LES AND REGULATIONS BELLEYUE HOSPITAL, October 1, 1863. Commissioners of Public Charities and Correction & DRAPER, President. M. H. GRINNELL, JAMES B. NICHOLSON, ISAAC BELL, Jr., Secretary. John E. White, Warden. ^JBS^>- y/ MEDICAL BOARD. Consulting Physicians: Isaac Wood, M.D. President of the Board. John T. Metcalfe, M.D. Visiting Physicians: Alonzo Clark, M.D. Benj. W. McCready, M.D. Isaac E. Taylor, M.D. George T. Elliot, M.D. B. Fordyce Barker, M.D. Alfred L. Loomis, M.D. John W. Greene, M.D. Theodore G. Thomas, M.D. Austin Flint, M.D. House Physicians: Irving Wr. Lyon, M.D. Francis Delafield, M.D. J. B. Luce, M.D. H. G. Olmsted, M.D. Senior Assistants: Geo. Engs, M.D. Geo. H. Porter, M.D. S. D. Wadsworth, M.D. William Lee, M.D. Consu I ting S u rgeons: Valentine Mott, M.D. Alex'r. H. Stephens, M.D, Vts'tting Surgeons: James R. Wood, M.D. Lewis A. Sayre, M.D. John J. Crane, M.D. Stephen Smith, M.D. William Parker, M.D. Alexander B. Mott, M.D. Carl Theo. Meier, M.D. John W. S. Gouley, M.D. William II. Church, M.D, Frank II. Hamilton, M.D. House Surgeons: J. W. Southworth, M.D J. V. Lauderdale, M.D. E. L. Mola, M.D. Senior Assistants: J. G. Smith, M.D. R. M. Wyckoff, M.D, E. O. Rowe, M.D. HOUSE STAFF. RULES AND REGULATIONS FOR THE GOVERNMENT OF THE BELLEVUE HOSPITAL The Bellevue Hospital shall be organized as follows: CHAPTER 1. The Warden. There shall be appointed by the Commissioners of Public Charities and Correction, a Warden of Bellevue Hospital, wTho shall hold his office during the pleasure of the Board. He shall reside in the building, in apartments to be designated by the Board for that purpose, and shall receive a compensation of Fifteen Hundred Dollars per annum, but shall not be allowed any other emoluments, perquisites, or fee* whatsoever. i us DUTIES. 1st. He shall enforce all the police and other rules and regulations of the establishment, and shall receive and transfer all patients, in accordance with the existing laws, and the present and future orders of the Board of Commis- sionprs ofPublie Charities. 4 2d. He shall provide meals for the Resident Staff of the Hospital, at such hours as the Committee of Inspection may direct, and meals shall not be provided at any other hours, except in case of sickness. 3d. He shall supervise and direct the duties of his As- sistants, Apothecaries, Orderlies, Nurses, and Subordinates, and, generally, the whole police and economy of the estab- lishment. 4th. He shall see that the outer gates are locked at a seasonable hour, every evening. 5th. He shall suffer no patient to go out of the House without his special permission. 6th. He shall visit every ward at least once a day, and offcener if necessary, and shall make a note of anything he sees out of order or needing repair, and shall enter such notes in books to be kept in his office for that purpose, directing the same to be attended to by the party whose duty it is to see to them. 7th. He shall not permit any person, except such of the officers and servants of the Hospital enumerated in the regulations as are entitled thereto, and the members of his own family, to take their meals or sleep in the Hospital, or occupy any part of the premises. He shall submit to the Commissioners, on the Monday of every week, a cen- sus of all persons employed in or about the premises, and of all persons residing in the building. 8th. He shall take particular care that no wine or spirits shall be furnished to the patients, except by the written directions of the Physicians or Surgeons. 5 9th. When any patient is desirous to converse with any religious person, he shall invite the person desired by the patient to attend; and while such person is present, shall see that the other patients in the ward behave with de- corum. 10th. When a patient is discharged, the Warden shall cause the same to be entered in a book provided for that purpose, and kept by the Clerk, mentioning the patient as cured, relieved, incurable, eloped, or disorderly, with the date of such discharge, and his disease. 11 th. On the decease of a patient, the Warden shall cause the name and time of the decease of such patient to be entered in the Register, and the body taken to the Dead House, and there safely kept until delivered to the relatives of the deceased, when demanded by them, he notifying them of the death of the patient without a mo- ment's delay ; and he shall be particularly responsible for the execution of this duty, and that the name of the attend- ing Physician or Surgeon shall form a part of the record. 12th. If the House Physicians and House Surgeons or their Assistants, Students attending the Hospital, the Apothecary, Clerk, Engineer, or other persons employed in the Institution, shall disregard the rules and regula- tions, or otherwise misconduct themselves, it shall be the duty of the Warden to report the offenders, in writing, to the Commissioners, and also to the Committee of In- spection, if such offender is a House Physician or Sur- geon, Assistant or Student. 13th. The Warden shall take charge of all money, val- uables, or property found in possession of the patients on fi entering the Hospital, for which he shall be accountable; he shall give receipts therefor, and leport and transmit the same to the Board of Commissioners. 14th. When a patient dies, leaving clothes, money, or other articles of value, the Warden shall take charge of them, and shall report the same to the Commissioners, who Will give him the necessary directions for their proper disposition. 15th. On the last day of every month, and oftener if required, the Warden shall make a written report or statement to the Commissioners of all monies received by him for them during the month, and shall pay it over to them. 16th. The Warden, in addition to signing all requisi- tions for supplies, shall sign all bills, discharges, and passes. 17th. He shall receive all patients, see to their classifi- cation, and transfer them, under the direction of the Medical Officers or Commissioners. 