delaware.
Scope of organization.—Generalized service to all children of the
State under legal age, and prenatal nursing service to expectant
mothers.
1. Family History Record.
One family history record only is to be made out for each family.
I t is to be made out when the first member of the family is enrolled,
and filed in front of the records for the individual members of the
family. No record of visits is made on this record. I t is a card of
information about items which affect the entire family, and should
be used as follows:
INSTRUCTIONS FOR FILLING OUT ITEM S.

General.—Never leave an entry blank. Enter a dash (—) if the
item does not apply to the case, UnTc. (unknown) if the mother can
not give the information and it can not be secured otherwise, and
Unw. (unwilling) if the mother is unwilling to give the information.
When words are to be checked, be sure the check goes through the
word in such fashion that no question can arise regarding where it
was intended to be.
1. Family name.—Enter the family name first, followed by the
father’s name. Even though he is dead, enter his name.
2. Address: (a) County— (b) District {Town)— (c) R. F.D. No. —;
(d) Remarks—.—An attempt has been made to provide sufficient
room for the address. Under (1) may be given directions for reaching
homes which can not be definitely located by any given address.
3. First names.—Enter the first names of the father and mother
and of all the children, living and dead, and results of other preg
nancies in order of occurrence, (a) being the first born.
Enter Misc. for all issues of less than seven months gestation.
Enter SB for issues of seven months or more, dead at birth.
4. Age—192—.—Enter the age of each living member of the family,
the year the record is filled out, not the day it is made out. For
members of the family who have died enter D.
5. Date oi birth.—This should be filled out for every member of
the family, whether dead or alive, and for stillbirths and miscarriages
when possible. Enter month, day, and year.
6. Sex.'—-Enter M for male and F for female.
7. Period gestation.—Make entries in months for all pregnancies.
Enter dash (—) for father and mother.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

168

FAMILY HISTORY RECORD.
_
[Size: 5 by 8 inches.]
. „
; *_
../District
1. Family name................................................ ............... i..;, 2. Address (a) C op n ty..................................................................... w \T ow n..
(c) R. F. D. No......................................................................... (d) Rem arks.....................................................................-...................................
3. First Names.

4. Age 5. Date of
birth.
192 .

7. Period
6. Sex. gestation.

8. Health.
(If dead give age at death and cause.)

9. Date
enrolled.

10. Remarks.

Pregnancies:

22. Employment record.
17. Country of birth.

23. Discharged: (a) Date..........................................................
Delaware Health Centers; Form 1—1920.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

18. Years in
U. S.

19. Color.

20:Spk.Eng. 21. Read Eng.

(a) Name.

(b) Place.

OFFICE ADM INISTRATIO N

HODSING: 11. No. Families................... 12. No. Rooms................... 13. Occupants: (a)................... Family.................... (b) Other (specify)................... (c) Tota
14. Toilet: (a) Type:
•
W.G., P .N .
(b) Location: Yd., House, Other (specify).
15. Water supply: (a) Source, Well, City, Cistern, Other, (b) Location, In , Out. (c) Directionfrom privy: U. D. L. (d) Direction from stable U. D. L.

FAMILY HISTORY RECORD (REVERSE).

Notes.

57716
OTHER AGENCIES.
Date.

..... .....

Work done or information secured.

APPENDIX,

- ............

Agency.

..................... - ...........

¡ft

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

170

OFFICE ADMINISTRATION.

8. Health (if dead, yive age at death and cause).—Enter here any
evidence of chronic disease or deformity for living members of the
family, preceding entry by date of entry. For all members of the
family who have died, enter the age at death in years and months,
and state the cause briefly.
4
9. Hate enrolled.—This means enrolled with the D.H.C. I t does
not apply to the father nor to any members of the family who have
attained their legal age. I t applies to the mother for prenatal care
10. Remarks.—Enter here notes about members of the family not
living a t home to explain discrepancies between total in the family
(item 13-c) and the First names, column (item 3).
HOUSING :
Mi? ,
11. No. Families.—Enter the number of families living m the house.
12. No. Rooms.—Enter the number of rooms in the house, even
though lodgers or other members of the household occupy some of
13. Occupants, (a) Family.—The figure entered should check with
item 3 as corrected by item 10.
Other
(specify).—Enter first the total number of other occu
(ft)
pants and then specify who they are in terms of relation
ship to the father.
(C) Total.—This is the sum of (a) and (b).
14. Toilet (a) Type If. 0., P., N.—Check the appropriate letter—
W. C. for any flush toilet; P, for privy vault, always
located in yard, and N for none. If there is none, enter
under 16. Remarks what facilities the family use.
(b) Location, Yard, House, Other (specify) .—Check the appro
priate word and if neither House nor Yard applies, state
the facts after the inquiry; e. g., in the cellar, hall, etc.
15. Water Supply (a) Source.— Well, city, cistern, other.—If the
family uses two sources, check both, but double check the
source which supplies their drinking water.
(b) Location, In, Out.—Check this item to indicate the water
supply is in or outside dwelling. If it is outside, specify
under 16. Remarks, how far the water has to be carried
and up how many flights of stairs.
.
Direction
from
privy.
U.
D.
L.
(Up,
Down,
Level).—If
there
(c)
is no privy vault dash (—) this entry. Otherwise check
the appropriate word. The distance from the privy is
important too, but entries on this point are so difficult to
ascertain accurately that it has been omitted. However,
the family should be educated in regard to the danger
which may surround wells. If they read English they
should be given the U. S. Public Health Service and U. S.
Department of Agriculture pamphlets on “ Wells and
Sanitary Privy Vaults.”
(d) Direction from stable. U. D. L. (Up, Down, Level). Check
the appropriate word, following instructions for (c).
16. Remarks.—Enter here any evidence of unsanitary conditions
not provided for above. If there are none, enter the word None.
17. Country of birth.—I t is difficult to state the boundaries of the
European countries at this time, but the entry should be according to

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

171

the name of the country at the time of the birth of the father or
mother.
18. Years in U. S.—For those born in the United States enter a
dash (—). This item applies only to the foreign born.
19. Color.—The only question in regard to color which might arise
would be in connection with the colony of “ Moors” in Delaware.
They often look like Negroes, but they have been given the status of
American Indians by the U. S. Government. Therefore their color
is Red, but for the purpose of this study it will be more satisfactory
to enter Moor under Color for this group. White, Black, Yellow,
and Red will cover other possible entries.
20. Spk. Eng. Enter “Yes” only for those persons who can carry
on in English a simple ordinary conversation. For all other cases
enter “No.” This inquiry must be answered for every case as some
persons born in the United States can not speak English.
21. Read Eng. “ Yes” should be entered only for those who can
read an English book or newspaper. For all others enter “ No.”
This entry shows whether the mother can profit by the literature
you have lor distribution. If she can not, you should inquire whether
some member of her family can read to her.
22. Employment record {at first admission):
(а) Name.—Enter here the first names of all members of the
family working at a gainful occupation at the time the
family history record is made out.
(б) Place.—Enter lor each member of the family listed under
{a) the name of the firm for which he is working. If
work is done at home, this should be stated. In the case
of a man working on his own farm, enter Own Farm,
or in case one of his children works with him, the place
of employment for the child would be “ Father's Farm.”
(c) Occupation.—For a farmer enter Farmer, Tenant, or Laborer.
23. Discharged:
(a) Date.—Enter the date the last member of the family is
discharged.
(&) Cause.—Enter Moved if the entire family has moved; No
Coop, if the mother refuses to cooperate. Specify other
causes.
REVERSE SIDE.

Enter on the back of the card information affecting .the entire
family which would not appear on any-other record for members of
the family.
This record should not be destroyed until the last member of the
family has been discharged..
On the lower half is a space to be used in entering the facts about
the case secured from the confidential exchange or other agencies interested in the case.
CHILD’S RECORD.

A child’s record is to be made out for every child under legal age
who either comes to the health center or is visited in the home by the
nurse.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

[Size: 5 by 8 inches.]

1. Family name.............. : — ...........................2 . Father................................................. - ........... ...

3 . (a) County............ ......... . . . . . ...............

172

CHILD’S RECORD.

[D ist..
0?)|,Town.

(c) Remarks.............................................
7 . Registered Y rN.Unk.....................- —
BIRTH: 5. D a te............................... .......... 6. Place (city, State)— .................................................................................
9. Delivery: Normal,Instrumental,Caesarian.
8. Attendant, Mwf. Phy’n, None, Other (specify)............................................................... ....................................................
11. Eyes at birth: O. K ., N . 12,: Drops: Y. N. Unk.
10. Injury at birth, None, Yes(specify).................................... -........................................................ • v ..................................
ADMITTED: 13. Date...........................................
14. Age......................yrs.^................ ....m o s........................... days. 15. Referred b y .......................................................................

4a. Child’s name......................................................

................| ..........
Mother..........,............................................

(e) Total Sleep in 24 hrs..............................hrs.

(f) If Habits are irregular ( s p e c if y ) ...................................... -....................... ..................................................*..........' ' .................\

DIET: 19. (a) Breastonly....................... m o . t o . . . . .........................mo.

(d) Infant feed supervised by: Phy’n. None......... ..............................- ................................[ ...........

(b) Breast and bottle.................................m o .to ................. .............. mo.

(e) Kinds of bottle foods....................................................-.............................. ......................... . . . . . . .

(f) Table food first at.................................- ............... mo.

20 . Bowel movements (a) Daily, Y . N

(b) Normal No. Y .N . (specify)...................................... -.............
..................... -........ *...............
i
__
Chi Grade
............
(c) Normal Y. A. B . (d) If not Normal give cause..............................................
° ..................
Occupation: 21. School (a) Name............................................................
(e) Teacher’s name.
22. Industry (a) Firm............................. ...» —
(d) Hours per wk................hrs.

(b) Occupation—

(e) Earnings per wk., $.............................

............................ ..................
(f) Begin working at........................................... —

To.

i ............................................. | ’

ENTRANCE PHYSICAL EXAMINATION.
23 Date

........................................... .........................

24. Physician’s name

FINDINGS: 25. Circulatory system.................................................................................
26. Respiratory system ............................................................. ...........................................
27. Bony system ................. .............................................................. .................................
28. Skin............... ...........................- ...........................-................................................... .
29. Ear
35. Discharged (a) Date................................. - —
(b) Cause

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

30. E ye...................................... .................. - .............
31.
32.
33.
34.

Nose.................. .
—
•
Throat and naso-pharynx............................
Mental and nervous condition...........................
Other findings......................................................
(c) Condition.............. ..........................
(d) On rolls---- yrs.

. .m o s.,__ das.

OFFICE ADMINISTRATION.

17. B e d r o o m Windows Open: (a) Winter Y .N . (b) Summer, Y. N.
SLEEP: 16. Sleeps alone: Y .N . (specify)...................................................... I........- - - - - - - ...........
18. (») Retires at...............P .M . 0 » Arisesat................. A .M . (c) Total Night Bleep................ " ...................hr»- < » Total Additional Sleep........................... . . . . . . . . . . . . h r s

CHILD’S RECORD (REVERSE).
Name (Family).................................... .............................

Child’s....... ............................................................................

Address.

[

Age.

Weight.

Height.

Date.
Yrs.

Mos.

Days.

Lbs.

Ozs.

Inches.

H
D
C

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX,

•

Nurse.
Doctor.

Services rendered.

174

OFFICE ADMINISTRATION.

No attem pt has been made below to write instructions for the
items which are perfectly obvious. If you find that any of these need
instructions, refer the m atter to the supervisor.
Note that in the section headed u B i r t h , ” items 5 to 12, inclusive,
are to be answered only for children under 2 years of age. For all
others dash (—) these items.
I
.
Effort has been made to supply possible entries so that checking
will be the extent of the clerical work the nurse will be called upon
to do. Y always means “ Yes,” N “ No,” and U n k . “ Unknown.”
Items 7 and 12 are educational questions, and the mother should be
made to understand the importance of having drops placed in the
child’s eyes at birth, and having its birth registered. Both of these
are required by law.
3. A d d r e s s : ( a ) C o u n t y — (5)
— (c) R e m a r k s —. This sec
tion was designed to meet the needs of rural nurses. Wilmington
nurses will enter W i l m i n g t o n after town and the street address after
(c ) R e m a r k s .
A d m itte d :
13. D a t e . —Enter

the date the nurse or lay assistant first sees the
child, either at home, school, dispensary, or at the center.
14. A g e . —Yrs. — mos. — . The child’s age on the day of admis
sion.
. . .
15. R e f e r r e d b y . ^ Enter the name of any agency or institution,
followed by the name of the member of the staff who refers the case;
e. g., Delaware Hospital, Dr. Green. If a private individual refers
the case, enter first his relationship to the patient and follow with his
name.
Sleep*
18. ( d ) T o ta l a d d i t i o n a l s l e e p — H o u r s . —This refers to naps during
the day.
<
.
.
( f ) I f h a b i t s a r e i r r e g u l a r { s p e c i f y ).—If the habits are so irregular
that items 15 and 17 { a , b , and c ) must be dashed (—),
enter the facts after ( /) . The mother should have ex
plained to her the value of regular hours of sleep, and
regularity in the hours of retiring and arising. When it
has become a regular habit for the child to go to bed and
arise at a regular hour, the fact should be noted on the
reverse of the record in its proper chronological order.
19. D i e t — If the child is still breast fed at admission, do not fill out
the diet section, but as the child’s diet changes, note it as required.
If the child is breast fed from birth, enter capital B instead of a figure
in the first space in item 19-u.
{ d ) I n f a n t f e e d , s u p e r v i s e d b y : P h y ’n ’s n a m e .
The purpose of
this item is partially educational; it furnishes an oppor
tunity to tell the mother that, if possible, a child’s formula
should be prescribed by a physician who is a specialist in
infant feeding.
20. B o w e l m o v e m e n t s , (b ) N o r m a l N o . Y . N . — This refers to the
normal number of stools daily according to the age of the patient.
Specify any apparently serious irregularity.
•

O c c u p a tio n s
21. S c h o o l.

