THE CHARTER, LAWS, AND EULES Philadelphia.. PENNSYLVANIA HOSPITAL. PHILADELPHIA: COLLINS, PRINTER, 705 JAYNE STREET. 1859. CHAETEE. ANNO VIGESIMO QUARTO. GEORGII REGIS. At a General Assembly of the Province of Penn- sylvania, begun and holden at Philadelphia, the fourteenth day of October, Anno Domini 1750, and from thence continued by adjournments to the sixth day of May, 1751. An Act to encourage the establishing of an Hospital for the relief of the sick poor of this Province, and for the recep- tion and care of lunaticks. Whereas the saving and restoring useful and Preamble. laborious members to a community, is a work of publick service, and the relief of the sick poor is not only an act of humanity but a religious duty; and whereas there are frequently, in many parts of this province, poor distempered persons, who languish long in pain and misery under various disorders of body and mind, and being scattered abroad in dif- ferent and very distant habitations, cannot have the benefit of regular advice, attendance, lodging, diet, and medicines, but at a great expence, and, there- fore often suffer for want thereof; which inconveni- ency might be happily removed, by collecting the 6 patients into one common Provincial Hospital, pro- perly disposed and appointed, where they may be comfortably subsisted, and their health taken care of at a small charge, and by the blessing of God on the endeavors of skilful physicians and surgeons, their diseases may be cured and removed. And whereas it is represented to this Assembly, that there is a charitable disposition in divers inhabitants of this province to contribute largely towards so good a work, if such contributors might be incorporated with proper powers and privileges for carrying on and compleating the same, and some part of the pub- lick money given and appropriated to the providing a suitable building for the purposes aforesaid. Therefore, for the encouragement of so useful, pious, and charitable a design, we pray that it may be enacted, And be it enacted, by the honourable James Hamilton, Esquire, Lieutenant-Governor under the honourable Thomas Penn, and Eichard Penn, Esquires, true and absolute proprietaries of the pro- vince of Pennsylvania, and counties of New-Castle, Kent and Sussex, upon Delaware, by and with the advice and consent of the representatives of the free- men of the said province in General Assembly met, subscribers and by the authority of the same, That it shall and empowered to meet. may be lawful to and for all persons, each of whom shall have contributed or subscribed the sum of ten pounds or more, towards founding an Hospital, for the reception and relief of lunaticks, and other dis- tempered and sick poor within this province, or as many of them as shall think fit to assemble and meet on the first day of the month called July next; and for all persons who shall thereafter contribute the like sum of ten pounds or more (together with the said first subscribers) or so many of them as shall think fit to assemble and meet on the second 7 day of the first week, in the month called May, yearly forever, at some convenient place in the city of Philadelphia, then and there to elect by ballot, And t0 elect r > J ' managers twelve fit and suitable persons of their own number ^1desmake to be Managers of the said contribution and Hospital, and one other person to be Treasurer of the same, until the next election; and farther, to make such laws, rules and orders, as shall appear to them the said contributors met, or the major part of them, to be good, useful and necessary, for the well govern- ing, ordering and regulating the said Hospital, and for the regulation of the future elections of man- agers, treasurer and other necessary officers and ministers thereof, and for limiting and appointing their number, trust and authority, and generally for the well ordering all other things concerning the government, estate, goods, lands, revenues, as also all the business and affairs of the said Hospital: All which laws, rules, and orders, so to be made as afore- said, shall be from time to time inviolably observed by all concerned according to the tenor and effect of them, provided they be not repugnant to the laws of England or this government, and are approved by Rules to be the Chief Justice, the Speaker of the Assembly, and &c. the Attorney-general of this province for the time bein°\ under their hands and seals. And the said contributors z>> mcorporat- contributors shall be, and are hereby made a body ed. corporate in law, to all intents and purposes, and shall have perpetual succession, and may sue, or be sued, plead, or be impleaded, by the name of The Corporate • 7-r • -i • n name. Contributors to the Pennsylvania Hospital, in all courts of judicature within this province, and by that name, shall and may receive and take any lands, tene- ments, or hereditaments, not exceeding the yearly value of one thousand pounds, of the gift, alienation, Limitation bequest or devise of any person or persons whom- 8 soever; and of any goods or chattels whatsoever; and the said contributors are hereby impowered to have and use one common seal in their affairs, and the same at their pleasure to change and alter. Money^ &c, Provided, nevertheless, That no general meeting capiuistocL °f tne sa^ contributors, nor any persons acting expended under them, shall employ any money or other estate, wstoniy.46" expressly given or added to the capital stock of the said Hospital, in any other way than by applying its annual interest or rent towards the entertainment and care of the sick and distempered poor, that shall be from time to time brought and placed therein, for the cure of their diseases, from any part of this pro- vince, without partiality or preference. when 2000Z. And for the further encouragement of this benefi- ts raised by ° ^u^c^ir°n> cent undertaking, Be it enacted by the authority afore- out ofrthered