18th. On their admission to the Hospital, the Warden shall examine them, under oath if deemed necessary, as to their name, age, and residence, nativity, time in the country, &c, and also as to any property or money they may have, and their ability, or that of their rela- tives, to support or pay for them, and he shall report to the Commissioners the result of such examination in all cases. < 19th. The Warden shall see that police, accident, and all supposed insane and other dangerous cases, are promptly attended to, immediately on their arrival, and he shall report to the Commissioners and to the Committee of Inspection any neglect on the part of the House Sur- geons or Physicians in the performance of this duty. 20th. He shall suspend from duty any employee of the Institution, wilfully disregarding or breaking the rules thereof, or refusing to perform his proper and necessary orders, and he shall immediately report, in writing, such suspension to the Commissioners, with the facts of the case. 21st. He shall give certificates in all cases of death, and furnish duplicate certificates to relatives and any parties interested, whenever properly requested. 22d. He shall report to the Commissioners on Monday of each week, the time of abscence of all officers of the Institution, for the previous week during business hours, specifying what portion of such absence is on their own business. And he shall also at same time, report to the Commissioners the number of mechanics employed in the Institution for the week, and the kind of work they were engaged on, and whether paid mechanics or inmates of the Hospital. 23d. He shall at least twice in each month report to the Commissioners and to the Committee of Inspection, the amount of liquors consumed in the Hospital for the previous two weeks, and also what he may deem the unnecessary increase in the consumption of any other article. 8 24th. On the first days of April, July, and October in each year, he shall report to the Commissioners the quan- tity and kind of work and labor performed in the Institu- tion for the quarter ending at the date of such report; and at the close of each year he shall make an Annual Report to the Commissioners of all matters appertaining to his office. CHAPTER II. The Clerk. There may be appointed by the Commissioners of Pub- lic Charities and Correction, a Clerk of Bellevue Hospital, who shall hold his office during the pleasure of the Board. He shall receive a compensation of Eight Hundred Dollars per annum, but shall not be allowed any other emolu- ments, perquisites, or fees whatsoever. HIS DUTIES. 1st. He shall keep all the books of the establishment, including proper and full Registers of all patients received, discharged, deceased, the name, age, sex, place of nativity, residence, and malady of the patient, the name and resi- dence of his nearest friend or relation, the date of recep- tion and of discharge of the patient, and also an alphabet- ical list thereof, and including such other books as shall be directed by the Board of Commissioners to be kept by him. 2d. He shall receive and enter the bills or invoices of all supplies received at the establishment. 9 3d. He shall enter all requisitions of the Warden, and keep copies thereof. 4th. He shall prepare, enter, and keep copies of all re- quisitions made by the Warden on the Board of Commis- sioners for supplies of any kind. 5th. He shall examine the several requisitions, and bills, and invoices for supplies, and note any discrepancies. 6th. He shall prepare for the signature of the Warden, and transmit to the Board, weekly reports of the census of the Hospital, the consumption of Hospital Stores, and all other reports and communications that may be re- quired by the Committee of Inspection or the Warden, as may be requisite or proper. 7th. He shall have personal charge, under the Warden, of all Hospital stores, unmade Linen, Blanketing, Cloth- ing, the Clothing of deceased Patients, and of all other moveable properties, to the receipt and distribution of which he shall personally attend, under the direction of the Warden. Sth. He shall make his requisitions on the Warden, from time to time, on Monday of each week, and enter the same. 9th. He shall compare the requisitions with the sup- plies of articles furnished in his department, and note any discrepancy therein. 10th. In any case requiring the attendance of a Coroner at the Hospital, it shall be the duty of the Warden to im- mediately send a notice to that effect to the Coroner's office, 10 11th. When a patient dies, the Clerk shall, under the direction of the Warden, make a full inventory of the clothing, and other effects left by such patient, in books to be kept by him for that purpose; and he shall also enter in same books, the final disposition made of such ar- ticles, and on whose order the same were disposed of. 12th. He shall also enter in full in books provided for that purpose, the examinations taken under the direction of the Warden, of all patients admitted to the Hospital. 13th. Immediately on the death of a patient, he shall notify the relatives or friends of such patient; and shall perform such other duties connected with his office as the Warden may direct. CHAPTER III. Of the Engineer. There shall be appointed by the Commissioners of Pub- lic Charities and Correction, an Engineer of Bellevue Hos- pital, who shall hold his office during the pleasure of the Board; he shall reside in the building, in apartments to be designated by the Board for that purpose, and shall re- ceive the compensation of dollars, but shall not be allowed any other emoluments, perquisites, or fees whatsoever. HIS DUTIES. 