(a ) N a m e — (b ) G r a d e — (c ) N o r m a l Y . A. B.—If the
child is attending school, enter after {a) the name of the school; after

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

175

(&) the grade he is in; after (c ) check Y for Y e s , A for a b o v e , B for
according to whether he is in the proper grade for a child of his
age, ahead of, or below it.
(d ) I f n o t n o r m a l g i v e c a u s e — If he is not in the normal grade for
his age, state the cause.
(e ) T e a c h e r ’s N a m e . —Enter the teacher’s name.
22. I n d u s t r y , ( a ) F i r m — (b ) O c c u p a t i o n — (c) H o u r s — to —
i d ) H o u r s p e r w k .— (e ) E a r n i n g s p e r w lc. $ —.—This entire inquiry is
to be filled out only for children who are working on the date of
admission.
( /) B e g a n w o r k a t — y e a r s . —This item is to be filled out when
the child goes to work.
b e lo w ,

ENTRANCE PHYSICAL EXAMINATION.

23. D a t e . —Enter month, day, year.
24. Physician’s name.
25. C i r c u l a t o r y s y s t e m . —Note enlargement of heart or functional or
organic murmurs.
26. R e s p i r a t o r y s y s t e m . —Note bronchitis, tuberculosis.
27. B o n y s y s t e m . —Note rickets, flat foot or other deformities.
28. S k i n . —Note general condition, or specific condition.
29. E a r . —Note otitis media, impacted cerumen.
30. E y e . —Note strabismus, nystagmus, or eye strain.
31. N o s e . —Note deviated septum, polyp.
32. T h r o a t a n d N a s o - p h a r y n x —Note enlarged tonsils and adenoids.
33. M e n t a l a n d N e r v o u s C o n d i t i o n s . —Note chorea, mental sluggish
ness.
• •
.
34. O th e r f i n d i n g s .
The above listed items from 25 to 34 are to be filled in with the full
clinical diagnosis as given by the physician in charge, particular
attention being given to the conditions mentioned. If nothing
abnormal is found, enter O. K. in the space following each item.
. 35. D i s c h a r g e d . —If the cause of discharge is death, enter the date
of death as the^date of discharge, after c a u s e enter the cause of death,
and after c o n d i t i o n enter D e a d .
i d ) o n r o l l s — y e a r s — m o n t h s — d a y s . —Tnis is the difference
between the date of admission and the date of discharge.
REVERSE SIDE OF RECORD.

On the reverse side of the record should appear a chronological
history of the child’s health record and all services performed for him.
A summary of dispensary findings will appear here also, but the
full dispensary record will be kept at the dispensary. The child’s
record should show health center visits, home visits, correspondence,
telephone calls, conferences about the child, etc., as well as nature of
advice given. The physician’s orders are always to be made in red
ink.
MATERNITY RECORD.

This record is to be made out the first time the patient is seen by
the nurse, either at home or at the health center. In order to make
sure that all important points in prenatal care are covered at each
visit, they are printed on the record and provision made for checking
the proper entry.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

176

MATERNITY RECORD.
[Size: 5 by 8 inches.]
Name (family).......................................................................... -.......... .(First)............. ...................................................... Address.................................................
Date admitted...............................................- ........ ............. Confinement expected (date)............................................Attendant to be Mwf., Phy’n. (name).

Summary of care.
Type.

Vaginal soreness.

J Blood pressure.

"33

Bld’y.

1o
o

| White.

I Diarrhea.

Vaginal
discharge.
1 Headache.

I All day.

j Spots before eyes.

1 Dyspno’a and sufl.

1 Feet.

So
©
3

Nausea
and
vomit
ing.

Urinalysis.

Quantity in
Specific
gravity. Reaction. Albu’n. 24 hours.

Delivery.
1. Date..................................................... 2. Delivered by Dr., M w f.........................
3. Place: Home, Hosp............................................ 4. Assistant, Nurse, Mwf., N., Other..............
5. Issue: L. B.
S. B.
M.
6. Term.........Mos.
7. Sex: M.
F.
8. Spontaneous.
9. Lacerations Y. N.
10. Repaired Y. N.
11. Hemorrhage, N., Mod. Severe.

Month of pregnancy.
Totals.

Y. N.

POSTPARTUM: 12. Attendants’ Visits.....................................................................
13. In bed.......................days. 14. Extra assistance...........................days (specify).

(a) Visits to Phyn..
(b) Visits to center,
fc) Visits td disp. . .
id) Home visits---(e) Urine exams__
(f) Blood pressure..

Child enrolled with D. H. C.
REMARKS: ................... .

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Date (if not enrolled give cause)
Delaware Health Centers—Forms 3—1920.

OFFICE ADMINISTRATION.

Face.

Resp.
Flat.

Pulse.

Inv’rtd.

Temp.

Erect.

Date.

Hands. |

Edema.

Nipples.

Varicose veins.

OBSERVATION OF PATIENT DURING PRESENT PREGNANCY.

MATERNITY RECORD (REVERSE).
Name....... .............. ............................................................................................ ......................
Date.

Address.......................

Services rendered.

Doctor, Nurse.

APPENDIX.
.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

,177

178

OFFICE ADMINISTRATION.

The chart headed Summary of Prenatal Care should be made out as
nearly month by month as is possible in order to secure greater
accuracy. All of the entries will be in figures, 0 being used for None.
The back of the record is to be used for a chronological history of
services performed or visits made which do not appear on the face of
the record; e. g., the day the patient was referred to a hospital,
giving facts. An entry should be made also giving the subjects upon
which she was instructed and the titles of literature given her.
DAILY REPORT.

This report sheet fits in the back of the nurse’s record book and
provides for all types of entries which must be made', except those
which will appear upon the financial sheet. I t must be made out
and mailed to the main office at the close of each day. I t will
take the place of the monthly report which will be compiled in the
main office from daily reports.
1. Bate.—Enter the month, day, and year; e. g., Feb. 6-20 for
February 6, 1920.
2. County or district—Cross out the term which does’ not apply.
3. Nurse.—Enter your last name.
4. 5, 6, 7, 8. Hours on duty.—These are to be kept in order that
the. total hours of service rendered by the staff may 1be stated to the
commission at the end of the period. I t will undoubtedly show a
large amount of overtime, which must be considered in the recom
mendations to the legislature regarding the number of nurses required
to perform the work in various parts of the State.
Wilmington nurses will reckon their hours of service from the time
they arrive at their first case or at the main office instead of from the
time they leave home.
9. Home and health center record.—Enter here a summary of the
services you performed at the home or health center for each indi
vidual seen. Under if) Type, check C for all children and P for
prenatal cases. No other cases are to be enrolled. Under (g) Work
Done give subjects covered when you instruct a mother or child, e. g.,
Instructed on diet, clothing, sleep,” not merely “ instructions.”
Enter findings of physical examinations following the entrance exam
ination, but be sure to enter height and weight here for the first
physical examination and note that it is the first examination.
Enumerate under (a) defects or the fact that they have been corrected,
titles of literature distributed, and number of copies. If the case was
discharged, state the cause of discharge and the condition of the
patient on discharge. If a case is referred to another agency or to an
institution, state this fact, but do not discharge the case. All social
service visits or emergency services at the center or home should
appear here. Enter all visits made, stating under (g) when the patient
was “ not at home” or “ not seen” or “ too busy to see nurse,” etc.
10. School report.—This section is not needed by the Wilmington
nurses, but should be filled out by every rural nurse whenever she
visits a school.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

NURSE’S DAILY REPORT,

[Size: 5 by 8 inches.]

l . D a t e . . . . ..................... ...................................... .............2 . County or district....................................... ...............3. Nurse.............
4. Began work a t . . . . ........................ A. M. 5. Stopped a t . . . . . . . . .......................p .

6. Offdutyfrom .................to .................... 7. Cause...,:........... 8. On d u ty...... ................hrs

9. HOME AND HEALTH CENTER RECORD.
(c)
(a) Name.

Place.

(b) Address.

(e) Case.

(f) Type.

(d) Age.
H.

(g) Work done.
Old.

New.

APPENDIX.

... __
.....

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

179

Delaware Health Centers—Form 4—1920

180

NURSE’S DAILY REPORT (REVERSE). [Size: 5 by 8 inches.]
10. SCHOOL REPORT.
(a) Name of school......... . . . . . . .................... 0 » Grade.............................. ................- - * - W No. examined............. . . . , ........ - ............-.(d) No. referred.
(e) Physician..................... -.............................(f) Nurse’s services: (Examining, talks, literature, clerical)............................................................................. -

11. CONFERENCES AND LETTERS.
.(e) Time
consumed.

(d) Place.
C.

............
12. DISPENSARY REPORT.

13- Physician

(d) Age.

(b) Address.
Old.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

New.

(e) Diagnosis.

(f) Services rendered.

" OFFICE ADMINISTRATION.

. (c)
(b) Subject.

(a) Names of individuals.

APPENDIX.

181

11. Conferences and letters:
(a) Names of individuals.—Enter here the names of individuals
with whom conference is held, or to whom the letter is
addressed.
(b) Subject.—This item needs no explanation,
(c) C. L.—Check C for conference and L for letter.
(d) Place.—Enter place where conference is held. For letters
give the address of the person to whom the letter is
written.
(e) Time consumed.—Enter the time consumed for letter or
the conference.
Time spent in going to the place of conference and
returning to work, and time lost in waiting, should all be
charged against the conference.
.
12. Dispensary report.—This space is to be used only by nurses
doing dispensary work, according to instructions given for filling out
the home and health center section where applicable.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

182

OFFICE ADMINISTRATION.

RECORD SYSTEM IY.
E v a n s v il l e , I n d ., B a b i e s M il k F u n d A s s o c ia t io n — 1920.

Scope.—Nursing service to sick children under six years of age.
1.
2.
3.
4.
5.

Call Slip (white).
Child’s First-Visit Slip (white).
Child’s History Record (buff).
Prenatal First-Visit Slip (tan).
Prenatal History Record (blue).

6.
7.
8.
9.

Daily Report Sheet (pink).
Child’s Clinic Record (white).
Loan Closet Record.
Time Book and Total Sheet for Time
Book for Nurses Monthly Report.

N o t e .—Numbers 8 and 9 do not properly belong in the case record
system, but because they are used m connection with the system in
recording some of the nurses’ duties, they are included.

r. Call Slip.
d ir e c t io n s

for

m a k in g

out

call

s l ip .

When a call is received, all items printed on the call slip should be
filled out from information secured from the person giving the call,
with the exception of “ Physician’s orders” and “ Discharged, Cur
rent, New.” For every item the applicant is unable to answer, enter
“ Unk. ” for unknown. If there is no family physician in attendance,
write the word “ None” after 'physician, and “ No physician” after
Physician’s Orders. If there is a physician, the office manager will
telephone the doctor and write his orders on the slip before placing
it on the nurse’s clip board. If the office manager is unable to reach
the physician before the nurse comes into the office, enter “ U. T. R.”
(unable to reach), after Physician’s Orders. In such cases, the nurse
should visit the family and follow standing orders. The office man
ager must secure the physician’s orders at the earliest moment pos
sible.
CALL S L IP .
N am e...

[Size: 3 by 5 inches.]
..................... . ............................... ..Discharged. Current. New.

Address:

.............................................................. District.................................

Reported because......... ............... .................................................................................................. ...........................
Physician’s diagnosis...................................................................................... . ..................................... - .................

Physician’s orders

Physician.
Case reported by.
Recorded by: —

Hour....................M. Date..................................192..........
B. M. F. A. Evansville, Ind. 1920. Form 1.

Routing the call slip.—When the call slip is completed, the clerk
will check the name of the patient with the alphabetical index file,
to see whether the case is Discharged, Current, or New, and she will
check the proper word. For discharged cases she will attach the call

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

A P P E N D IX .