sa,id, That when the said contributors shall have treasury. met an(j chosen their managers and treasurer as aforesaid, and shall have raised by their contribu- tions, a capital stock of two thousand pounds value (the yearly interest or rent of which is to be applied to the accommodating of the sick poor in the said Hospital, free of charge for diet, attendance, advice and medicines), and shall make the same appear to the satisfaction of the Speaker of the Assembly for the time being; that then it shall and may be lawful for the said speaker of the Assembly, and he is hereby required to sign an order or orders on the provincial treasurer, or trustees of the loan-office, for the pay- ment of two thousand pounds, in two yearly payments, to the treasurer of the said Hospital, to be applied to the founding, building, and furnishing of the same. beCCmadeSup ^n<^ ^e ^ furt^er enacted by the authority aforesaid, edtnnuaiiy." That the accounts of the disbursements of the said two thousand pounds, so ordered by the Speaker of 9 the Assembly aforesaid, or any part thereof that shall be hereafter expended, as the case may be, and of the rents, products and interests of any real or personal estates or sums of money charitably given to the use of the said Hospital, together with a list of such donations, shall be fairly drawn out and pub- lished annually in the Gazette, or other newspapers: and the Managers of the said Hospital shall at all times, when required, submit the books, accounts, affairs, and ceconomy thereof, to the inspection and free examination of such visitors as may from time visitors to be J appointed. to time be appointed by the Assembly of this pro- vince, to visit and inspect the same. Provided always, and it is hereby further enacted by the authority aforesaid, That if at any time hereafter, there should not be a constant succession of con- tributors to meet yearly and chuse managers as aforesaid, then the said Hospital, and the estate and affairs thereof, shall be in the management, and under the direction of such persons as shall be from time to time appointed by act of General Assembly of this province for that purpose. 10 LYING-IN DEPARTMENT. Extract from an Act of the Legislature of the State of Pennsylvania, approved April 11th, 1793, en- titled An Act for extending the benefits experienced from the institution of the Pennsylvania Hospital. Section 6. And be it further enacted by the authority aforesaid, (The Senate and House of Eepresentatives of the Commonwealth of Pennsylvania,) That as the relief of unfortunate women labouring in child-birth and not able to provide for the expenses necessarily incident thereto, and also the misfortunes of suffer- ing and forsaken infancy, are objects very deserving of some humane provision, it shall and may be law- ful for the Managers of the Pennsylvania Hospital to provide commodious apartments for the purpose of answering the ends intended by a Lying-in and Foundling Hospital, whenever moneys shall be placed in their hands for such a purpose, and that they are hereby authorized to call for any such sums as may now be destined for such an use, whenever they shall be in a situation to carry the benevolent design for which such moneys were granted into full effect, any thing in the Constitution or Charter of the said Hospital to the contrary thereof notwith- standing. 11 ELECTIONS BY THE CONTRIBUTORS. A Law for regulating the Elections of the Managers and Treasurer of the Pennsylvania Hospital, and declaring their Trust, Duty, and Authority. Whereas by an Act of the General Assembly of preamble. the Province of Pennsylvania, intituled, An act to encourage the establishing of an Hospital for the relief of the sick poor, of this province, and for the reception and cure of lunaticks, the contributors to the said Hospital are made a body corporate, and impowered to meet, and to make such laws, rules, and orders, as shall appear to them the said contri- butors met, or the major part of them, to be good, useful and necessary, for the well governing and regulating the said Hospital, and for the regulation of the elections of Managers, a Treasurer, and other necessary officers and ministers thereof, and for limiting and appointing their number, trust, and authority. And whereas, in pursuance of the said law, the contributors have met, and have chosen twelve Managers and a Treasurer, which Treasurer hath received considerable sums of money for the use of the said Hospital, and it is now become necessary, for the more orderly disposition and application of the said moneys, and of such sums as may hereafter be received, and for the more sure direction of the Managers and Treasurer therein, to declare and appoint their trust, authority and duty: Therefore it is enacted by the contributors to the Pennsylvania 12 Disposition of money paid to the Treasurer. Patients. Officers and servants. General meetings of the contri- butors. Corporate seal. Accounts of the Treasur- er, &c. Managers to receive no fee or re- ward. Hospital, in general meeting duly assembled, That the Managers of the said Hospital for the time being, shall have the power of disposing of all moneys paid to the Treasurer for the building, furnishing, sup- port, use and service of the Hospital, and for the hiring and furnishing a house or houses for the reception of patients, until the said Hospital shall be built, under the limitations and restrictions of the before mentioned act of Assembly. And the said Managers shall likewise have the power to direct the manner and terms of receiving and discharging of patients; and all officers and servants belonging to the Hospital, other than the Treasurer, shall be in the choice, and under the direction of the Managers, who shall allow and order their respective salaries, and may displace them, and appoint others, as often as they shall think fit. And the said Managers shall have the power of calling general