1st. The Engineer, under the supervision and direction of the Commissioners of Public Charities and Correction, 11 shall have charge of the boilers, and steam machinery and apparatus of all kinds in the establishment. He shall have the care of the tanks, hot and cold water apparatus and fixtures. It shall be his duty to provide an adequate sup- ply of hot and cold water, to keep all the steam pipes, boilers, force pumps, washing and other machinery, and iron work in good order and repair. He shall be responsi- ble for the economical use of coal and of steam, and for the neat and orderly condition of the boiler-house and air chambers, and everything connected therewith. It shall be his special duty to see that a uniform temperature of 68° to 70° of Fahrenheit thermometer be maintained in all the wards during the winter, and visit them night and day, as often as may be necessary, to secure this object. The Engineer and his assistants shall be subject at all times to the direction and control of the Commissioners of Public Charities and Warden. 2d. The Engineer shall also have charge of all the gas pipes and fixtures of the Hospital, and shall see that they are kept in proper order and repair. And there shall be kept in the office of the Warden a memorandum book, in which shall be entered all matters out of order, or needing attention in the department of the Engineer; which book shall be at all times open to the Inspection of the Com- missioners. Afld it shall be the duty of the Engineer to immediately attend to such matters, and when done, to make an entry to that effect in such book. 12 CHAPTER IV. The Matron. There shall be appointed by the Commissioners of Pub^ lie Charities and Correction a Matron of Bellevue Hospi- tal. She shall reside in the building, in apartments to be designated by the Board of Commissioners for that pur- pose, and shall receive in addition thereto a compensation of Four Hundred Dollars per annum, but shall not be allowed any other emoluments, perquisites, or fees whatsoever. HER DUTIES. 1st. She shall visit all the wards in the Hospital every day, and see that they are properly attended by the nur- ses and assistants. 2d. She shall oversee the female patients and servants, and take care that the wards, bath rooms, halls, windows, entries, and Doctors' apartments, the beds, clothes, linen, and other things are kept clean and in order. All the pa- tients, nurses, and servants, under the direction of the Warden, must obey her orders. 3d. She shall immediately report to the Warden, any of the nurses, or their assistants, who neglect to keep their wards in order, or violate any of the rules of the Institution. 4th. She shall take care of all the household goods and furniture, placed by the Warden under her charge. 13 5th. She shall perform such other duties as the Board of Commissioners from time to time shall prescribe, and shall be subject at all times, to the control and direction of the Commissioners and Warden. CHAPTER V. The Apothecary. There shall be appointed by the Board of Commissioners of Public Charities and Correction an Apothecary of Belle- vue Hospital, who shall hold his office during the pleasure of the Board. He shall reside in the building, in apart- ments to be designated by the Board for that purpose, and shall receive in addition thereto a compensation of Nine Hundred Dollars per annum, but shall not be allowed any other emoluments, perquisites, or fees whatsoever. HIS DUTIES. 1st. He shall compound and make up all medicines pre- scribed agreeably to the formulae from time to time directed by the Physicians and Surgeons of the Hospital, which shall be recorded in a book, to be kept in each ward for that purpose. 2d. He shall deliver no medicines which are not ordered by the Attending Physicians or Surgeons, or House Physi- cians or House Surgeons, which are not registered in the prescription books, and shall permit no medicines to be carried out of the House, except under the direction of the Attending Physicians or Surgeons, and only to patients taking their discharge. 14 3d. He shall put up the medicines intended for each ward, separately, and shall annex to them labels contain- ing the names of the patients for whom they were re- spectively prescribed, and the number of the bed which the patients occupy, and, when necessary, directions for taking them. 4th. He shall send them to each ward by the Orderly man, to be by him distributed to the patients. 5th. He shall regularly attend the office, and never be absent without the Commissioners' permission. lie shall keep the shop open from 7 o'clock in the morning until 9 o'clock in the evening, and everything appertaining to it, clean and in perfect order. 6th. No liquid medicine shall be put up in a larger quantity than 2 oz. bottles. 7th. He shall carefully observe economy in everything relating to his department; be particularly prudent and careful in the delivery of medicines, and permit no patient to enter the shop unnecessarily. 8th. He shall have charge of the liquors provided for the patients' use, and he shall deliver no liquors except on the written order of the Attending Physicians or Sur- geons, or House Physicians or House Surgeons, or on the written requisition of the Warden. 9th. He shall make a semi-monthly report to the War- den of the amount of liquors consumed for every purpose for the previous two weeks, and he shall also state in such report, the increased consumption of any other ar- 15 tide in his department, which increase he may deem ex- travagent or unnecessary. 10th. No person shall be appointed Apothecary unless he be twenty-one years of age, nor until he shall have pro- duced sufficient testimonials of his good moral character, and have obtained a certificate, signed by at least two Physicians and two Surgeons, setting forth his competency and good character. CHAPTER VI. The Medical Board. There shall be appointed by the Board of Commission- ers of Public Charities and Correction, regular Practition- ers of Surgery to be Attending Surgeons, and regular .Practitioners of Medicine to be Attending Physicians to the Hospital. They shall also appoint two other regular Practitioners of Surgery to be Consulting Surgeons, and two other regular Practitioners of Medicine to be Consult- ing Physicians of said Hospital. All the said appoint- ments shall be honorary. The above-mentioned Consulting and Attending Physi- cians shall, together, compose "The Medical Board" of the Bellevue Hospital. They shall hold their offices during the pleasure of the Board of Commissioners. THEIR DUTIES AND POWERS. 