183

slip to the “ Discharged ” record after copying the old record 8 into
the new form, correct the 3 bv 5 file card by crossing out the old dis
charged date, enter above it r<Readmitted ” and give the date. The
discharged record and the new call slip will be placed on the clip
board at the proper nurse’s desk. The nurse will verify the copying
and destroy the old record. If the call slip is for a “ Current” case—
which will be discovered only by checking with the index file—the
word Current will be checked and the call slip will be placed on the
proper nurse’s desk, but the record will be filed in the place where
the nurse has filed it. For “ new” cases the clerk will merely check
the proper word and place the call slip on the nurse’s clip board.
Upon her next visit to the office, the nurse will copy onto her
daily report sheet the facts from all call slips which have not been
telephoned to her, leaving the call slip on her clip board. When she
next comes to the office, she will attach all call slips of cases visited
to her daily report sheet and place them in the basket on the super
visor’s desk. The supervisor will check call slips with the daily report
to be sure that the cases have been visited and that first-visit slips
have been turned in for all call‘slips. If there is no further* use for
the call slips, they may be destroyed, but call slips for all new cases
must be kept until the first-visit slip is complete. All other, call
slips may be destroyed as soon as the information is copied onto
the records. Call slips while being held should be filed alphabetically in a 3 by 5 drawer labeled Call Slips. The office manager should
inspect this drawer daily in order to make sure that first-visit slips
are turned in promptly for cases having call slips held.
Call slips will be made out for calls given to the nurses when they
telephone in during the day, and these slips will be placed on the
proper clip boards. They should bear a note in the lower right-hand
corner showing that the call was given to the nurse by telephone;
e. g., “ Phoned 11 A. M.”
2. Child’s First-Visit Slip. ,
First-visit slips will be made out for all new cases at the first home
visit or at the first visit to the clinic. Old active cases will have firstvisit slips made for them by members of the association, but all slips
needing revision will be referred to the nurse in the district.
If more than one child in a family is admitted at the same time,
only items 1-24 on the first-visit slip need be filled out for any child
in the family except the first admitted. Write across these items
“ See —,” and give the name of the child whose slip bears complete
information.
Whenever possible, the nurse will make entries on the first-visit
slip in the home, as this will prevent the necessity of a second visit
to obtain items omitted. Mothers will not often resent notes being
made in their presence if you explain to them that you have more
than 200 children to visit each month and that it is impossible for
you to remember all the facts about each one unless you write them
down. You can also say that you have to send a report into the
main office about every child you visit and it is therefore necessary
that you have every statement exact. When you are unable to
obtain every item at the first visit, consult your supervisor about
making a return visit the following day.
®These instructions were prepared to cover the period following a change in the record system .

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

184

CHILD’S FIRST-VISIT SLIP.
[Size: 5 by 8 inches.]
1. (Surname).................................................. C. 2. Child’sn am e............................ ........................

3. Address.............. "..................................

5. Father’s name.................... V..........................................

......................... 7. Classification: New Disp.; Old Disp.; New Non.; Old Non-

6. Mother’s name..............................

8. Reported by (a) name.........................................................

(b) Address...................................

4. District............................................

................................ (c) Kinship to child..........................................................L—

CHILD: 9. Sex M. F. 10. Negro Y. N. 11. Date of birth................................. ...................... ..

19___ 12. Born in (city)............ ..............................

13. Birth registered Y. N. Unk. 14. A g e ............ yrs............... mo............... days. 15. Feeding

. (a) Breast only................................ mo. to.........................

16. Kinds of bottle foods......................................................................................................................

. (b) Breast and bottle......................mo. to................................mo.;

Reg. Y . N.

' 17. Sleeps alone Y. N. 18. Bedroom windows open (a) Summer Y. N. (b) Winter Y. N ----

. (c) Bottle o n l y . . . . . . . .................... mo. t o .. ............................ mo.;

Reg. Y.N.

(State)............. .
mo.; Reg. Y.N.

CHILD’S PRESENT ILLNESS: 21. Diagnosis: (physician’s ) .............................................
22. Doctor’s orders:......................................................................... ................................. <..................
....... ...................................................... ....................................................................................... .....................................

23. Doctor’s name

24. Brief history with length of illness to date...................................................................................................................................................

(Signed) Nurse........................................................................
HOUSING: 25. No. rooms......... ........................ 26. Cleanliness: C., F., D., V. D. 27. Light: G., F., P. 28. Ventilation: G., F., P. 29. Rent per m o.,$.....................
30. No. Occupants: (a) Adults......... .. (b) Children............. (e) Total............. 31. Toilet: (a) Type: W. C., P. (b) Location: Yd., Dwel., Oth. (c) No. Fam. Using.
32. Ice Box. Y. N. 33. Remarks:......................................................................... 34. Daily Report................................................ — .............. ................ ............ ----- ........
(e) Visit.
(a) Date.

(b) Temp.

(d) Work done.

Inst.

Work.

(f) Approved.
Supt.

0 . M.

B. M. F. A. Evansville, Ind., 1920—Form 2.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION

. (d) Table food first at.................................................................. mo.; Reg. Y. N.

}9. Out of doors daily (a) Summer, Y. N. (b) Winter, Y. N. 20. Fam. Phy’n . . . ...................

CHILD’S FIRST-VISIT SLIP (REVERSE).
35. FAMILY HISTORY.

57716

(a) Name.

(b) Sex.

(d) Age in
years.

(e) Health.
(If dead give age at death and cause.)

(f) Remarks.

H ........; . . . .
W ..............
Pregnancies:
1................
2................
3.........................
4...........
5 ................

APPENDIX.

6...........
7...........
8.........................
36. FAMILY EARNINGS.
(a) History No.

(b) Occupation.

(d) Weekly
earnings.
------- j
$............

..................... ...........

.
....... 9___
37. Total income: (a) Total weekly earnings $.............................
38. Societies interested:...........

(b) Total additional weekly income 8............................. .... (c) Total weekly income $

185

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.
186
Take great care to write the names and addresses plainly, print
the first letter of every word and the remainder of the word unless
your writing is plainer than your printing. Be especially careful to
distinguish between e and i, F and S, a and 0 , n and u, 1 and t,

aI1When there is insufficient room on the face of the slip for the entry,
encircle the number of the inquiry, enter the same number on the
back of the slip as near the top as possible, and enter the additional
facts.
INSTRUCTIONS FOR FILLING OUT ITEMS.

1 Surname.—Enter plainly the family name. Try to obtain the
correct spelling, as this is essential when the various records for a
child are^matched in the main office. Be sure to indicate plural
births by writing in the upper ri^ht-hand comer an identifying
statement; e. g., ‘Twin of Robert.5'’
i-y h
2. Child’s name.—Enter the child’s first name If the child has
not been named, enter “ Not named m pencil. As soon as the
child is named, attach to the child’s history record a slip bearmg
the address and the statement, “ The child has been named —.
TW office manager will then enter it on the record.
o Address —As the 3 by 5 index will show all former addresses,
•t is not necessary to enter on first-visit slips made for old cases any
address^^excepf^e present address. If the family live in an apart
ment or tenement, indicate the floor immediately after the address,
e & 2 FI If the address is difficult to locate, give additional facts
on the back of the slip, first encircling the number 3 on the face of the
slip and entering the same number at the beginning of your entry
on the back.
„
.. , ._.
4 District.—Enter the name of your district; e. g., Worth.
5 . Father’s name.—Enter the father’s first name. If he has a
second (not last) name enter the initial of this name, B ut do not enter
an initial for the first name, as it is not sufficient identification.
6 . Mother’s name—Enter the mother s first name>m full.
7. Classification. New Disp.; Old DisV.; New Non.; Old Non —
Check the proper answer, first making certain that you are co^ect.
New Disp. means that the patient attended clinic this current for

^O hpDisp. means that the patient attended clinic prior to the
CUTNew Aon. means that the patient has never been to clinic and was
visited in the home for the first time during the current month.
Old Non. means that the patient has never been to clinic but has
been visited prior to the current month.
8 . Reported by: a-Name, b-Address, c-Kinship to Child,
these
items apply to individuals other than those connected with organiza
tions. f o r these, enter the name of the individual after (« .and the
name of the organization she serves after (b) and her occupation after
(c). This applies to BMFA nurses also and should be used for
cases referred to the nurse in the field. For cases secured from birth
certificates, enter BC after (a), and dash ( - ) the spaces after (&)
and (c).
Sex M. F.—Check F for female and M for male.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPE2?£>iX.

16.
Begro Y'. ffl.-“ Cheek Y if the child’s parent or parents are
Negroes or muiattoes from any country. Cheek Wfor all other eases.
1 1 . Date erf birth.—
—
Enter the month, day, and year.
f 2 . Born in (city) (State);.-—For foreign-horn children’ enter the
country of birth and the letters FB.
13- m m registered Y . M W . —This query is known as an
educational query. Its purpose is to teach the mother the value of
registering the child’s birth. If the birth is not registered, you should
urge her to have it done" and explain its value. If you have not
ifirju e; p™mplllet on
registration published by the Federal
Children s Bureau, you will find it at the public library or’ at the
main office. If you wish a copy for your own nse, you can secure’ a
copy without charge by writing to the Children’s Bureau, W ashing
fen, D: C.
.
_Check Y if the birth is registered1, B if it is not registered, and
tJnk. if the mother does not know'whether'it is registered.
Even though you know the birth is registered because the source
of the ease (Case referred by)’ was the birth certificate, you should
aisli ftfate mother if silo Ikiio^s whether tifie' tnrtih; kf registered;
&=&aexpiain rt to’h’e rif she does not seem to understand its impoTtasee.
Age Yrs. Mos. Days.—For old cases enter the age of the child
at the first visit and for’new cases enter accordingly. This is secured
by subtracting the date of the child’s birth from the date of the first
Visit. (In this case first visit means the first visit- to either the clinic
or the home, whichever is the first).
W. Feeding.—FMter the feeding as indicated up to the date of the
finU visit. Eachtype of feeding means that that type- only was given,
rtu
sT "
means “ Was the time of feeding; regular. ”
Check for each type up to the time of the first visit. Bash (—)
inapplicable items.
16.- Kinds of bottle foods.—W rite Bone or enter the names of the
brands as conditions require. If only cow’s milk was used, ente.r
e M w & n m it was diluted enter Cbws-modi:
a^one
W? 18—Bedroom windows open, (a) Summer
■m f'S.(o) Winter Y . N., and 19—Out of doors daily, (a) Sunrmer Y . M
m Winter Y . N.—Cheek Y for Yes and N for N& for each item
according to facts.
20. Fam. Phyn. Enter the name of the family physician even
though it is the same as that entered in £1.
21. Diagnosis, Physician s. -This must always-be the physician’s
diagnosis and the facts generally can be ascertained from the call
slip. If there is no physician on the case- write NO BE'after 2 1 .
22. Doctor’s orders .-““These must be secured from the physician bv
the office manager.
23- Doctor s name.- Enter the name of the doctor giving the orders
entered in 22V
24. Brief history with length of illness to date.—For instructive cases
6nt®p herer the reason for enrolling the case 5 e. g., BiTt% cevt. case ov
feemntf ernes.
25. Bo. rooms.—Enter the number of roomsfor which rental shown
m 29 lspaid.
26. Cleanliness: C., F., D., FB.—Cheek C. for Clean, F. for Fairly
Clean, D. for Duty, and VD. for Very Dirty. This applies to the
dwelling as a whole, or to that part of it which you are able to see at

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

188

OFFICE ADMINISTRATION.

your first visit. If later visits convince you that your original entry (
was unfair to the family, it should be changed on the record.
L
27. Light, G., F., P.—Check G. for Good, F. for Fair, and P. for Poor. I
Light varies according to the time of day, weather, season, condition
of the windows, and other factors. In order to have a reasonably
fair basis of comparision the standard for Good will be understood as
light enough to see to read ordinary print 6 feet from the window,
without artificial light on a fair day.
*
28. Ventilation G., F., P.—This applies to the actual ventilation of
the room as you find it.
.
29. Rent per Mo. $.—Enter the rent per month. If no rent is paid
or if onlv partial rent is paid, enter the facts in a note on the back of
the slip.
30. No. occupants, (a) Adults—(b) Children—(c) _ Total.—In
clude all persons residing in the rooms for which rent is paid. An
adult person is a person aged 16 years or older. Persons under 16
years of age are to be entered as children.
31. Toilet, (a) Type W. C., P.—Check WC. for Water-closet,
meaning a flush toilet, and P., for Privy, meaning a yard vault. If
you find other kinds, encircle 31 and enter a note on the back of the
slip.
(b) Location Yd., Dwel., Oth.—Check Yd. for Yard, Dwèl. for
Dwelling, and Oth. for Other location. If the location is
especially bad, enter the facts under 33.
32. Ice box Y ., N.—This means—has the family an ice box suitable
for ice ? Check Y . for Yes and N. for No. If possible inspect the ice
box. This is important because the BMFA will supply ice to families
unable to purchase it and it saves the ice and consequently the funds
of the BMFA if the ice box is in good condition.
33. Remarks.—Enter here any remarks concerning insanitary
housing conditions, especially those which should be reported to the
city departments.
' 34. Daily report.—This section is supplied for the report of the
nurse’s first visit. On the regular daily report sheet only the entry
First Visit will appear in the section Work Done. This means that
all the information will be found on the first-visit slip. (See instruc
tions for daily report.)
35. Family history—
(a) Name.—E nter first the nam es of the husband and wife in the
spaces headed H. and W_. Enter the mother’s (wife’s)
maternity history below, giving in order every pregnancy,
commencing with the first on the line numbered 1. For
all cases of pregnancy not resulting in live births, enter SB.
for stillbirths and Mise, for miscarriage. A still birth is
the result of a pregnancy of seven or more months gesta
tion, born dead. A miscarriage is the result of a pregnancy
of less than seven months gestation, born dead. If there
have been more than eight pregnancies enter “ See 2 d
sheet” under Remarks on line 8 and make out another
family history section, placing new numbers in the preg
nancy column following those printed there.
(b) Sex.—Enter M. for Male and F. tor Female.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

A&PEXDIX.