meetings of the contributors, as often as they judge it necessary for the service and advantage of the Hospital; and shall cause due and public notice to be given of the time, place, and design or purpose of such occasional meeting, at least ten days before the same is to be held, and shall nominate some discreet member to preside therein, and regulate the debates thereof. And the said Managers shall have the keeping, and power of affixing, the seal of the corpo- ration, which seal shall be made nearly agreeable to the form or draught hereunto annexed; and they shall settle the accounts with the Treasurer from time to time, and take care that all laws, rules and orders made by the contributors, and legally ap- proved, be duly and faithfully executed; for all which, or any other services relating to the Hospital, they shall not claim, receive, or retain, any fee, gratuity, or reward whatsoever. 13 And for the more orderly execution of their duty ^°0^f and trust, the Managers are hereby required to meet at least once a month at the Hospital, or some other fit place in the city of Philadelphia, to confer and conclude concerning the matters hereby committed to them: and shall cause fair minutes of their T° keeP ' minutes. proceedings to be kept by their clerk, in a book to be provided for that purpose: in every of which ^^"ST meetings of the Managers aforesaid, eight of their iuorum- number met shall be a quorum, capable to consult, confer and conclude of and upon all matters apper- taining to their trust, according to the aforesaid act of Assembly, and the laws of this corporation; and whatsoever seven of the number so met shall An<* seven to agree. so conclude, shall be deemed and taken for and as the resolution of the managers for the time, and accordingly entered in their minutes. To which minutes, and also to the Treasurer's accounts, all persons concerned shall have free recourse at all seasonable times. And it is further enacted by the contributors Treasurer to give secur- aforesaid, that every Treasurer hereafter chosen shall, ny. before he take upon himself the execution of his office, enter into an obligation, with one sufficient surety, in double the value that doth, or probably may come into his hands, during the continuance of his office, as near as can be estimated by the Man- agers, unto the Contributors to the Pennsylvania Hospital: conditioned that he will, once in three to account r ' ' to the mana- months, or oftener if required, render his accounts gersandpay , A / to their or- to the Managers of the said Hospital, and well and der. truly account, adjust and settle with them when rea uired, for and concerning all moneys that are or to pay bai- i -i -i i • i -j ancean(* shall come into his hands belonging to the said deliver books to his contributors, and pay the balance that shall appear successor. on such settlement to be in his hands, unto such 14 person or for such service as a Board of Managers for the time being shall order and appoint, and not otherwise; and that he will at the expiration of his office, well and truly deliver up and pay the balance of the moneys then remaining in his hands, together with the books of accounts concerning the same, and other the papers and writings in his keeping belonging to the contributors, unto his successor in the said office; and that he will do and execute all other things as Treasurer to the contributors afore- said according to the true sense and meaning of this law. And he is hereby authorised immediately upon entering into his office, to demand and receive of the preceding Treasurer, his heirs, executors or administrators, the cash, books of accounts, writings and other effects belonging to the corporation, giving his receipt for the same. Elections, And for the more regular and satisfactory con- place, hour, . . J and notice ducting of future elections, and the preventing of disputes and misunderstandings among the contri- butors, concerning the same, it is hereby farther enacted, That the place and hour of the election shall be appointed by the Managers of the current year, and notified by their clerk, at least twenty days before the election, by printed advertisements; judges of. and the said Managers shall and are hereby required and impowered to nominate three discreet members of this corporation to inspect and judge of the said election, and declare who are the persons elected; and the Managers shall cause their clerk to enter in their book of minutes the names of the persons elected according to the tickets. Managers And if any person elected Manager, shall refuse may supply ^ L ° ' vacancies in or neglect to act, or shall be absent from three suc- their Board. # ° ' cessive monthly meetings of the Managers, in any of the first ten months of the year for which he 15 shall be elected Manager; or if within the same year or term of his office, he shall be confined by sickness, or otherwise rendered incapable of execut- ing the office of a Manager, according to the true meaning of this law, or shall die, the rest of the Managers, as often as occasion shall require, in any of the cases aforesaid, shall proceed in their duty and office without him; or if they think fit they shall nominate another of the contributors to supply his place of a manager until the then next ensuing election. And if any person so elected Treasurer, shall j^ce'the absent himself from his said office for the space of Treasurer- thirty days, or shall be otherwise rendered incapa- ble, or neglect his office or duty of Treasurer, it shall and may be lawful for the Managers for the time being, to displace him from the said office; and the Managers causing their clerk to make a minute for the purpose, containing their reasons for displac- ing him, he shall thereupon, and from henceforth, cease to be the treasurer aforesaid, and shall, upon notice thereof, adjust and settle with the Managers, and pay and deliver the