1st. The Medical Board shall advise the Board of Com- missioners, through the Committee of Inspection, in all matters pertaining to the health and physical well being of the inmates of the Hospital. 2d. They shall prescribe and regulate the duties of the Physicians and Surgeons of the Hospital, and of the House Physicians and House Surgeons and their Assistants, and they shall moreover prescribe and regulate the manner and time of giving clinical instruction, and take measures for securing the necessary publicity of their regulations on this subject. 3d. They shall receive applications, and examine strictly into the qualifications of all applicants for appointment in the Medical Staff of the House, including the Apothecary, and report to the Board of Commissioners for appointment those whom the Committee may consider competent to perform the duties of the several stations applied for. 4th. The examination shall be conducted by a Commit- tee of not less than five of the Medical Board, appointed for that purpose. 5th. In case of a vacancy in the Medical Board, they shall nominate to the Board of Commissioners, suitable persons for appointment. 6th. The Medical Board shall meet regularly on the last secular day of each month, at 1 o'clock, P. M., in the Commissioners' Room, in the Hospital. 7th. At their first regular meeting in each year, the Medical Board shall elect, by ballot, a President, Vice- President, and Secretary, who shall perfomi the duties of those offices respectively, during the year. 17 8th. They shall also elect, by ballot, every twelve months, three of their number, to serve as a Committee of Inspection, and five as a Committee of Examination. 9th. They shall also elect annually, by ballot, two of their number, to serve as a Committee on the Apothecary's department, whose duty it shall be to examine frequently into the quality of the drugs and medicines furnished for the use of the Hospital, to maintain a general supervision over this department, and to report to the Medical Board as occasion may require. 10th. The Medical Board shall regulate the diet of the patients in the Hospital, as well as their hours of eating, and the modes of cooking their food. For this purpose a regular Diet Table for the Hospital shall be prepared, which shall be revised as occasion may require, by a Com- mittee of the Medical Board. 11th. Special meetings of the Medical Board may be called at any time by either the Board of Commissioners, the President of the Medical Board, or by the Committee df Inspection. CHAPTER VII. The Committee of Inspection, The Medical and Surgical Department of the Hospital shall be under the supervision of a Committee, to be termed " The Committee of Inspection," which shall be composed of three members of the Medical Board, 3 18 rrs powers and duties. 1st. The Committee of Inspection shall meet at least twice in each calendar month, at the Hospital, to transact business. 2d. In case the House Surgeons, House Physicians, or their Assistants, or any of them, shall neglect any of the duties prescribed to them, or refuse to comply with any proper request of the Committee of Inspection or Warden, the joint Committees may suspend the offender, and report the case forthwith to the Commissioners—and, in the meantime, the Committees may supply the vacancy. 3d. They shall personally inspect, at least once a week, the Hospital and grounds—examine into the state of the Surgical and Medical Police of the Institution—see that all proper requirements for the treatment and welfare of the patients be supplied, and that the rules and regulations provided for the government of the Hospital be rigidly en- forced, as far as they shall be able, exercising due economy in the use of medicines, and of medical and surgical appli- ances, and in the allowance of extra diet and liquors. 4th. They shall keep a book of written minutes of their proceedings. 5th. They shall inquire into the behavior of the Matrons, Nurses, Orderlies and Subordinates towards the patients- shall examine whether the wards are kept in proper or- der—if the bread and other provisions are of good quality, and the patients allowed a sufficient quantity, and are regularly attended by the Physicians and Surgeons-*if the ID Apothecary's shop is neat and in good order, and whether any improvements can be made for the greater comfort of the patients—also, whether the Wards, Water Closets, Bathing Closets, and Dead House are kept in good con- dition, and are properly ventilated, so that they may be supplied with pure and wholesome air. 6th. They shall, at least once in each month, examine the House Physicians and House Surgeons as to the per- formance of their respective -duties, and as to the daily attendance and behavior of the Assistants, intended as candidates for the offices of House Physicians and House Surgeons. 7th. Their Book of Minutes shall be the property of the Commissioners, and at all times open to their inspection. 8th. Twelve hours after death, post mortem examina- tions may be directed to be made by the Attending Phy- sicians and Surgeons of the Hospital, by their signing a ticket for that purpose; but no post mortem shall be made, should the relatives of the deceased object, and such objection shall be given in writing, and if insisted upon, an appeal may be made to the Commissioners; and all post mortem examinations shall be made with all del- icacy and propriety, and any disregard of a proper respect for the body, on the part of those making the examination, or of the Keeper of the Dead House, of his duties, shall be reported to the Commissioners by the Committee of In- spection. All post mortems, previous to being made, shall be reported to the Warden of the Hospital, and entered by him on a book provided for that purpose. 