189

(c) Date of birth.—Enter month, day, and year. Abbreviate
the month but do not use figures, as they are often inac
curate.
(d) Age in Yrs.—For infants under 1 year of age enter 1. For
stillbirths, miscarriages, and dead children enter Dead.
(e) Health.—E nter here any evidence of chronic disease for livin g
members of the family. For members of the family who
have died enter the age at death in years and month and
state the cause briefly.
(/) Remarks.—This section affords an opportunity to enter re
marks about individual members of the family and should
not be used for general remarks which do not apply to the
member of the family indicated by that line.
36. Family earnings:
■(a) History No.—Enter H. for Husband, W. for Wife, and the
proper pregnancy number for each of the children work
ing. Do not include earnings of lodgers who are not mem
bers of the family.
(b) Occupation.—Enter the exact occupations, as carpenter,
chauffeur, etc. If lodgers are kept this is entered as the
mother's occupation. If she does day work it should be
entered as washing, ironing, or cleaning, as the case
may be.
(c) Name of firm.—-This section may be dashed for odd jobs or
other occupations changed too frequently for the employer
to know the employee.
(d) Weekly earnings.—Enter in dollars and cents the earnings of
each member of the family at work the week previous to
the first visit. If this was an unusual week, take down
the facts and confer with your supervisor regarding the
proper entry.
37. Total income:
(a) Total weekly earnings $—.—Enter total of earnings shown
in column 36.
(b) Total additional weekly income $—.—Enter any additional
regular income in cash.
(c) Total weekly income $—.—Enter total of (a) and (b).
■38. Societies interested.—Enter only the names of the organizations
interested. The following abbreviations may be used:
A.C. for Associated Charities.
S.A. for Salvation Army.

K.D. for King's Daughters.
St.V. de P. for St. Vincent de Paul.
J.C. for Juvenile Court.
Names of lodges and churches giving relief should be entered in full.
3. Child’s History Record.
Use.—This record is to be kept up to date, by the office manager.
I t is to be typed from the reports turned in by the nurses and others
regarding the child. I t is to be filed in the main office according to
district, alphabetically by father's name and then by child’s name.
When the child becomes 6 years of age, or dies, the date and cause of
discharge (giving cause of death if the child dies) will be entered on
the 3 by 5 index card for the case and the record will be destroyed,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Jgjg

CHILD'S HISTORY RECORD.
[Size: 43j b yS inches. 1
o i^aA jw
____ ____ 4. Mother.
- ¿n..................
2. Child.............. ...........................vr-, i a>tîieï5. HOUSING.

1. Surname.

(j) Toilet,

(i), Occupants.
(b) Address.

(a), Da.te.

(b) Sex;,

(Jo) Date of birth.

7.
(a) Hist. No.

(b> Occupation.

f a m il y

Agein

(d) years

(h) Heat,

Total-

6. FAMILY HISTORY.,
(e) Health,
(If dead give age at death and cause.)

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Child’n.

Type-

Lpc-

Kam,

Using-

(f) Remarks,

8. TOTAL WEEKLY HiCOME-

EARNINGS.
Weekly
(d) Earnings.

».......

». Date of first; home yisjt......... , - - ,, - -,-... -...,
II. Dismissed: (empete...-.............................
Ï2, On rolls,. , , . yr s , . . . , ............mos...

Ad.

10. Rate of first clinic visit---'V 'Y . y . ____
(b) Cause.......................
’.days’ ’ 13. Total visits (a) H om e,,,.........

(b) Clinic.........

(a) Total weekly earnings: $ ................
(b) Total additional income:
tc) Total i ncome;—
,,
(d). Other a s s i s t a n c e : ....... -,- - -

OFFICE ADMilîOSTRATION.

(a) Piarne.

(i) Cleanli (g) Light.
Rent
No.
(c) District. (d). Rooms. (e) per Mo.
ness.

CHILD'S HISTORY RECORD (REVERSE).
14. S u rn am e................... .
CHILD: 17. S ex ,,___. . . .

21.

24.
25.
27.
28.

............................... . . . . ........ 15. Child.............
16. F a t h e r . . . ............... ...........
—, ........... .
.............................. 18. N e g r o .,.,.,,.,,.......
19, D ateofb irth ...........__ . . . . . . . . . . . . . . . . . . . 20. Borni»"
Birth registered...........
22-..........................
Age...........yrSi,„..„.tnos...
. . . . . .days. 23. Feeding:/.’.'.. 1(a) Breast only . . . . . . . . ............ . .mo. tÒ.. , ....... mo., Beg'
Kinds of bottle foods.
..
(b) Breast and bottle..................mo. to,..................mo., Reg.
Sleepssdonei..... 26. Bedroom window open (aysum«i.«r.'*'*'**7 b )’Wtittlr
Out of doors daily (a) summer................................
(b) Winter v
Family physfeian...............................
'
.............
(e) B ottle o n l y . .......... . ,,m o . t o . .. . . . . . . . . . . .m o., Reg.’
(d) Table food first a t . . . .......................... ...................... ...m o ., Reg.

29. RECORD OF CARE:.
(b) Temp.

(d> Work done.

(g>Approved.
(e) Visit.

(D Nurge.
Supi.

............

............................... .

..........'*•
* ...............................

!J..j

........— - ........... — ........| |

.....

161

.......

;

Nurse.

’XigjtadaT

(a) Date.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

192

unless the medical history is of sufficient interest for briefing and
placing on the index card. All cards recommended for destruction
because of these two reasons (dead or over age) must be so ^ ar^ d
and approved by the supervisor before the office manager makes the
notations on the 3 by 5 card. As soon as the notations are made
the office manager may destroy the clinic and nursing records for
tillG C&SG.

INSTRUCTIONS FOR FILLING OUT RECORD.

As the items are the same as those on the first-visit slip, it is not
necessary to repeat their meaning. The difference lies m tV fo rm of
the items- i. e . on the first-visit slip all answers were provided so
that the nurse could check the proper answer. On the h'story record
a space is left in which the answer is to be written *5 checked on the
first-visit slip. This is much simpler than trying to check a given
H o ^ i 4 J- ^ p ” ceriias been arranged for four successive addresses
for a family. If more space is needed it will probably be necessary
to use an additional sheet. As each address becomes obsolete draw
a line through it and always be sure to place the new address on the
3 bv 5 index file card before the history record is filed.
All other items are to be answered only at the time of the first visit.
Any changes will be noted in the nurse s notes.
,
Items 11 12, 13 are to be answered by the office manager only at
the time the case is dismissed. If the case is readmitted, cross out
old information and enter new. Be sure to draw only a .light pencil
line through any items to be replaced as they must stdl ^ legible..
29 (e) Visit.—Enter Inst, f o r Instructive visit and Work for Work^(q^Avvroved Supt., N u rsed In this column enter the supervisor’s
initials only as they appear on the line from which this was copiedon
the daily report. As soon as this daily record is copied, the office
manager will attach it to all history records ready for filing and the
nurse will verify the^ typing to be sure the office manager has made
no mistakes. The nurse m il enter her initial in the section of (|r)
headed Nurse and will destroy the dady reP°rt fheetj_ The history
record will then be placed m the basket marked Ready to file.
It
will assist the nurse to verify cases if she will draw a
each
case entry on the daily report as she completes her verification of it.
4.

Prenatal First Visit Slip.
INSTRUCTIONS FOR PRENATAL FIRST-VISIT SLIP.

Use.—As soon as the new system is installed, the first-visit slip
for prenatal cases will be filled out for new cases only, but until that
time it will be necessary to fill out a first-vimt sfip for every a c ^
case. Of course each case needs only one first-visit slip made out
f°T h e form of the slip makes it necessary to fill out the record m the
presence of the mother. I t will prove educational 1 ^ if y o u ^ l
explain the importance of each item as you ask it the first time, lffis
WiFi educate the mother to expect complete prenatal c a ^ ^ o juclude
specific items and will make it unnecessary to offer explanations on
succeeding visits.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

PRENATAL FIRST-VISIT SLIP.
[Size: 5 by 8 inches.]
1. Surname......... ....................................... 2. Patient’s nam e................... .............................. 3. Address..................................................
5. Husband’s name...................................................................

10. Employment (a) Occupation...................................................................
12. Doctor’s orders................ ..................................
13.

Condition of patient on first visit.

(b) Finn’s name............................................. ; ....................

(a) Nourished well; poorly ¡'emaciated;
14.

(a) Order. (b) Year.

(b) Teeth: Clean; dirty;

(e) Order.

15. Present confinement expected: (Date)......................................................................................... .

22. Edema: N., hands, face, feet, legs.

23. Varicose veins, Y. N.

(f) Year.

(g) Mos.
Gest.

(h) Condition if living.
(If dead, give age at'death and cause.)

5
__________ i ..................
6
....................
7................
8................

..............

FIRST VISIT: 17. Date ...... ......... ,192... 18. Temp ................

i 6. Attendant to be (name)

19. Pulse .............. 20. Resp ............. '.. 21. Nipples: Erecf, flat, inverted.................................
24. Dyspnoea, Y. N.

29. Diarrhea, Y. N.

25. Spots before eyes, Y. N.

APPENDIX.

1..................
2................
3
....................
4
....................

n . F. doctor

HISTORY OF PREVIOUS PREGNANCIES.

(d) Condition if living.
(If dead, give age at death and cause.)

27. Headache, Y. N.
28. Constipation, Y. N.
32. No. of urinalyses each month to date........................

4. District

6. M., W .,S.,Div.,Des.,Sep. 7. A g e.............yrs. 8. Negro, Y .N . 9. Reported by..

26. Nausea, N., A. M., all day.

30. Vaginal discharge: No. white, yellow, bloody.

31. Vag. sore, Y. N.

33. Quantity in 24 hrs............................................... .............................................. 34. No. times blood pressure taken each month to date......................
35. Remarks..................................................................... ................
,
36. Instructions given.................... ....... 1...... ...................................

.........................

37. Visit; Inst., N u r s in g ..........

(Signed) Nurse.

[See page 194.]

B. M. F. A., Evansville, Ind., 1920.
CD
CO

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

|0 4

PRENATAL FIRST-VISIT SLIP (REVERSE).
[Size: 5 by 8 inches.]
HOUSING: 38. No. room s..................... 39. Cleanliness; C. F. D. V D ......... .
42. No. occupants (a) A d u lts ...:...............

(b) Children

40. Light, G. F. P .......... .

41. Ventilation, G. F. P ............... .
.......

44. Toilet; Type; (a) W. C., P.

.............. (c) No. of familes using.. .*.

(b), Location: Yd., dw eL, oth. (specify).................................................................. ...................... ........ '

...... -'**

4a. R e ja w k s,,,,...,» ,.......................... ......... .................................................................. ....................... .......................
46. FAMILY EARNINGS.

............................................................
...... ...... ...............................
....... ...................................................

(d) We<ikly
earnin gs.
$............
................

................
....... — —

.................- ...................- ........

47. (a) Total weekly earnings

.......................... . ....................

(b> Total additional weekly income,*............................................. (c) Total weekly income,:

48. Societies interested: , .................. .
[See page 193,}

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

......

OFFICE AIIMIÎvISTUATION,

(b) Occupation.

(a) Name.

APPENDIX.

Routing.—The first-visit slip should be attached to the daily-report
sheet for the day the first-visit s ip was made out,, and on the dailyreport sheet after your entry “ Instruction given” enter 1st Vs to call
the attention of the office manager to the fact that you turned one in
bhe will copy your information onto the history record and return
both to the nurse, who will initial the history record to show that th e
information has been properly transcribed. The first-visit slip will
then be filed for other use.
r
INSTBUCTIONS FOB FILLING OCT ITEMS.
1.
2.