money, books, writings, ac- counts, and all other effects whatsoever in his hands belonging to this corporation, to such person or per- sons as the Managers shall order and appoint, and in that case, and so often, and also if the treasurer shall depart this life, the Managers shall nominate another of the members of this corporation, but not of their own number, to be Treasurer until the next meeting for the annual election, or other general meeting of the contributors. Provided always, any thing herein contained to Building the contrary notwithstanding, That before the Man- sanctioned agers for the time being proceed to erect any build- tributors. ing for the said Hospital, a plan of such proposed 16 building, with an estimation of the expense, shall be prepared and laid before a general meeting of the contributors for their consideration; and their ap- probation shall be obtained before the same is car- ried into execution. Signed by order of a general meeting of the contributors. Joshua Crosby, President. January 17, 1752. The above bill was read three times at a general meeting of the contributors to the Pennsylvania Hospital and passed by a very great majority. B. Franklin, Clerk. We approve this law, William Allen, Chief Justice. Isaac Norris, Speaker of the Assembly. Tench Francis, Attorney-General. RULES OF THE PENNSYLVANIA HOSPITAL. OF THE MANAGERS. 1. The stated meetings of the Board of Managers shall be held at the Hospital, on the last Second-day (Monday) of every month; to assemble at 4| o'clock P. M. Fine for non- attendance at any stated or special meeting, fifty cents; and for absence at the hour of meeting, twenty-five cents. 2. The Managers shall at their first meeting after their election in the Fifth month (May) every year, choose by bal- lot four Doctors of Medicine, as Physicians; and four Doctors of Medicine, as Surgeons; to visit and prescribe for the pa- tients in the Hospital in the city; and one Doctor of Medi- cine as Physician of the Hospital for the Insane, and two Doctors of Medicine as Assistant Physicians thereof; all of whom, except the last named, shall be members of this cor- poration, and not less than thirty years of age. They shall also at the same time, choose by ballot, a Steward, Matron, Apothecary, Clerk and Librarian, for the Hospital in the city; and a Steward and Matron for each department of the Hospital for the Insane. 3. No Physician shall act as a Manager during the term for which he is chosen to serve the Hospital in a professional capacity. 4. The Managers shall, from time to time, -elect, by ballot, 2 18 three Doctors of Medicine as Eesident Physicians of the Hospital in the city; who shall each serve eighteen months from the period of his election. THE ATTENDING MANAGERS. 1. A Committee of two Managers, to be called the At- tending Managers, shall be appointed monthly, whose duty it shall be generally to supervise the affairs of the Hospitals, and who shall have the sole power to admit and discharge patients, except as hereinafter mentioned. 2. They shall attend at the Hospital on Pine Street on the Fourth-day (Wednesday) of every week, at 10 o'clock A. M. for the above purposes; and shall visit the Hospital for the Insane on the afternoon of the Seventh-day (Satur- day) of every week. 3. They shall keep regular minutes of the admissions and discharges of patients, in both Hospitals; and shall insert thereon all orders given by them for the expenditure of money. OF THE HOSPITAL IN THE CITY I. Of the Attending Physicians and Surgeons. 1. The medical practitioners chosen to serve this Hospital shall be classed with each other, and give their attendance at such seasons as shall be concluded and agreed upon by themselves and the Managers. 2. The Physician and Surgeon on duty shall visit their respective wards daily, in the forenoon; and at such other times as may be necessary for the faithful performance of their duties. They shall also, on the Fourth and Seventh days (Wednesday and Saturday) of every week from 10 to 19 12 o'clock A. M., deliver clinical lectures to such students of medicine as may have acquired the right to attend them. 3. They shall not furnish admission certificates, except agreeably to the rules of this Hospital regulating the admis- sion of patients. 4. Except in cases of emergency, no important surgical operation shall be performed without a previous consultation, of which all the surgeons shall have due notice. 5. The physicians and surgeons shall have power to estab- lish rules for the regulation of their respective wards, to be framed and hung up therein—subject to the approval of the Managers. 6. Each physician and surgeon of the Hospital shall have the privilege of introducing, not exceeding eight of his pupils at one time, to observe the practice of the Hospital, and have the use of the Library; subject to the regulations of the attending Managers. II. Of the Resident Physicians. 1. Candidates for the office must be graduates of medi- cine at the time of their application. 2. The Eesident Physicians shall have charge alternately of the medical and surgical wards, for such terms, and in such manner, as shall be agreed upon by the physicians and surgeons, and approved by the Managers. They shall regu- larly visit the patients under their charge, at least every morning and evening, and to the best of their skill, admi- nister to their relief. They shall accompany the attending physicians and surgeons in their daily visits, report to them all new cases which may have been admitted in their ab- sence, and regulate the practice according to their orders. They shall record all cases of fracture in the book provided for that purpose; shall also keep records of such other cases as may be required by the physician or surgeon on duty; and (permission of the friends of the decedent being first 20 obtained) make such autopsies as may be desired. They shall also have a general superintendence of the nurses, and shall promptly report to the Steward and Attending Mana- gers all instances of neglect of duty. 3. It shall be the duty of the Eesident Physicians to re- port to the Clerk, as soon as practicable after admission, the name, age, disease or accident, place of nativity, occupation, and whether married or single, of every patient who may be admitted without the usual certificate (such as custom- house patients and recent accidents) in their respective wards. 