20 9th. They shall examine at least tvyipp in each month into the consumption of the liquors for hospital purposes, and see that due economy is exercised in the orders of the House Physicians and House Surgeons. 10th. They may grant leave of absence to the House Physicians and House Surgeons, and their Senior or Junior Assistants, but such leave shall be immediately reported to the Board of Commissioners of Public Charities and Correction for their approval. CHAPTER VIII. Of the Consulting Physicians and Surgeons. 1st. The Consulting Physicians and Surgeons shall be two regular practitioners of Medicine, and twTo regular practitioners of Surgery, whose age and professional ex- perience may render their opinions and services highly desirable and useful. 2d. They shall be invited to attend all capital opera- tions at Bellevue Hospital. 3d. They may recommend to the Commissioners of Pub- lic Charities and Correction, persons to be admitted as patients. 21 CHAPTER IX. Of the Attending Physicians and Surgeons. 1st. There shall be appointed by the Board of Commis^ sioners of Public Charities and Correction, regular prac- titioners of Medicine and regular practitioners of Surgery of the city of New-York, wTho shall be called the Attend- ing Physicians and Surgeons of Bellevue Hospital. Their appointment shall continue during the pleasure of the Board. 2d. It shall be their duty, during their terms of service, to prescribe for and direct the treatment of all the patients under their charge. They shall visit eveiy medical pa- tient wdio may be afflicted with an acute disease, at least once every day, and as often as is necessary, and every medical patient in the Hospital, without exception, twice in every week. They shall visit the Hospital daily, during their term of service, and shall enter their names at each visit in the Register kept for that purpose. 3d. At such visits the Attending Physician or Surgeon shall inquire whether his directions and prescriptions have been carefully observed; if not, the reasons to be given for his neglect. He shall be required to attend to the neat- ness and ventilation of the wards, and give such directions pn those subjects as may be necessary to the Warden. He shall direct the House Physicians or Surgeons to report to the Warden such patients as are in a proper condition to leave the Hospital, or such as should be transferred to the Alms House or Island Hospital. 09 4th. If any Physician or Surgeon shall be prevented from attending in his turn, he shall procure one of the other Physicians or Surgeons belonging to the Hospital to attend in his stead ; but no Physician or Surgeon shall provide a substitute unless absent from the city, or pre- vented by sickness, for more than one week during each term of service, the name of the substitute to be reported to the Board of Commissioners, with his acceptance of such service. Entire absence from duty for one month will leave the Commissioners at liberty to fill the vacancy. 5th. The Attending Physician and Surgeons, or any of them, shall be present when required by the Board of Commissioners, to confer with them on the management of the House. 6th. No capital operations, except in cases of emer- gency, wherein, by delay, the life of the patient would be endangered, shall be performed, without a previous con- sultation, to which all the Surgeons and Consulting Sur- geons of the Hospital shall have been invited ; and in case after consultation such operation shall be deferred to another time, notice of its performance shall be sent to all the Physicians and Surgeons composing the Medical Board of the Hospital, and to the Commissioners; nor shall any operation be performed (except as in hereafter provided) unless by the Surgeon in attendance on the patient. 7th. In cases where extra diet, owing to peculiar cir- cumstances, may be necessary, the Physician or Surgeon in attendance shall direct, by order on the Warden, such extra articles to be supplied to the patient. 23 8th. Each of the Attending Physicians and Surgeons shall report in writing to the Medical Board, and Board of Commissioners, after his term of service is completed, the general condition of the Hospital during that period, and this report shall state wThether the House Physician and the House Surgeons, and their Assistants and the Apothe- cary, have discharged their respective duties with skill and fidelity ; and whether the Nurses have treated the sick with care and humanity, and shall also contain such sug- gestions and remarks as shall appear to him to be useful. In case the Physician in attendance shall require Surgical advice or assistance, he shall call upon one of the Surgeons on duty at the time. 9th. At the close of every year, and oftner if required by the Board of Commissioners, a table of the diseases of the patients in the Hospital during the past twelve months shall be made out and duly arranged, in order that the same may be published with the general account of the state of the Hospital, wThich table shall be prepared by one Physician and one Surgeon, to be appointed for that purpose by the Medical Board. 10th. In order to render the Hospital, as far as may consist with the welfare of the patients, conducive to the advancement of medical science, the Physicians and Sur- geons may provide among themselves adequate and regu- lar practical instruction, by observations accompanying operations and prescriptions, by clinical lectures or other- wise, to the students admitted to see the practice of the House, during the ordinary periods of lecture at the medi- cal institutions of the City, and longer if deemed expedient. 24 Due notice of the time and period of such instruction shall be given, and when announced, shall be punctually observed* 11th. It shall be the express duty of the Physician or" Surgeon to guard against any examinations of patients by pupils, except under their own inspection, and against all acts calculated to alarm or injure the patients; and in cases where any observations in their presence might have an injurious tendency, they shall be postponed to the halls or theatre. 