Surname,.—Enter the family name;; i. e., Brown.
Patient's name.—Enter the first name of the patient.
3. Address.—Enter street, house number, and floor.
4. District.—Enter as on other record cards.
5. Husband's name.—Enter the full first name of the husband and
other initials, except for the family name, which is not to be entered
here. It the husband is dead enter dead after his name, but enter the
name. If the patient is not married, her family name will appear in
1 and after 5 enter /$.. for illegitimate.
6 . M., If..,. S Dw,-} De8.f Sep-.—fHheek- the letter or abbreviation
appropriate to the case.
M means married.
W means widowed by death.
S means single.
Din. means divorced.
Des. means deserted.
Sep. means separated.
7. Age, yrs.—Enter the patient’s age in years only, on the birthday
preceding; the date of the nurse’s first visit.
3. Negro, Y . IV.—Check Y for Yes, and if for No.
Reported by. Enter Patient for patient, otherwise enter the name
of the person reporting the case and under the name enter the relation
to the patient; i. e., neighbor, mother, etc.
Employment (a) Occupation.—“This applies to the week during
which the first visit is made. Be sure to note if the patient is keeping
lodgers. If the mother is keeping house, enter MW for housewife,
if the family is boarding and the mother has no duties, enter the facts
after {a).
(b) Firm s name.—For keeping lodgers or doing laundry work at
home, enter At home. If it is impossible to make entry in this column,
as it would be for a woman who did cleaning in a great manv places’
enter a dash (—) after (6). .
•
’
1 1 . F. Doctor.—Enter the name of the physician who is supervising
the patient s pregnancy. If there is no doctor, enter None.
1 2 . Doctor’s orders.—If the case is referred by a doctor, the orders
vnll appear in the call slip. If the patient refers the case, generally
there will be no orders—-in that case enter None. If later in the case
orders are given, enter them with date. Whenever a nurse finds that a
patient has engaged an attendant (doctor or midwife) for the con
finement, the nurse is instructed to- give no advice to th at patient
nuM the permission of the attendant has been secured.
i The remaining items should be perfectly clear as to meaning, with
the- following few exceptions:

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

196

PRENATAL HISTORY RECORD.
[Size: 5 by 8 inches.]
1.
5.
10.
13.

.................................... 4. Dist.
9. Reported by.......................

Surname............................................................ 2. Patient................................................ ............3. Address..................- ................
Husband............................... .............. ........................... 6. *................-.................... 7. Age................................yrs. 8. Negro........
Employed..................................................... 11. Doctor...................................................... 12. Doctor’s orders.......................
Condition of patient on first visit (a).................................................. (b) Teeth............................................... (c) Teeth cavities.

................... (d) B o d y ..........

14. History of previous pregnancies.
Order.

Year.

Mos. Gest.

Condition if living.
(If dead give age at death and cause.)

Order.

3
4

....................
....................

Mos. Gest.

Condition if living.
(If dead, give age at death and cause.)

....................
....................
....................
....................

15. Present confinement expected...................................- - -............................................ - - •............... 1®* Attendant to b e............
HOUSING. 17. No. rooms.................................................. 18. Cleanliness................................. 19. Light.......................... 20. Ventilation.
22. No. Occupants (a) Adults......... ....................... (b) Children.................................. (c) Total.................................. 23. Toilet: (a) Type..
(c) No. Families using.......................... 24. Remarks.............................................................................................................................................

21. Rent per mo. $.
.. (b) Location___

25. Family earnings.
(c) Name of firm.

(b) Occupation.

(a) Name.

Weekly (d)
earnings.
$................

•...................................
::::

.......

26. (a) Total weekly earnings $................
27. Societies interested................................ ....................... ................... ............ ........................ — - ........... . *............ ........................................................................................... .
28’ * EntryTrbe typ'ed from Itein6 on Prenatal First-Visit Slip.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

B. M. F. A. Evansville, Ind. 1920. FormS.

OFFICE ADMINISTRATION.

5
6
7
8

1.................

Year.

PRENATAL HISTORY RECORD. (REVERSE).
29. Surname.

30. Patient.................................... . ......................31 Address..........................

..........................Dist.

32. Observation of patient during pregnancy.
(a)

(b)

(c)

(d)

(e)
Of) Nipples.

(b)

(g) Oedema.

(i)

Varicose vein:

Legs.

Hands.

Feet.

Inverted.

Flat.

Erect.

Resp.

Pulse.

Temp.

<
ÜD
C3
Ph

Nausea
an d (k )
Vomiting

(m )

(n )

(o) Vaginal
discharge.

(P)

(s)

(r) Instructions
given.

3
2)

(1)

03
'Ö

.
.

APPENDIX,

1 ..
2 ..
3 ...
4 ...
5 ...
6 ...
7 ...
8 ...
9 ...
10..

Date.

Order.

1
33. Summary of care.
g * g ® ? * * (Date)................................................ „35. Delivered by.
Type.

£«KSto^v.v.v.v.vv...

Month of pregnancy.

.......... «• I**.

a i r s i s -:................••........
Total.
(a) Visits to Phyn...............
(b) Visits to Disp................
(c) Home Visits...................
(d) Urine Exams................
(e) Blood pressure..............
45. Child enrolled with B. M. P. A. (a) Date.
46. Patient died: (a) Date..

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

(b) Cause.

-(b) If not enrolled give cause.

193

OFFICE ADMINISTRATION.

14. History of previous pregnancies:
(as) Order.— This m eans th a t previous pregnancies should he
listed in the order of their occurrence.
(&.) Y ear.— This-m eans th at the year in which each pregnancy
occurred should be entered.
(c) Mos. Gest.— This m eans m onths gestation.
The right half of th e page is a duplicate of the left-hand side in
order to- allow for entries for eight pregnancies. If this space is; in
sufficient, write Cont. on line 8 and use another sheet -which should
be numbered Sheet 2 in the upper right-hand corner. A ll identifying
item s, names, and addresses should appear on Sheet 2, as well as on
the original record.
Reverse of slip .— All item s on the back of the slip are identical with
item s on the child’s first visit slip, and the same instructions apply.
Important.— As soon as possible after the patient has been con
fined, the nurse should check the proper item s (34 to 44) on the section
headed Delivery on the prenatal History record, and leave the record
on the slip board w ith the remainder o f the d ay’s work. This means
the case is discharged.

5. Prenatal H istory Record.
INSTRUCTIONS FOR PRENATAL HISTORY RECORD.

Use.-—This record is to be typed b y the office manager. Follow
instructions for the first-visit slip1as filled out b y the nurses. N otice
that the num bering of item s is: different. If the space provided is
found to be insufficient for an entry, adopt an abbreviation— enter
this abbreviation and the full word in these instructions and always,
use the same abbreviation. In item 32 enter a dash (— ) for No,
and Y for Yes:
33. Summary of care.— This; is to be kept up-to-date from m on th
to m onth, as the nurse visits the patient..
34 to 44. Delivery.— When this section is filled out the case is

considered as discharged and should be filed alphabetically accord
ing to family name and mother’s name in the Discharged—Pre
natal drawer. A t the same time the 3 by 5 index card should
have the date and cause of discharge entered; e. g., Discharged
June 6 , 1920s; delivered June 6 , 1920.
The active prenatal histories w ill be filed w ith the children’s
cases, as they ean readily be told b y their different color,
6. D aily Report Sheet.
INSTRUCTIONS FOR MAKING OUT THE NURSE’S DAILY REPORT SHEET.

1.
The first step in the m orning’s work is the correction of- records
turned in on the previous day. These will be found on each nurse's
clip board and each record will bear a statem ent of the corrections
to be made. These corrections will be m ade b y the nurse and the
records w ill be placed in the wire basket on the office m anager’s
desk, marked “'Corrected Records Office M anager,” if the correc
tions were clerical. If the corrections w ere m ade b y th e supervisor,
the nurse w ill correct and place the records i n the basket marked
“ Corrected Records Supervisor”— or w ill tak e up- personally with

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

NURSE’S DAILY REPORT.
[Size: 5 by 8 inches.]
1 ,D a te ............................ ..........192--"

2-N urse........................................................ ................... ......... ......................... ; 3. District......................... ............................................................

4, (a) Began work a t . . . . . . A. M. (b) Stopped a t , , , , , , P.M. (c) Ofl duty from.. . . . . . . .

(d)

............

O n d u t y ............... Hours.

5. Home visits.
(c) Disp.
(a) Address.

(d) i fon-D.

(b) Names of patients.

©, Visit.

(?) Fee.

(e) Work done.
0.

a.......
. . „ ......................
. . ................

....................

APPENDIX.

b.
c.

e............ ...................................
f .....................

h....................
i..................... . ........
•
k .. . ............. . ............. .
1...............................
m ....................................

...

ii.......................................
o....................................
-------------------------—

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

B .M .P .A . Evansville,Ind. 1920. Form 9.

|9 ^

[S eep a g em i

200

NURSE’S DAILY REPORT (REVERSE).
[Size: 5 by 8 inches.)
6. Daily expenditures.
(a) Purchase.

(b) Amount.

1. Clinic from............... 1........ .............. ........ M. to......... ...................................... M.

8. Prenatal visits.
(a) Name.
1.................................................................................
2........................................... .....................................
3.............................................................................

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

(b) Address.

OFFICE ADMINISTRATION-.

7. Miscellaneous services:

,(d) Approved.

APPENDIX.

201

the supervisor those cases which she is unable to correct. In the
same w ay, she will consult w ith the office manager regarding any
corrections signed b y her which are n ot clear. B oth the office
manager and the supervisor will initial the bottom of the slip bearing
corrections. Each correction will be preceded b y the number of
the item to be corrected; e. g., 23 Not Answered.
The supervisor reviews the daily report sheet before the nurse
leaves on her daily rounds to see th at her work is planned w ith a
view to econom y of travel, th at she has taken enough cases to visit,
and that she has n ot taken more than she should do. W hen the
daily report sheets are com pleted, the supervisor reviews them to
be certain th a t all new calls were m ade and th at entries are m ade
so as to show clearly just w hat work was done. The supervisor
crosses off unnecessary words and has the nurse change ambiguous
entries.
W hen the sheet is corrected so th at it presents a true picture of the
work the nurse has done and when it is approved b y the supervisor,
P^aces R *n.
basket in the office m anager’s desk marked
■R eady for T yp ing,” together w ith the records upon which the entries
are to be m ade. The typin g should be done the sam e day the records
are com pleted satisfactorily to both the supervisor and office manager.
This is extrem ely im portant. The typing should then be checked
w ith the daily report sheet b y the nurse who m ade out the daily
report sheet. If she finds th at the office manager has m ade any m is
takes, she should have them corrected. If the report is satisfactory
to the nurse she should enter her initials in the column provided on
the record and destroy the daily report sheet. Nurses should be
careful n ot to destroy any daily report sheet which does n ot bear the
initials of the office manager, followed b y the word “ D estroy.”
2. The daily report sheet is turned in the morning following its
com pletion. F irst-visit slips should be attached for all cases for
which call slips are on the clip board. The daily report should be
placed w ith first-visit slips attached on top of the records and call
slips for all cases entered on the daily report. The package should
be secured w ith a rubber band and placed in the basket marked
‘‘N ew W ork” on the supervisor’s desk. This clears the nurse’s desk
for the second part of her m orning’s work; i. e., planning her work for
the day.
3. Each morning when the nurse comes into the m ain office she will
plan her work for the day, arranging upon her daily report sheet the
nam es and addresses of patients to be visited in the order in which
she expects to visit them. She will take the records for these cases
from her file and arrange them in the same order in which th ey are
arranged on her daily report sheet. If she has call slips for cases not
y e t visited, she will copy the inform ation onto a first-visit slip and
insert the call slip in its proper place among the records for cases to
be visited during the day. This makes it possible for the office
manager to answer questions during the day about the calls the nurse
is to make. During the day any call telephoned to a nurse has a call
slip m ade and after entering the hour it was telephoned to the nurse,
the office manager inserts it am ong the calls to b e m ade th at after
noon b y the nurse in th at district.
57716°—22-----14

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

202

Hems.—The items needing explanation follow:
5 «. Address.—If cases are arranged according to streets, it saves
writing to enter the street bnt once; e. g., Main 1234, 1346, etc.
5c. Dispensary, O. N.—O stands for Old. N stands for New.
New Dispensary means the case came to dispensary for the first time
during the current month. Old Dispensary means the ease has been
to dispensary before the current month.
5 d. Non. D: O. N.—Means Non Dispensary Old and Non Dispensary
New. Old Non Dispensary means that the case has never been to the
dispensary, but has been visited in the home prior to the current
month. New Non Dispensary means that the case has never been
to the dispensary and was visited in the home for the first time during
the current month.
5 c. Work done.—Enter a brief but complete statement.
5\f. Visit N. I.—Put a check in the space under N for a, nursing
visit and under I for an instructive visits
5 g. Fee.—For cases not paying a fee, draw a line through the spaee
under Fee.
8.
Prenatal visits.—Enter the name and address of each patient
and number the cases consecutively. In the Instructions Given
column (c), enter such information as “ Not at home” or other facts
for all cases not seen. If the case is seen, dash this space and make
entries regarding patient’s condition on a prenatal history record,
using one Tine for each patient, giving the patient the same number as
that entered on the daily report sheet for her name and address. If
only one case is to be seen and that a new case, use the first-visit slip
and on the daily report sheet enter in the column for instructions
given “ 1 st Visit.”
7. Child’s Clinic Record.
Used.—A clinic record is to be filled out for every child at the time
of its first physical examination by the clinic physician. I t is to be
filed in the district drawer and transported to and from the main
office as required. Upon succeeding visits the child will be examined
and the physician’s notes entered on the back of the record as indi
cated. In filing the record, it will serve as a folder and will contain
all other records pertaining to the child. At the conference stations
the records will be filled out for the physicians by the volunteers, but
no volunteer should be permitted to do this clerical work without
reading the instructions and examining a record form before clinic
day. Unless volunteer service is expert and careful, the expense of
spoiled records and useless records wifi be greater than the cost of paid
clerical service. I t is desirable that each child be given a complete
examination once a year. Each clinic physician should have a copy
of the record and a copy should be kept before him at clinic.
INSTRUCTIONS FOR FILLING OUT CHILD’S CLINIC RECORD.