4. It shall also be the duty of the Eesidents to write legi- bly the diagnosis of each case on the admission card sus- pended over the bed of the patient, as soon after admission as practicable. 5. The Eesident who has charge of the Lower Surgical Wards shall have the instruments kept in order, and be accountable therefor, during his term of service. He shall preserve an inventory of them, which, together with the instruments, he shall deliver to his successor. No instru- ment of any kind is to be loaned to any one without the written order of the Attending Surgeon on duty. 6. The Eesidents shall not all be absent from this Hos- pital at the same time. 7. No Eesident shall engage in the teaching or practice of his profession, or in any other occupation out of the Hos- pital, while acting as Eesident Physician thereof. 8. The Physician or Surgeon on duty, as the case may be, shall have the power of appointing a substitute for a Eesi- dent who may be unable to attend to his duties from sick- ness, or has leave of absence; subject to the approval of the attending Managers. Such appointment and approval, in all cases to be entered on the minutes of the latter. 21 III. Of the Steward and Matron. 1. The Steward shall have the general care of the build- ings of this Hospital and lots attached thereto. Subject to the direction of the Attending Managers, the fuel, furniture, food and stores of all kinds shall be purchased by him ; and he shall keep regular accounts of receipts and expenditures to be vouched and laid before the Board as at present. He shall hire the gate-keeper, all the nurses and domestics, and discharge them when he thinks proper. He shall attend to the proper warming of the house in winter, and see that the nurses generally do their duty. 2. The Matron shall have particular supervision of the wards and buildings as to their cleanliness, and the good order of the bedding and clothing used therein; and, sub- ject to the directions of the Physicians, shall superintend the preparation and distribution of the food and diet of the patients. She shall have the general control of the domes- tics, and in conjunction with the Steward take care that the patients are well treated and attended to by the nurses. IV. Of the Apothecary. 1. He shall reside in the Hospital, and perform all the duties appertaining to his department. He shall regularly preserve every prescription of the physician; and no medi- cine or other article shall be delivered by him to any person, unless prescribed in due form. 2. He shall keep pass-books in which all medicines pur- chased by him shall be duly entered. 3. He shall not absent himself from the Hospital, without notifying one of the Eesident Physicians; nor shall he permit patients or others (except officers of the Institution) to occupy the shop. 22 V. Of the Cleric and Librarian. 1. He shall prepare the monthly, annual, and other ac- counts ; and generally perform such duties as appertain to his office, or may be assigned to him by the Managers. 2. He shall have the care of the Medical Library, subject to the Eules for the management thereof. VI. Of the Nurses and Servants. 1. It is the duty of the nurses faithfully to attend to the patients under their charge, and to obey implicitly the directions of the Attending and Eesident Physicians and Surgeons in regard to them; to see that they behave with propriety, and observe all the regulations of the institution, and to report any irregularity or breach of rule to the Steward. 2. Any nurse who shall refuse or neglect to follow the directions of the Attending and Eesident Physicians and Surgeons, as above, or who shall be negligent or inattentive in his or her duties generally, shall be at once discharged by the Steward, on a request to that effect from the Attend- ing Physician or Surgeon on duty, as the case may be. 3. None of the nurses or domestics employed in the Hospital shall absent themselves from their duties therein without having first obtained permission from the Steward, or Matron. And in all cases they are to go and return through the gate on Eighth Street. VII. Of the Watchman, and Watchwoman, or Night Nurses. 1. The Watchman shall commence his duty at nine o'clock P. M., and pass hourly through the men's wards until daylight. He is strictly enjoined to attend to the safety of the kitchen fires, and shall extinguish all lights in the wards, not directed by the Physicians, Steward, or Matron. 23 He is to administer such medicines as may be intrusted to him by the Eesident Physician or Surgeons, to be given in the night to patients. He is also required to report to the Steward all irregularities he may observe during the night. 2. The Watchwoman is charged with the same duties in the wards appropriated to women. VIII. Admission and Discharge of Patients. 1. Persons accidentally wounded or otherwise injured, shall be received at all hours, subject to such rules on the matter, as the Managers shall from time to time enact; provided always, that the accident or injury happen in Pennsylvania, and the patient is brought to this Hospital within twenty-four hours after its occurrence. 2. The number of patients to be admitted on the charity of the institution in this Hospital is now limited to eighty- five, exclusive of recent accidents as above. 