12th. No surgical operation shall be undertaken with- out the consent of the patient; but if, in! the judgment of the Surgeons in consultation, such operation be decided absolutely necessary to the patient's safety or welfare, such patient may, by direction of the Surgeon in attend- ance, be discharged from the Hospital, on refusal to have? the operation performed. CHAPTER X. Of the House Physicians and House Surgeons. 1st. There shall be appointed by the Board of Commis- sioners of Public Charities and Correction, on the nomina- tion of the Medical Board, regular graduates of medicine, who shall be House Physicians and Surgeons to the Hos- pital. They shall hold their appointment for six calendar months, and shall reside in the building, in apartments to be designated by the Warden for that purpose, and shall 25 receive in addition thereto, their washing and board, and shall not be allowed any other emoluments, perquisites or fees whatsoever. 2d. The term of service of each of the House Physicians and House Surgeons shall be equally divided among the medical and surgical wards, under direction of the Medical Board. 3d. No person shall be appointed to the offices of House Physician or House Surgeon, unless he shall have per- formed in regular order the duties of Junior and Senior Assistant for their respective terms, to the satisfaction of the Medical Board. 4th. The House Physician and House Surgeons shall Visit their respective wards once, at least, every morning and evening, and be prepared to report the state of the patients to the Visiting Physicians and Surgeons. They shall see that the medicines sent to the sick are regularly taken, and that they are administered with care and neat- ness, and without delay. They shall also report to the Attending Physicians and Surgeons, at their next visit, all prescriptions made during their absence. They shall sign the prescription book upon leaving the ward, and it shall be their duty to send the book to the Apothecary at or before 11 o'clock, A. M. and 7 o'clock, P. M. 5th. In any medical, surgical, or obstetrical case of emergency, the House Physician and House Surgeon shall promptly request the immediate attendance of the Attend- ing Physician or Surgeon, and if he cannot be found, of any other of the Physicians or Surgeons of the Hospital. 4 '26 6th. There shall be on duty one House Physician and one House Surgeon for the period of one week, who, during that time, shall examine every patient applying for admission to the Hospital, and decide upon the nature of their disease, whether medical or surgical. They shall report to the Clerk the name, residence, age, and sex of the patient, also their diagnosis, the time the examination was made, and by whom, registering the same in a book provided for that purpose. In case of doubt, they shall call upon one or more of the House Physicians and Sur- geons, and the majority shall decide. In case of doubt as to the propriety of admitting a patient to the Hospital, the examiners shall immediately report the case to the Warden for his action, or if necessary, for that of the Com- mittee of Inspection. It shall also be their duty to see that the patients shall, when there exists no reason to the contrary, take a bath immediately on their admission. 7th. The House Physicians and House Surgeons shall take their turn in attending the Examination Rooms, as above provided for, in rotation, beginning with the first medical and first surgical divisions. The time of such atten- dance to commence on Monday morning of each week. The House Physician or House Surgeon on duty in the Lying- in Department, will not be required to perfomi this ser- vice, his place will be filled by the House Physician, or House Surgeon of the next following division. In the temporary absence of the House Physician, or House Sur- geon ou duty at the Examination Room, that service will be performed by the House Physician, or House Surgeon who is doing duty on the division following. In case the House Physician or House Surgeon, whose dutv it is t»< 27 perform this service, shall be absent from the Hospital on leave, and his Senior Assistant is acting House Physician, or House Surgeon, it shall then be the duty of such Senior Assistant to perform this service. 8th. The following shall be the regular hours to be ob- served for the examination of patients, applying for ad- mission to the Hospital; 10 o'clock, A. M., 12 o'clock, M., 3, 4£, and 6 o'clock, P. M. 9th. All accidents, and all cases requiring prompt at- tention, are to be examined immediately on their arrival, by any House Physician, or House Surgeon called upon. ] 0th. All Diet orders, Liquor and extra orders for pa- tients, and also all prescriptions must be signed by either the Visiting, or the House Physician, or House Surgeon of the division such orders and prescriptions are intended for, and all complaints in complaint books, are to be made and signed by the House physician, or House Surgeon. During the absence of a House Physician or House Surgeon, from the Hospital, Senior Assitant will act, specifying in Ills orders such absence. 11th. All examinations of patients for admission, shall be made in the place designated by the Board of Commis- sioners for that purpose. 12th. It shall be their duty to report the disease of which any patient dies, immediately after his death, to the Clerk, in order that the register may be regularly kept. 13th. Neither the House Physicians nor House Surgeons shall discharge a patient without the consent of the Attend- 28 ing Physicians and Surgeons ; but they may report to the Warden, proper cases, in their opinion, for discharge or for transfer to the Island Hospital, or the Alms House. 