Every question must be checked. For example, abnormal con
dition, N. If the condition is abnormal, check abnormal; if it is
normal, check N, meaning No. Care should be taken that the check
is in the letter or word intended. Carelessness in checking means
inaccuracy in tabulations. All items headed Diagnosis should be the
examining physician’s diagnosis.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

CHILD’S CLINIC RECORD.

(b) Child.

2 . Address.

(d) Mother___1........
4. Clinic....... , .......................
CHILD: 7. M. F. 8. Born.

5. Examined by. . . .
19............ 9. Age. . 4

[(a).

3. District

1(a).

.(b)

....... .........

1 (b),

M. D.
•yrs.

6 . Date.

.mos. 10. Nurse.

11. Mental condition: Normal, N. (spec.).
12. Laboratory findings............................
13. Previous illness: (a) Contagious,.....,

(b) Respiratory..

APPEKDIX,

(d) Other.

14. Bad habits...... ......................................
15. Summary of defects and diseases........

16. Recommendations.
Baby Milk Fund Assn., Evansville, Ind., 1920. Form 4 .

fcO
Ü

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

OFFICE ADMINISTRATION.

[Size: 4$ by 8 inches—forms the back of the folder described on p. 203.]
Physician’s notes.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Physician.

GENERAL: 17. Weight................ lbs..................oz. 18. H eigh t........... ..................in.
19. Anemia, N ........................................ 20. Nutrition: Excel., G., P., V P .......................
21. Temp.......................° 22. Vaccinated, N. (a) Age.................... yrs. (b) Scar, N ........
HEAD: 23. Size: Normal, large, small.............. ..................... ...................................... '.......
Circumference......................................................... ..........in...................... .................
24. Shape: normal, abnor. (spec.).............................................................................................
25. Fontanelle: closed, open...................................................................cm............................
26. Craniotabes, N ............................................... 27. Abnormal condition, N .....................
28. D IA G N O S IS ........................................................................................................ .
EYES: 29. Vision (a) R.................................. (b) L ........................... (c) Imposs. to test,
30. Diseases.

(b)
(c)
(d)
(e)

Stye..................................
Ptosis..............................
Corneal opacities.._____
Corneal ulcer....................

N. R.

Diseases.

N. R.

(f) Conjunctivitis, N.
Chronic..........................
Phlyctenular................
(g) Strabismus...................

GLANDS: 64.
(a) Occipital..........................
(b) Submaxillary..................
(c) Cervical............................
(d) Axillary..........................
(e) Epitrochlear....................
(f) Inguinal............................
(g) Other...............................

Greatly Associated infection (spec.)
Palpable Enlarged Enlarged
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N

Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N
Y .. ..N

N .........
N __
N ............
N ..........................................
N ..........................................
N .......................
N ..........................................

CIRCULATORY SYSTEM: 65. Heart................................. (a) Apex beat displ., N ........
(b) Enlarged, N ..............................................(c)M urmur, N. (Loc.)....................
Transmitted back, axilla, sternum, N .......................................... ..........................................
66. Heart disease, N., Diagnosis.................................................................................................
RESPIRATORY SYSTEM: 67. Chest: (a) Excursion......... ...... Normal, Abnorm. (spec).
(b) Fremitus: normal, deer., incr............................................. ................................. .............
(c) Dullness, N. (spec.)............................ ............ ......................................................
(d) Rales: N., kind..................................................................loc............................................
68. Other defects..... ...................................... ....................................................... ...................
69. Respiratory dis., N., Diagnosis......................................................................... ..............
BONY and MUSCULAR SYSTEM: 70. Beaded Ribs, N. 71. Harrison’s groove, N.
72. Enlarged epiphyses, N ............ .. 73. Round shoulders, N ...........................................
74. Winged scapulae, N ___ 75. Scoliosis, N _____ 76. Lordosis, N .............................
77. Kyphosis, N. (loc.)___ 78. Knockknee, N ___ 79. Bow-legs, N ___'.........................
80. Flat foot N ......... 81. Pigeon toe, N ......... 82. Club foot, N1 (spec.)............................
83. Arthritis, N. (spec.)..............................................................................................................
84. Paralysis, N. (spec.)............................... .-............. ...............................................................
85. Other defects (cong. and acq.)..............................................................................................
NERVOUS SYSTEM: 86. Speech defects, N. (a) Stuttering, N. (b) Stammering, N.
87. Tic, N. (spec.)................................................................ 88. Chorea, N. (spec.).............
89. Other defects................... l ................................................... ................................................
90. Nervous dis., N., Diagnosis.................................................................................................
GENITALIA: 91. Male, (a) Prepuce adherent, contracted, normal..................................
(b) Circumcised, N ......... ........................... ................................................................................
92. Female: Vaginal discharge, N ....... , ........ ...........................................................................

205

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

High arch palate, N ......... .. 60. Adenoids: Y., N.: Removed, N ..................
Tonsils: Rem. (a) enlarg., N.............. (b) greatly enlrg., N .............. (c) dis. N
Other abnorm............ .......... ............................... ............. ...................................
DIAGNOSIS OF SP........................................................................ ....................

APPENDIX.

32. Other abnorm............
33. DIAGNOSIS OF SP,
EARS: 34. Hearing: R ..‘. ..............................ft. L................................................................ ft.
35. Otorrhea: (a) Acute, N., R., L......................................... (b) Chronic, N., R., L....... .
36. Other abnorm................................................................................................ ........................
DIAGNOSIS OF SP;................................................................................................................. .
MOUTH: 38. Teeth: (a) Temp. No..............Decayed No..................... Filled No................ .
(b) Perm. No.......... Decayed No...........Filled No........ 39. Malocclusion, N ....... ..............
40. Alveolar abscess, N ......... ..................................... 41. Other abnorm............................ .
SKIN: 42. Pediculosis: (a) Body, N ......... (b) Scalp, N.;
Insects, N.;
Nits, N.
43. Eczema, N . (loc.)............................................................. 44. Acne, N ..........................
45. Impetigo, N................................................
46. Infected sores, N .................. ............. .
47. Scabies, N ............ 48. Ringworm: (a) Scalp, N .....................(b) Body, N .................. .
49. Other conditions................................................., .................................................................
ABDOMEN : 50. Distension, N ................. ..............................................................................
51. Tenderness, N. (loc)................................................................2.................................! . . ........
52. Enlarged liver, N ................................................................................................................... .
53. Enlarged spleen, N ..................................................................................................................
54. Hernia, N ......... Umbilical..'..........Inguinal, R., L ...........D ou b le...................................
Femoral, R., L............................... Double........................... 55. Other defects.....................
NASOPHARYNX: 56. Mouth breathing, N. 57. Nasal discharge, N. 58. Nasal obstr., N.

59.
61.
62.
63.

OFFICE ADMINISTRATION.

206
1 . Surname
5urnani 6 .??

(a) Enter the family name on the line above the word
(b, c, d.,) Enter the first names of the child., father,

2. Addresses: Space has been provided for one change
(a and b.) Enter the house number and street.
Sheet N° .................... CHILD’S CLINIC RECORD (Continuation).9
[Size 4J by 8 inehes.J
1. Surname,

2. Child.

3. Address.

4. District.

6. Mother

5. Father.

Physician.

Physician’s notes.

Date.

B. M. F. A., Evansville, Ind., 1920, Form 6.
9 Same on both face and reverse.

3. Districts (a and 6).—Enter the districts as they correspond to
the addresses on the same lines.
.
.
4. Clinic.—Enter the name of the clinic m which the examination
5. Examined l y .—-Enter the name of the doctor who made the
examination.
.
The remaining instructions are practically the same as those given
for the medicalnistory card in Record System 1—pp. 138 139.
8. Loan Closet Record.
This record requires little explanation. All articles loaned will be
reported to the office manager who will make the appropriate entries
on the record. No article may be loaned without the written approval
of the supervisor. The slip bearing her approval should contain all
the information needed by the office manager. Below are given the
headings for the columns to be entered on a sheet m the back of the
time book or elsewhere if more convenient.
Family name.

Address.

Article.

Date
loaned.

Date
returned.

Nurse responsible.

Every article should be seen at least once each year if used by
families with records in the active file. If a family which has bor
rowed an article is discharged the office manager should call the atten
tion of the supervisor to the fact that this family has some of the
property belonging to the association.
.. , . .
N. B.—All articles which have been loaned should be listed in me
inventory.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX.

207

9. Time Book.
Instructions to office manager.
INSTRUCTIONS FOR KEEPING TIME BOOK.
,

[Daily report of nurse’s visits.J

General:
The time book is kept in the main office by the office manager.
I t contains—
a. Permanent items (Name, Address, Sex, Date of Birth, Birth
Registration).
b. Items which change monthly (visits carried forward, dispensary
or nondispensary, age classification).
c. The daily report checkerboard.
d. The loan closet sheet (in the back of the book).
e. The total sheet' for the monthly reports (in the back of the book
if desired).
/ . Nurses’ time and financial record (in the back of the book).

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

INDEX
A B C of Exhibit Planning, The, by Evart G. Routzahn and Mary Swam Routzahn, 103.
Accounting:
Essential principles of, 92-93.
For supplies, 48.
Publicity as means of, to public, 97.
Yearly, 8.
Accounts, annual auditing, 92.
Addresses, lost, 86.
Addressographs, 43.
Administration:
Books on, 32,117.
Committee on, 92.
Economy in, 33, 43.
Efficiency in, 5-6.
Financial, 91-97.
Agencies, cooperation with other:
Libraries, 77,101-102, 103Social agencies, 33, 43, 115-116:
Alphabetical filing:
Advantages, 80.
B y name of father as well as of child, 80.
Distinguishing between active and discharged
cases, in, 81.
Growing preference for, 83.
Phonetic system of, 80.
Rules for cross referencing, 79.
American Red Cross, New York chapter, 107.
Annual report:
Auditor’s statement in, 92.
Charts, 100.
Content, 98-99.
Definition of, 71-72.
Interpretation of statistical data in, 99-100.
Maps, 100. .
Photographs, 100.
Size, 98.
Statistics for, 14.
Stories in, 100.
Text of, 99-100.
Writing of, 14.
Appliances, office, 43-44,91.
Application blanks, employee, 23, 26.
Area served by child health organizations, 2, 3.
Arrangement of office furniture and equipment, 45.
Art committee, 19.
Auditing, annual, of accounts, 92.
Auditor’s statement, publication of, in annual
report, 92.

Bills:
Cheeking, by office manager, 17,52.
Filing, 17, 52.
Paying, 52.
Receipting, 17.
Sending out, to members, 17.
Board of education, cooperation of, with child
health agency, 61.
Book index, 78.
Bookkeeping:
Books—
Cash, 17, 93, 95.
. General ledger, 17, 93, 95.
Journal, 93, 95.
Payroll, 93.
Petty cash, 17,93.
Cards—
Donation, 95.
Ledger, 95.
Membership, 95.
Patient’s receipt, 95, 96.
Definition, 92.
Essential principles, 92-93.
Fee envelope, 96-97.
Office manager’s responsibility for, 17 .
Preventing mistakes, 95.
Bookkeeping machine, 43.
Boston Instructive District Nursing Association,
30 note, 31-32.
Boy scouts, as volunteer workers, 18.
Brainard, Annie M.: Organization of Public Health
Nursing, 6 note, 9 note, 91.
Board of managers:
Definition of chief executive’s duties by, 13.
Duties of, 9, 91-92, 108.
Policy as to use of case-record material, 71.
Selection of chief executive by, 24-26.
Bridgeport, Conn.—Visiting Nurses’ Association,
2 note, 145.
Brinton, Willard Cope; Graphic Methods for Pre
senting Facts, 102.
Budget planning, 92.
Building:
Construction, 33.
Location, 33, 34, 35, 36.
Selecting for office, 33-34.
Service, 34.
Storage facilities, 34, 50.
Built-in equipment, 37.

Baby health conferences, 107.
Baby Hygiene Association, Boston, 32,
Basis of study, 1-3.
Bibliography, 33,117-118.
Bids for supplies, 52.

Calculating machines, 43.
Calls:
Recording, 56-57.
Telephoning, to nurses in field, 57.
Camp-fire girls, as volunteer workers, 18.

209

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

210

INDEX.