3. These shall be distributed as follows :— The men's medical ward shall be limited to twenty beds for poor patients. The women's medical ward shall be limited to twenty- five beds for poor patients. The men's surgical wards shall be limited to twenty beds for poor patients, exclusive of recent accidents. The women's surgical ward shall be limited to twenty beds for poor patients, exclusive of recent accidents. 4. Provided always that room be reserved in the surgical wards for the reception of cases of accident; and that, if these increase beyond the capacity of the wards, the number of other poor patients must be reduced in proportion. 5. The physician and surgeon on duty shall have the power of admitting poor or charity patients in their respect- ive wards, to the numbers above respectively allotted to each ward, subject to the general rules governing the admis- sion of patients into this Hospital. The admission in all 24 cases to be by printed certificate of name, age, place of nati- vity, occupation, whether married or single, and of the dis- ease; under the signature of the doctor admitting. When- ever practicable, the doctor admitting shall also require security for the clothing of the patient, and his or her removal when discharged, from some friend or relation of the applicant, or refer the parties to the Steward for that purpose. 6. The admissions as above made shall be registered by the Clerk and reported to the Attending Managers, on their weekly visits, to be entered by them on their minutes. 7. No person having any infectious or contagious disease shall be admitted into this Hospital. 8. No patient shall be admitted on the charity of the institution whose case is judged to be incurable. 9. Pay patients may be admitted by the Steward on the certificate of a Hospital Physician, at the rates hereinafter established. 10. No person having a syphilitic disease, or mania-a-potu shall be admitted as a charity patient; or at a lower rate of board than four dollars per week for the former, and seven dollars for the latter. 11. The lowest rate of board for pay patients (except as above) shall be $3 50 per week. 12. All pay patients shall give good security for the pay- ment of their board. 13. All patients shall be discharged as soon as they are cured; and all charity patients whose cases, after a reason- able time of trial, shall be judged incurable, shall be dis- charged. 14. All discharges, except for misconduct, shall be made under the direction of the Attending Physician or Surgeon. 25 IX. Of Patients. 1. The patients shall conduct themselves with decorum towards each other, the officers of the Hospital, nurses and servants. They shall not smoke tobacco or play at a*iy game of chance in the Hospital, on pain of immediate ex- pulsion therefrom. 2. No syphilitic patient shall be placed in any other ward than those especially appointed to that class of patients, to which they are to be strictly confined; and no such patient shall have leave of absence, except granted by an Attending Manager. 3. No liquors, provisions or medicines of any kind, shall be furnished to any of the patients by their friends; and no patient shall be permitted the use of any diet prepared in the house other than that which may be ordered by the proper officers. 4. No patient shall be allowed to leave the Hospital while under treatment, except by special permission of the Phy- sicians and Steward. 5. Such charity patients as are able, shall give assistance in nursing or otherwise, when required to do so by a Eesi- dent Physician, or the Steward or Matron. 6. If any breach occur in any of the above rules, the offender shall be liable to be discharged by the Attending Managers; or, in their absence, by the Steward, who shall report to them. 7. When any patient shall desire to see a minister, or teacher of religion, the same is to be communicated to a Eesident Physician; and if it be deemed proper in a medi- cal point of view, the Physician or Steward shall notify the individual whose presence is required; but, except in such case, religious exercises are not to be conducted in the wards of the Hospital. 26 X. Of Visitors. 1. Visitors to patients, nurses and domestics, will be ad- mitted on the Second and Fifth days of the week (Mondays and Thursdays), between the hours of 2 P. M. and sunset; on all other days a special order for admission from a Manager or the Steward will be required. 2. Those admitted to visit patients shall not be permitted to ramble over the house and grounds, but shall be directed to the apartment in which he or she may be; and after a reasonable time, they shall withdraw from the premises. 3. No visitor shall lodge in the Hospital without permis- sion of the Steward. XI. Gatekeeper. 1. The Gatekeeper shall admit no person into the Hospital after ten o'clock P. M. except in case of recent accident. 2. He shall allow no patient to pass from the Hospital without an order from the Steward. 3. He shall immediately report to the Steward all cases of persons attempting to bring in liquor, or coming in intox- icated, and all other irregularities falling under his notice. 4. He shall allow no person to take into the Hospital any liquor, provisions or medicines for any patient, nurse or domestic therein. GENERAL RULES OF ORDER. 1. The Eesident Physicians, Apothecary, and Clerk and Librarian are enjoined to be regular at their meals. As punctuality in this matter is considered essential to the dis- cipline of the Hospital, the Steward is required to report frequent breaches of this rule to the Attending Managers. 2. All lights, except in the wards, entries, Steward's, Ma- 27 tron's, and Physicians' rooms, are required to be extinguished at half past ten o'clock P. M. at the latest. No reading in bed at night is to be allowed, either by patients or any person connected with the establishment in any capacity. A second breach of this rule will render the offender liable to imme- diate expulsion. OF THE HOSPITAL FOR THE INSANE. The title of this branch of the Institution shall be " The Pennsylvania Hospital for the Insane." The new building shall be styled, "the department for males," the other, "the department for females." Officers. The officers of the Pennsylvania Hospital for the Insane, shall consist of a Physician in Chief for the whole establish- ment, and of one or more Assistant Physicians, a Steward and a Matron for each department. I. Of the Physician in Chief. 