14th. They shall not be absent at the usual hours of at- tendance of the Physicians and Surgeons, and when either of them intends to go off the premises, he shall leave notice with the AVarden where he may be found, and shall take care to provide a substitute, in the person of some other House Physician or House Surgeon, to attend in his ab-' sence, and shall before leaving, mark his absence from the Hospital iu a suitable place to be provided by the Warden for that purpose, and when leave of absence shall be ob* tained by any House Physician or House Surgeon, or their Assistants, they shall before leaving, report such leave to the Warden, stating for what length of time the same has been granted, and who has been appointed to act as his substitute, and in no case shall three of them be absent at the same time. They must tee in the Hospital at a season- able hour in the evening, and shall not sleep out of the House, except by^ special permission of the Committee of Inspection or Commissioners. . 15th. They shall not engage in any other business than that of the Hospital, nor shall they practice out of the House. 16th. The House Surgeon of the first surgical division shall have charge of all the surgical instruments, and the House Physician of the first medical division of all the obstetrical instruments and apparatus belonging to the Hospital, and shall be responsible for them and for their good order. 29 17th. On taking charge of the instruments, the House Surgeon shall immediately make a catalogue of all the surgical instruments for the general service of the Hospi- tal, noting their condition, and specifying what instru- ments have been lost or not accounted for by his pre- decessor, and he shall submit the same to one of the Sur- geons on the Committee of Inspection, and have the instruments compared with such catalogue. The House Physician on taking charge of the obstetrical instruments and apparatus of the Hospital, shall also in like manner make a catalogue of them, and submit it with such in- struments, for examination by a Physician on the Com- mittee of Inspection. They shall deposite with the Com- mittee of Inspection and Warden copies of such catalogues. 18th. All new instruments or apparatus purchased for the use of the Hospital, shall immediately be entered on the catalogues, and a statement of such new purchases shall be furnished the Committee of Inspection and War- den. The instruments and catalogues shall at all times be open to the inspection of the Commissioners. 19th. The House Surgeon and House Physician having charge of the instruments, shall never suffer any of them to be lent or used out of the Hospital, and on giving up their charge, the instruments shall be compared with the catalogues in the possession of the •Committee of Inspec- tion and the Warden, and their successor shall sign re- ceipts for the same, in duplicate, one of which receipts shall be delivered to the Committee of Inspection and Warden. 20th. When any instruments are mislaid, injured or lost, the House Physician or Surgeon having them in charge, 30 shall immediately notify the Committee of Inspection and Warden of the same, and in case he omits to give such notice, or that such instruments are lost through his ne- glect, he shall, in the discretion of the Commissioners and Committee of Inspection, be held responsible for them, and liable to replace the same. 21st. The House Surgeon having charge of such sur- gical instruments, shall keep the same locked in proper cases to be provided for that purpose, and shall keep the keys of such cases, and during his temporary absence, he shall leave the same with his senior assistant or with the Warden, and shall not give the same to any other party without the consent of the Committee of Inspection or Warden. 22d. There shall be kept in the instrument room of the Hospital a pass or memorandum book, in which shall be entered every instrument taken out of the cases, with the name of the Physician or Surgeon taking the same, and the ward or place where they are to be used ; and the House Surgeon or House Physician taking the instrument shall be held responsible for their proper return to the cases. 23d. Each member of the House Staff on receiving a Pocket Case of Instalments belonging to the Hospital, shall immediately report to the Committee of Inspection and Warden the state of such case, and furnish them with a catalogue of the contents of the same, and they shall be held responsible for them, and for their good order. 24th. No instruments for general use, or for a pocket case, shall be purchased, except on the requisition of a 31 Visiting Physician, and the Chairman of the Committee of Inspection, to be submitted through the Warden, to the Commissioners. 25th. The House Physician and House Surgeon, having charge of the Instruments of the Institution, if they have performed their duties to the entire satisfaction of the Commissioner and the Committee of Inspection; will, on their discretion, on the expiration of their term of service, be presented by the Commissioners with a Pocket Case of Instruments. But, in no case will such pocket case be given, when a resignation has been tendered, without the approbation of the Board of Commissioners. 26th. It shall be the duty of the House Physicians and House Surgeons to make post-mortem examinations, when directed so to do by the Attending Physician or Surgeon to whose service they may be attached, and perform such other professional duties as the Physicians or Surgeons in attendance may from time to time require. 27th. No examination of females in the Institution shall be made by any member of the House Staff, without two or more of them being present. 28th. It shall be the duty of the House Physicians and House Surgeons, to immediately notify the Warden of any case in their divisions, which in their opinion, requires the attendance of a Coroner at the Hospital; and notices shall not be sent to the Coroner's in any other manner, than as herein before specified. 29th. No House Physician or Surgeon who leaves the Hospital before he has completed his term of service, shall receive a diploma from the Medical Board. 