Chicago Visiting Nursing Association, 30 note.
Car tickets, 97.
Chief executive:
Card index:
Duties—
Of cases, 78.
Agisting board of managers and com
Of equipment, 46, 47.
mittees, 9.
Of potential subscribers, 91.
Field work, 10.
Of supplies, 52.
General supervisory, 12-14.
Vertical, 78.
Planning records and filing systems, 53, 68,
Visible, 78-79.
77, 82.
Case numbers, 82.
Publicity, 14, 19, 98-101, 108.
Case records:
Responsibility for expenditures, 92.
Abbreviations, 58, 60,64-65,69.
Supervision of correspondence, 14.
Basis, 53-54, 60-61, 82.
Outside activities, 13,105-106.
Changing items, 55-56,69-70.
Selection, 9-10,11-14, 24r-26.
Checking, 58, 86-87.
Training, 4,10,12,33,100,104.
Confidential nature, 85.
Child care:
Copying, errors due to, 58.
Program for continuous, 61.
Dates, 69.
Scope, 61.
Destroying, 85.
Child Welfare Association, New Orleans:
Discharged, 85-87.
Bookkeeping system, 93-95.
Duplication, 55, 82.
Executive secretary, 13-14.
Entries, 60, 68-69, 70.
Office administration study made for, by U. S.
Failure to use, 71.
Children’s Bureau, 2 note.
F ilin g Office manual, 13.
Equipment, 83-84.
Phonetic alphabetical filing used by, 80.
Systems, 80-83.
Record system, 121-144.
Importance, 52-53.
Child Welfare Committee, Kansas City, Mo. (Now
Instructions, 67-70.
Transas City, Mo., Children’s Bureau),
Notes, 69.
2 note, 20-22.
Planning, 52-70.
Children’s Bureau, U. S.:
Protecting, 85.
Film, Children’s Year, 107.
Purpose, 52-54.
Information as to exhibits, furnished by, 163.
Revision, 55-56.
Studies of office administration, 1-3.
Size, 65.
Classes, educational, as publicity medium, 106.
Summarizing, 59.
Classification of equipment, 46.
Systems, 60, 61,121-207.
Clerical work:
Transfer to other agencies, 85.
Cost of, 71.
Types—
Eliminating duplication in, 2, 55.
Address books, 57-58..
Faulty, 55.
Call books, 56.
Of nursing staff, 16, 30, 56.
Call slips, 56.
Reducing amount of, 43-44, 46, 82.
Daily report sheets, 58.
Relation of, to nursing service, 2,30.
Day books, 59-60.
Standardizing, 116.
Permanent, 58, 59,60-68.
Supervision of, by office manager, 15, 26.
Street books, 58-59.
Committee(s):
Time books, 59-60.
Appointment of, 9-10.
Cashbook, 17,93,95.
Assistance to, by chief executive, 9-40,13,14.
Catalogue, manufacturer’s:
Education, 9.
Numbers, use of, in inventory, 47.
Equipment, 10.
Ordering equipment from, 91.
Finance, 9,91-92.
Ordering supplies from, 51,91..
Number needed, 9.
Centralized purchasing, 47.
Nursing, 10.
Chairs, 41.
Office administration, 10-11.
Chambers of commerce:
Printing, 9.
Advice of, on office administration, 32*
Program, 32.
Cooperation of, in placing exhibits, 102.
Publicity, 9.
Office manuals, 116.
Records, 9.
Chartography in Ten Lessons, by Frank J. Wame,
Community:
102.
Accounting to, 97.
Chart(s):
Health facts concerning, 97.
Executive Control, 7.
Needs, 13,97.
Exhibit, 102.
Opportunity to serve, 70.
For annual report, 100.
Relation of child health agency to, 71-72,
In training employees, 31.
105-106.
Check sorters, 44.
Check stubs, 92.
C0DAttenclance of public health executives at, 9,13.
Checks, 17.
Baby health, 107.
Chicago Infant Welfare Association, 30 note.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1HDEX.
Conferences—Continued.
Church, display of exhibits at, 102.
Group, 68.
Staff, 30-32, 53.
With other health agencies, 61.
Contests, as publicity medium, 106-107.
Control file for geographical filling system, 81.
Cooperation:
Art students, 19,102.
Board of education, 61.
Boy scouts, 18.
Business firms, 83, 91,116.
Camp-fire girls, 18.
Chambers of commerce, 32, 102, 116.
Librarians, 77, 101-102, 116.
Libraries, 32, 77, 101-102,103.
Physicians, 33.
Social agencies, 33, 43, 115-116.
Young Men’s Christian Associations, 1J6.
Within the organization, 5, 30.
Copyholders, 43.
Correspondence:
Filing, 14,17.
Supervision of, by chief executive, 14.
Cross indexing records, 78, 79, 80.
Daily report sheets, 58.
Dates, special attention to, in record keeping, 69.
Day book, 59-60.
Death certificates, checking case records with, 86-87.
Delaware health centers, record system used by
167-181.
Delaware Reconstruction Commission, Child Wel
fare Division, 2 note.
Desks, 39-40, 45, 46.
Director. See Executive, chief.
Discharged case records, 81, 86-87.
Distribution of literature, 108.
District (branch) office:
Keeping case records at, 59.
Location of, 33.
Responsibility of chief executive for adminis
tration of, 14.
Supplies for, 48.
District supervising nurses, 14-15. .
Donors, 8, 91.
Duplicate records, 79, 82.
Duplicating machines, 43.
Economy:
In furniture, 37-38.
In rent, 35-36.
In supplies, 47-48, 50.
Of space, in office arrangement, 45.
Use of labor-saving devices as, 43.
Educational aids in training employees:
'
Library, 32-33.
Staff and group conferences, 36-32, 53, 68.
Educational classes, 106.
Efficiency:
Application of principles of, to office manage
ment, 4, 5-6,12, 15,17, 26, 36, 44, 45.
Effect of employment of volunteers upon, 18,26.
Effect of surroundings upon, 33.
File, 83, 91.
In use of records, 70.
Maintenance of, in branch offices, 14.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

211

Efficiency—Continued.
New staff members’, 109.
Supply clerk’s, 50.*
Efficiency experts, 55.
Efficiency records, 29-30.
Employees:
Discharging, 14, 30.
Employing, 14.
Responsibility of chief executive for, 13-14,
Supervising, 5,14,15-16, 28, 91.
See also Efficiency and Training.

Equipment:
Addressographs, 43.
Arrangement, 36-37, 45.

Bookkeeping machines, 43.
Calculating machines, 43.
Check sorters, 44.
Classification, 45, 46.
Copyholders, 43.
Cost, 38, 41, 42, 43-44, 83.
Distinction between, and supplies, 45-46.
Filing, 47, 65, 83-84, 87, 91.
Ingenuity in providing, 44, 83-84.
Inventory, 46-47.
Labor-saving, 33, 43-44.
Typewriters, 16, 40, 42, 47 .
Esprit de corps, 5,14.
Essentials of an Annual Report, The, by Edwin D.
Solenberger, 98.
Evansville, Ind., Babies Milk Fund Association,
record system used by, 182-207.
Executive, chief. See Chief executive.
Executive control, 1, 5, 6-7, 92,116.
Executive secretary. See Chief executive.
Exhibits:
Charts, 102.
Cost, 103.
Location, 102-103.
Planning, 101-102.
Preparing, 101-102.
Source, 103.
Use of National, 103.
Family records:
Folder for, 84.
Indexing, 80, 81.
Fees:
Accounting firf, 95-97.
Envelope for, 96.
Field records, 44, 57-59.
Field service, part time, of executive, 10.
Field staff:
Explanation of records to, 30-31, 53.
Supervision, 14-15.
Files, 38, 40-41, 45.
Filing:
Accuracy, 91.
Advice, 83.
Checks on,'87-88, 91.
Completeness, 91.
Definition of terms, 77-78.
Expense of, 83.
Methods, 77, 78, 80-83.
Necessity for variety in systems, 82-83.
Of field records, 59.
Principles, 77, 80,
Filing aids, 84, 91.

212

INDEX,

Filing baskets, 47, 87.
Filing equipment, 47, 65, 83-84, 87, 91.
Finance committee, 9.
Finances:
Responsibility for, 91-92.
Statement of, in annual report, 99.
Financial support, 8, 91.
Financial administration, 91-97.
Folders, 84.
Foley, Edna L.: Visiting Nurse Manual, 59 note.
Foreign names, identification of, 81-82.
Forms. See Case records, and Record forms.
Free quarters, drawbacks of, as office location, 35-36.
Furniture, office:
Arrangement of, 36-37, 45.
Chairs, 41.
“ Cheap” 37-38.
Desks, 39-40.
Files, 38, 40-41, 45.
Selecting, 37-38.
Standard, 39.
Tables, 40.
Galloway, Lee: Office Management, Its Principles
and Practice, 15, 27 note, 34, 43, 51, 109.
Gardner, Mary Sewall: Public Health Nursing, 6
note, 9 note.
Geographical filing, 80, 81-82, 83.
Government reports, as aid in use of statistics, 100.
Graphic Methods for Presenting Facts, by Willard
Cope Brinton, 102.
Group conferences, 68.
Growth of organization:
Dependence of, on chief executive’s planning
ability, 11.
Filing system allowing for, 77.
Health interpretation, 1, 97.
Henry Street Visiting Nursing Association, New
York City, 30 note.
Hours of work, 9.
Impression blanks, 24, 26.
Income, 8, 91-92.
Index(es):
Alphabetical, to numerical file, 82.
Book, 78.
Equipment, 46, 47.
Ledger, 95.
Membership, 95.
Separate, for discharged records, 81.
Vertical card, 78.
Visible card, 78-79.
Indexing:
Cross, 78, 79.
Filing system, 83.
Of equipment, 46, 47.
Of library, 17.
Infant and child care:
Program for continuous, 61.
Scope, 61.
Information:
Case record, use of, 52-53.
Giving out, 19.
Information file, special, 87.
Inquiries, phrasing of, 64.
Instructions:
For entries on records, 58, 60, 64-65, 67-69, 70.
For routing records, 68.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Instructions—Continued.
For tally sheets, 74.
For use of patient’s receipt card, 95-96.
Preparing, 68.
To new employees, 28,116.
To volunteers, 18-19.
Interviews:
Analysis of, 28.
Oral, as publicity, 104.
Unnecessary, 28.
With prospective employees, 22-23, 24, 27.
Inventory:
Annual check on supply, 50.
Forms, 46, 48, 50.
Numbers, 46^47.
Of added equipment, 17, 47.
Perpetual, of equipment, 48, 50.
Records, 46-47.
Weekly, of supplies, 49-50.
Inventory ledger, 50, 52.
Investigation of community needs by chief execu
tive, 13.
Janitor service, 34.
Kansas City, Mo., Children’s Bureau (formerly
Child Welfare Committee), 2 note, 20-22
Iiabor turnover, expense, 22.
Labor-saving devices, 43-44.
Ledger:
Cards, 95.
General, 93.
Loose leaf, for supply inventory, 48.
Library:
Chamber of commerce, 32.
Organization, 17, 32-33.
Public, 32, 77,101-102, 103, 116.
Lighting, office, 34-35, 45.
Literature, distribution of, 108.
“ Little mothers” classes, 106.
Location of office, 33-37.
Loose-leaf binders, 44, 72, 73, 109.
Lost addresses, 80, 86-87.
Machines:
• Addressograph, 47.
Calculating, 47.
Mimeograph, 47.
Typewriter, 16, 40, 42, 47.
Manager, office. See Office manager.
Managers, board of, 9.
Manual(s), office:
Changes in, 15.
Contents, 15, 17, 19, 24, 52,58, 64r-65,69,92,101,
* 109,112^115,116.
Form, 109-110.
Development, 110-112.
Interchanging, 115-116.
Need of, 109.
Number of copies, 109-110.
Objections to, 116.
Of Child Welfare Association, New Orleans,
La., 13.
Preparation, 15,110-112,115.
Purpose, 108-109.
Value, 109,116.
Manufacturer’s catalogue, 47

INDEX.
Marsh, Eleanor Taylor: “ Telling the Public About
the Public Health Nurse,” 105.
Maternity care, scope, 61.
Maternity Center Association, New York City,
2 note, 58, 61, 79.
Medical supervisor, 7.
Medical supplies, purchase of, 51.
Meetings, public, 105-106.
Membership :
Cards, 95.
List, 17, 93.

213

Nursing service—Continued.
Specialized, 61.
Standards, 1.
Types, 3
Nursing staff, 1, 29-30,52-53.