1. The Physician of the Hospital for the Insane, shall be the official head of that department; and under the instruc- tions of the Board of Managers, shall have the general super- intendence and control thereof, and of all persons employed on the premises. 2. He shall reside upon the premises, and devote his whole time to the promotion of the interests of the Institution and the welfare and comfort of the patients. 3. He shall have the sole direction of the medical, moral and dietetic treatment of the patients; and his directions respecting them are to be implicitly obeyed by all persons about the establishment. 4. He shall have the power to select and dismiss at his 28 pleasure all the attendants and other persons employed in the care of the Insane, and the sole direction of their duties. With the sanction of the Attending Managers, he shall from time to time make such regulations for the government of the attendants, and all others engaged in any way about the Institution, as he may deem salutary. 5. He shall have the general direction of the farm, gardens and grounds of the Hospital; and he shall make contracts with the farmer and others employed thereon, and with the tenants (subject to approval by the Board of Managers). 6. He shall obtain as far as practicable a complete history of the case of every patient admitted into the Hospital, and shall keep or cause to be kept for the use of the Institution a register of the same, and as full a record of the subsequent treatment and results as he may deem likely to promote the interests of science, and tend to improve the treatment of the Insane. 7. He shall furnish to the Board of Managers, annually at its stated meeting in the First month (January) in each year, a detailed report of the operations of the Hospital, with tabular statements of the cases treated, during the preceding year, and of its actual condition; with such other observa- tions as he may deem useful or interesting. 8. All correspondence respecting the patients shall be under his direction. 9. He shall exercise a vigilant supervision of all expendi- tures, and as far as he can, shall indicate by some mark on all bills or receipts, that no purchases have been made or expenses incurred, without his approval, or at least without his knowledge. II. Of the Assistant Physicians. 1. The Assistant Physicians shall reside in the Hospital, and under the direction of the Physician in Chief, shall de- vote their whole time to its service, and carry out to the best of their abilities all the instructions of that officer. 29 2. They shall prepare and superintend the administration of all medicines prescribed for the patients; preserving in a book provided for the purpose, every prescription, with the name of the patient, and shall keep or assist in keeping such records, and performing such other duties as may be required by the physician. 3. They shall be as much as possible among the patients, visiting them regularly every morning and evening, and as often as they can at other hours, and do all in their power to contribute to their comfort and welfare; they shall have a general supervision of the attendants, and shall promptly report to the physician, all instances of neglect or of im- proper conduct on the part of any one connected with the Institution, that may come to their knowledge. 4. They shall not absent themselves from the Hospital, without the knowledge and consent of the physician. III. Of the Stewards. 1. Under the instructions of the physician, the Stewards shall have a general oversight of the buildings, grounds and farm, and shall see that they are at all times kept in perfect order and repair, and that all persons employed about the same perform their duties faithfully. 2. Under the direction of the physician and subject to the instructions of the Attending Managers, they shall purchase furniture, fuel, stores, and other necessary articles, and shall be responsible for their safe keeping and economical use. 3. They shall collect all moneys due the institution for board of patients, &c, as they become due, and shall keep fair and accurate accounts of the receipts and expenditures. They shall furnish transcripts thereof, approved by the Attending Managers, to be laid before the Board at each of their stated meetings. They shall also keep a regular regis- ter of the names and of the dates of admission and discharge of every patient. 30 4. Subject to the authority given to the Physician, and under his instructions, they shall hire, pay, and discharge all persons employed about the premises. 5. No purchases shall be made for the patients, but by direction of the Physician. 6. They shall pay particular attention to the quality of the provisions provided for the use of the Institution, and the manner in which they are cooked and served. They shall, as far as practicable, visit each dining-room during every meal, and see that all things appertaining to them are dis- posed in a neat and becoming manner, that good order and perfect cleanliness are preserved in every part of the house coming under their notice, shall promptly report to the Physician all instances of neglect or improper conduct that they may observe, and, as far as practicable, see that the warm- ing and ventilation of the buildings are properly regulated. IV. Of the Matrons. It shall be the duty of the matrons to look carefully after the comfort of the patients, and to have the immediate charge of the housekeeping. They shall observe the manner in which the attendants and others perform their duties, and report to the Physician any instances of neglect or improper conduct coming under their notice. They shall have the general over- sight and direction of the domestics, and shall superintend and direct the cooking and distribution of food, and in con- junction with the Stewards, shall see that the supply is abun- dant, varied, well cooked, and neatly served, in all the dining- rooms of the establishment, which they shall visit as often as possible at the hours for meals. They shall also see that the bedding, clothing, &c. of the patients are always kept clean and in good order. They are expected to devote their whole time to the service of the Institution, and under the instruc- tions of the Physician, to spare no efforts to promote its prosperity. 