Office:

Arrangement, 34,36-37, 45.
Branch, 33.
Building—
Construction, 33.
Terms of admission to, 93.
Location, 33,34,35,36.
.Metal signals, 84.
Storage facilities, 34,50.
Methods:
Definition of, 3-4.
Of executive control, 1 .
Equipment, 38, 39, 40, 41-47.
Furniture, 37-41, 45.
Of per forming clerical work, 17.
Layout, 34, 36-37.
Study of, by chief executive, 13,25,33.
Mimeographs, 47.
Management, 4-5.
Mistakes, method of preventing financial, 95-96.
Manager. See Office manager.
Monthly report:
Supplies, 34, 47-52.
Case stories in, 101.
Surroundings, 33, 34.
Form of, defined in office manual, 101.
Telephone service, 41-42.
Inclusion of reports of all special groups in, 101.* Office Administration, by J. William Schulze,
Material for, in time books, 59.
27 note, 43-44.
Writing of, by chief executive, 14.
Office management, definition, 5.
Motion pictures, use of, as publicity medium, 107.
Office Management, Its Principles and Practice, by
Lee Galloway, 15, 27 note, 34 note/ 43,
National Conference of Charities and Correction
109 note.
1909, 98.
Office manager:
National Organization for Public Health Nursing:
Assistance of committee on office administra
Conferences, 26.
tion to, 10-11.
Lists of exhibits, 103.
Budget-planning ability of, 92.
Publications, 6, 26.
Duties Of, 3-4,6,15-17,26, 27,47, 52, 91.
Recommendation, 9.
Saving effected b y ,.in purchasing 'supplies
Standards set up by, 26.
47-48.
“N ew ” cases, checking, 81, 82.
Selection of, 11,16,92.
New Orleans, La.: Child Welfare Association,
Office manual:
2 note, 13 note, 80, 93,121.
Changes, 15.
New York City:
Contents, 15, 17, 19, 24, 52, 58, 64-65, 69, 92, 101,
American Red Cross, New York Chapter, 107.
109,112-115,116.
Henry Street Visiting Nurse Association,
Form, 109-110.
30 note.
Development of, 110-112.
Maternity Center Association, 2 note, 61.
Interchange of, 115-116.
New York Maternity Center Association, 2 note
Need of, 109.
58, 61, 79.
Number of copies, 109-110.
Newspaper(s):
Objections to, 116.
Articles, as publicity medium, 103-105.
Of Child Welfare Association, New Orleans
Publications, on writing for, 104.
La., 13.
Nuisances, 33.
Preparation, 15, 110-112, 115.
Numerical case index, 78.
Purpose, 108-109.
Numerical filing, 78, 83.
Value, 109,116.
Nurses:
Office supply firms:
As executives, 11-12.
Catalogues of, 91.
Clerical work, 16, 30, 52-53, 58.
Filing equipment advice from, 83.
Promotion, 12, 15, 25, 30.
Filing system advice from, 83.
Senior, 15.
“ Open files,” 83-84.
Staff, 14, 26, 27, 29-30.
Oralinterview as publicity medium, 104.
Supervisor'of, 12 ,14-15,16.
Organization:
Telephone service for, 42, 57.
Functions and duties of, 8-22.
Training, 29-30, 53.
Importance of sound, 6-7.
Nurses'committee, 9 , 10 .
Need of scientific, 1-2, 5-6, 25.
Nursing service:
Organization of Public Health Nursing, by Annie
General, 60-6 1 .
M. Brainard, 6 note, 9 note, 91.
Infant and child, 61 .
Output:
Maternity, 61.
Increase in, due to reorganization, 2.
Record, 68-69,77.
Ofstaff, 11,12,16.
Scope, 1,2,61.
Overage case records, 86.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

214

xsriJEX.

Record (s):
Case. See case records.
Paper for case record forms, selection -of, 67.
Efficiency, 29-30.
Patient’s receipt card, 95-96.
Equipment, 46-47.
Pediatrist, need of, as medical supervisor, 7.
Field, binders for, 44.
Pencils, 45-46, 48, 73.
Financial, 93-97.
Perpetual inventory, 48.
Permanent monthly, of statistics, 74.
Petty cash, 17, 92, 95.
Planning, 30.
Philadelphia Social Service Exchange, 80.
Sorting, 44.
Philadelphia Visiting Nursing Association, 30 note.
Supply, 48.
Phonetic system of alphabetical filing, 80.
Visit of observation, 30.
Plans:
Volunteer service, 20-22.
Case-record statistics as basis for, 70.
Record filing, 77-91.
Chief executive’s ability to make and carry out,
Essentials of, 77.
11.
Selection of system for, 77-78.
Filing system, 77-78.
Record forms:
Record-system, 52-70.
Call sEp, 57.
Poster contests, 107.
Difficulties due to unsuitable, 53-54.
Preventive work, 70-74, 97.
Enrollment check, 87.
Prices:
Envelope (fee), 97.
Equipment, 38,41, 42, 43-44, 83.
Instructions for using, 67-68.
Furniture, 37-38.
Inventory , 46-47,48, 50.
•Office space, 33, 34,35-36.
*
Paper for, 87:
Supplies, 47-51.
Patient’s receipt card, 96.
Probation, staff nurse’s, 29-30.
Planning, 52-70, 91.
Protection o f records, 33.
Printing, 66.
Publications for distribution, 108.
Requisition, 49.
Public health courses, enrollment of executive in, 10.
Size, 65.
Public Health Nursing, by Mary Sewall Gardner, 6,
Spacing on, 66.
9 note.
Standardized, 61,65.
Publicity:
Storing, 50.
Annual report—
Subdivisions, 66.
Charts, 100.
Tally sheets, 73, 74, 75, 76.
Content, 98-99. .
Telephoned message, 57.
Interpretation of statistical data, 99-100.
Type for, 66.
Maps, 100.
Record system:
Photographs, 100.
Changes in, 5L56.
Size, 98.
Definition of, '56.
Statistics for, 14.
Examples, 121-207.
Stories in, 100.
Improving, 54.
Text of, 99-100.
Planning, 52-70.
Baby health conferences, 107.
Types, 56.
Classes, educational—
Receipt card, patient’s, 95-96.
"Little Mothers,” 108.
Registrar, 17.
Women’s club programs, 106.
Regulations, 5.
Contests, 106-107.
Rental, office, 33, 34, 35-36.
Distribution Ofliterature, 108.
Reorganization, results of, 2.
Exhibits—
Reports. See Annual reports, and Monthly re
Charts, 102.
ports.
Location of, 102-103.
Requisitions:
Planning, 101-102.
District office, 17.
Preparing, 101-102.
Duplicate copies of, 48-49.
Source, 103.
Form of, 48,49.
Function® of, 97.
Honoring, 52.
Library cooperation, 103,
Slips for, 48.
Mediums of, 98-108.
Sorting, 49.
Monthly reports, 101.
Systematizing, 49-50.
.•
Motion pictures, 107.
Responsibility, individual, 88.
Newspaper articles, 103-105.
Routine:
Poster contests, 107.
Definition of, in office manual, 108.
Public speaking, 105-106.
Executive control over, 5,116.
Purchasing supplies:
Schedules of, 92.
Centralized, 47.
Simplifying, 109.
Quantity, 47-48.
Routing:
Time of, 49,52.
Arrangement of office to facilitate, 45.
Orderly, 4, 5,55.
Qualifications of prospective employees, 23.
Records, instructions for, 68.
Quarters, free, drawbacks of, as office location, 35-36.
Overhead expenses, 35.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

INDEX.
Routzahn, Evart G., and Routzabn, Mary Swain:
The A B C of Exhibit P la n n in g , 103 note.
Russell Sage Foundation, publications on exhibits,
101.
Safe, use of, 92.
Salaries, need of adequate, 1, 9.
School of Public Health Nursing, Boston, 32.
Schools:
Art, 19,102.
Library, 101.
Location of exhibits in, 102.
Schulze, J. William: Office Administration, 27, 43.
Scientific office management, 4, 5.
Scope of report, 3-5.
Secretary. Set Chief executive.
Selection of employees:
Chief executive, 9-10,11-14,22,24-26.
Clerical staff, 22-24,26-27.
District supervising nurses, 14-15.
Nurses, staff, 26,27.
Office manager, 11,16 , 9 2 .
Senior nurses, 15.
Tests used in, 22, 23, 25, 27.
Senior nurses, 15.
Service of organization to community:
Cost, 12.
Effectiveness, 12.
Generalized, 29.
Specialized, 29.
Slide-rule, 43.
Social agencies, cooperation with other, 33,43.
Social service registration bureau, 82.
Solenberger, Edwin D.: “The Essentials of an
Annual Report,” 98.
Speaking, public, 105, 106.
Special information file, 87.
Spelling:
As factor in selecting employees, 23.
Variations in case names, 79, 81-82.
Staff:
Clerical, 17, 26-27, 28-29,30.
Discharge, 13-14.
Employment, 13-14, 26.
Meetings, 30-32.
Nursing, 1, 29-30, 52-53.
Reassignment of duties when enlarged, 6.
Supervision, 5,11,12,15, 26.
Training, 27-33, 52-53, 70, 87.
Standard equipment, 39, 55.
Standardization:
Nursing service, 1,29-30.
Office work, 4, 5,15,17, 26,116.
Qualifications for positions, 22.
Record forms, 61, 65.
Supplies, 51.
Volunteer service, 18.
Station, district:
Keeping case records at, 59.
Location, 33.
Responsibility of chief executive for adminis
tering, 14.
Supplies, 48.
Stationery, 40,50.
Statistics:
Cost of securing, 71.
Full use of, 100.
Interpretation of, in annual repoft, 99-100.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

215

Statistics—Continued.
Knowledge of, on part of chief executive, 25,
99-100.
Preparation of, 14,71-72.
Presentation of, to—
Public, in annual report, 99.
Staff, 53.
Records as source of, 30,52-53.
Tabulation from records, 14, 70-76.
Training staff nurses in use of, 30, 52-53,79-71.
Statistical clerk, 17,43.
Stenographers, 17, 39,40.
Stock taker, 48.
Storage facilities, office, 34,37,39-40,41,50.
Storeroom:
Amount of supplies kept in, 34,50.
Arrangement of, 50.
General, 50.
Location of, 34.
Office, 50.
Supervision of, 50.
Street file, 81-82.
Superintendent. See Chief executive.
Superintendent of nurses. See Chief executive.
Supervision:
By chief executive, 12,13,14.
By office manager, 14,15-16,91.
Of field staff, 14.
Of files, 91.
Of office staff, 15,26.
Of volunteers, 18-19.
Supervisor. See Chief executive.
Supervisor of nurses:
As assistant to chief executive, 12.
Duties of, 4,14-15,29-30,59.
Supplies:
Control of, by office manager, 47.
Distinction between, and equipment, 45-46.
Perpetual inventory, 48,50.
Purchasing, 17,37,47,52.
Replenishing, 51,52.
Requisitioning, 48-50.
Salvage, 50.
Storage, 34,36,37,39,50.
Supply clerk, 48,50,52.
Tables, 40.
Tabulation:
Checking, 72.
For annual report, 71-72.
Forms for, 74,75,76.
Method, 71-76.
Tally sheet for, 72-76.
Telephone service, 41-42.
Telling the Public about the Public Health Nurse,
by Eleanor Taylor Marsh, 105 note.
Tenants of office building, 33.
Tests:
Comparison of, with those given by business
firms, 27.
For chief executive, 25.
For employees, 17, 22,23,25, 27.
For labor-saving devices, 43-44.
For volunteer workers, 17.
Time records, 17.
Training:
Filing staff, 91.
*
In exhibit planning, 101.

INDEX.

216

Visits—Continued.
Record.of, 57.
To well children, 59,69.
Volunteers:
Art work, 19,102.
Assignment of duties, 18-19.
Record of work, 20-22.
Selection, 17.
Supervision, 18-19.
Standardizing service, 18.
Value, 17,20,26.

Training—Continued.
Means of—
General staff conferences, 30-32.
Group conferences, 29.
Library,32-33.
Office manual, 19, 28', 116.
Special courses, 29. ,
Office staff, 27-29,30-33.
Staff nurses, 27, 29-30, 30-33.
Statistical, 30.
Systematic, 28.
Training districts, 29.
Transportation facilities, 33.
Type, selection of, for record forms, 65
Typewriters, 16,40,42,47.
Typists, 17, 58.
Ventilation, office, 34.
Vertical card index, 78.
Visible card filing system, 78-79.
Visiting Nurse Manual, by Edna L. Foley, 59.
Visiting Nurses’ Asociation, Bridgeport, Conn.,
2 note, 145-166.
Visits:
Instructive, 60.
Of observation, by supervisor, 30.

Warne, Frank J.: Chartography in Ten Lessons, 102.
Waste:
Elimination of, in clerical departments, 17,55.
In accepting free office space, 35-86.
In failure to use available data, 52-53.
In labor turnover, 22.
In superfluous interviews, 28.
Unsuitable equipment as cause of, 38,42.
Wilmington, Del.—Delaware Reconstruction Com
mission; Child Welfare Division, 2 note.
Women’s clubs, 102,106.
Working conditions, 9, 27-28.

ADDITIONAL COPIES
OF THIS PUBLICATION M A Y B E PROCURED FROM
•THE SU P ER IN TE N D E N T OF DOCUM ENTS
G O V E R N M E N T PRINTING OFFICE
W ASH IN GTO N, D. C.
AT

20 CENTS PER COPY

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Full text of Office Administration for Organizations Supervising the Health of Mothers, Infants, and Children of Preschool Age, with Special Reference to Public Health Nursing Agencies, Bureau Publication No. 101

FRASER