31 V. General Rules. All persons engaged, in any way, about the institution, shall be careful to conform to the regulations made for the government of the Hospital, and at all times do what they can to promote its prosperity. No smoking of tobacco by any thus employed, shall be allowed within the enclosures, nor in the vicinity of the barns or other outbuildings; nor shall any persons be employed who are addicted to the habitual use of spirituous liquors. VI. Of the Admission of Patients. 1. Before any patient can be admitted into this Hospital, a request in writing to that effect from some near relative or friend, and a certificate of said patient's insanity signed by a respectable graduate of medicine, shall in all cases be required. 2. Neither idiots nor persons having mania-a-potu, shall be received into this Hospital. 3. A limited number of insane persons in indigent cir- cumstances, whose cases are recent, and such as are believed to offer a fair chance of cure, shall be admitted as patients by the Attending Managers for a period not exceeding three months for each case, and shall be treated without any charge. If promising favorably, and on the recommenda- tion of the Physician, the period may be extended at the discretion of the Board. Security for the removal of such patients when discharged, and for their clothing whilst in the Hospital, shall be required of some responsible resident of the city of Philadelphia, or its vicinity. The number of these patients shall from time to time be regulated by the Board of Managers, and is now fixed at 46. 4. Patients paying board may be admitted by any mem- ber of the Board of Managers, under the following rules. 32 5. The rate of board shall be regulated by the pecuniary ability of the patient, or of the friends of the patient, and the class of accommodations required. The lowest rate shall be— For residents of Pennsylvania ... $5 per week. For all others.........$6 " They shall not be admitted for a less period than three months, for which time the board shall be required to be paid in advance at the time of admission; and if taken away uncured before the expiration of that period, contrary to the advice and consent of the Physician of the Hospital, the amount as above paid in advance shall be considered for- feited, and no part thereof shall be returned. Four weeks board shall be retained in all cases. All payments shall be made quarterly in advance. Security of some responsible resident of the city of Philadelphia or its vicinity shall in all cases be obtained, for the payment of board and all other expenses whilst in the institution, and for the performance of the foregoing conditions. 6. When special attendants are desired they are always to be provided by the Physician of the Hospital, and the charge therefor is to bemadded to the board. REGULATIONS FOR THE ADMISSION OF VISITORS. The Board of Managers—recognizing the duty of shielding the insane from all improper exposure, and regarding their right of protection from the gratification of an idle curiosity on the part of strangers, just as great, while residents of a hospital, as in their own dwellings—have adopted the fol- lowing regulations for the admission of visitors:— 1. Visitors are not to be admitted before 10 o'clock A. M., after sunset, nor on the First day of the week. They are 33 not to be admitted on the afternoon of Seventh day (Satur- day) unless on special business with the Attending Mana- gers, or one of the officers of the house. 2. All parts of the Hospital not occupied by patients may be shown and explained during the hours for the admission of visitors. 3. No visitor, unless in company with a Manager, can be taken into the wards, without permission from the physician to the Hospital, or in his absence, from the Assistant Physi- cian ; and when visitors are allowed to enter the wards, they must always be accompanied by one of these officers, by the Steward or Matron, or by some person delegated by the physician for the purpose. 4. As this Hospital cannot be allowed to become a resort for idle curiosity, it is hoped that the friends of patients, and all others, will carefully avoid prolonging their visits unnecessarily. And those employed in the care of the patients or in the domestic departments are to avoid inviting company to the Hospital. 5. The Pleasure Eailroads and other contrivances for the amusement of the patients, are not to be used by visitors; nor are they to enter the museums or to pass through the pleasure grounds, except by special permission. 6. It is expressly forbidden to furnish any inmate of-this Hospital with tobacco in any form; or to deliver to, or receive from a patient, any letter, parcel or package, without the knowledge and approbation of the Physician. 7. Funds for the use of the patients are to be placed in the hands of the Stewards, to be used only under the direction of the Physician. 3 * 34 8. Under ordinary circumstances, carriages are not to enter the enclosures. When for any purpose they have been taken to the centre buildings, they are never to be left standing there; and drivers are aiways expected to remain with their vehicles outside of the gateway.