32 30th. If a member of the House Staff tenders his resigna- tion to the Board, unless the causes leading to such resign nation be perfectly satisfactory to the Board of Commis- sioners and to the Committee of Inspection, the resignation shall not be accepted, but the gentleman offering it shall be dismissed from the service. CHAPTER XI. Of the Assistants to the House Physicians and House Surgeons. 1st. There shall be appointed by the Board of ComnriV sioners of Public Charities, on the nomination by the Medical Board, regular graduates in medicine, who shall be styled "The Senior Assistants of Bellevue Hospital." They shall hold their appointments for the period of six months, and shall reside in the Hospital, in such quarters as may be provided by the Warden, and receive their board and washing, as in the case of the House Physicians and House Surgeons. 2d. They shall be subject to all the provisions of Sec. 14th, of Chapter X, in respect to House Physicians and House Surgeons, as to leaving the premises, keeping season- able hours, and sleeping out of the Hospital, and reporting their intended absence from Hospital, &c. 3d. To each House Physician and House Surgeon shall be assigned a Senior Assistant, who shall act (under di- rection of the Physician in attendance) as assistant to said 33 1 louse Physician and Surgeon. He shall always be present at the visits of the Physicians and Surgeons. 4th. The Senior Assistant to the House Physician shall, under the direction of the Attending Physician or Surgeon, keep a register of all medical cases which occur in the Hospital, in books which shall be kept in the library of the Hospital, making the entry therein as soon as practi- cable after admission. In this register shall be entered the name, age, and occupation of each patient, the probable cause and history of his disease, the remedies used before and after his admission, the name of the Attending Phy- sician or Surgeon, his daily reports on the case, the ter- mination of the disease, either in recovery, relief, or death, and other circumstances as may tend to illustrate the case and nature of the disease. 5th. No such Medical or Surgical Assistant shall be eligible to the office of House Physician or Surgeon, unless he shall have kept the prescribed Register to the satisfac- tion of the Medical Board. CHAPTER XII. Of the Junior Assistants. 1st. There shall be appointed by the Commissioners of Public Charities and Correction, regular students of Medi- cine, who shall attend the visits of the Physicians and Surgeons of the Hospital, but who shall not reside in the House. Their services shall be gratuitous, and they shall perform for the period of six months the following duties. 5 34 2d. They shall perform such operations in the way of cupping, leeching, bleeding, dressing, &c, as the Physi- cians and Surgeons, to whose service they shall be respec- tively attached, may direct. 3d. When necessary, they shall aid the Senior Assistant in making or copying records and reports of cases. 4th. They shall accompany the regular visits of the Physicians and Surgeons on duty. 5th. They shall hold themselves ready, upon the requi- sition of the Medical Board, or of the Committee of In- spection, to take the place of any Senior Assistant who may be temporarily absent or disabled. 6th. The assignments of Junior Assistants to the re- spective service, shall be made by the Committee of Ex- aminations, by giving the choice to the various gentlemen successively, in the order of their merit, as ascertained by the Examining Committee. CHAPTER XIII. Of Students admitted to see the Practice of the House. 1st. Any student of medicine who may be hereafter privileged on such terms and conditions as shall be pre- scribed by the Board, shall receive a ticket entitling him to visit and see the practice of the House, subject to the regulations of the Hospital, the same being matriculated students of any of the incorporated colleges in the city. 35 2d. No student shall be entitled to attend the Hospital except at the hours of prescription, operation or lecture. Every student shall produce his ticket to the gate-keeper at the gate, and shall behave with decorum and propriety. And if any student shall infringe any of the regulations of the Hospital, or be guilty of any improper conduct, smoking or using tobacco in the halls or wards, sitting or standing on the beds or tables in the wards, it shall be the duty of the Warden to report him to the Committee of Inspection, who may give orders to exclude him in future from the Hospital. And that he may be informed of the regulations to which he is subject, every student shall be furnished by the Warden with a copy of this by-law. 3d. No student shall be allowed to visit the Hospital in the evening, after the gates are closed.' CHAPTER XIV. Of the Patients. » 1st. No patient shall leave the House unless by permis- sion of the Warden ; nor play at any game of hazard with- in the Hospital ; nor introduce any spirituous liquors into the premises. 2d. No male patients shall go into the women's apart- ments, wards, or grounds, nor any female patient into the men's apartments. 3d. No patient shall smoke tobacco in the wards, ve- randas, halls, or entries, nor without the permission of the Warden, elsewhere in the House. 36 4th. When there is no Chaplain in attendance to per- form public worship, the Warden, on Sunday, at 10 o'clock in the morning, and at 3 in the afternoon, shall appoint a suitable person for each ward, to read audibly some chap- ters in the Bible to such of the patients as shall so desire; in which case they are to attend with decency and respect; and it is also recommended to the patients, as often as cir- cumstances will permit, to read the Holy Scriptures on other days of the week. 5th. If any patient shall not conform to the foregoing regulations, or such further regulations as shall from time to time be made for their government, or shall use pro- fane or indecent language, or get drunk, or behave rudely or indecently, or. shall wilfully waste or destroy the Hos- pital property, or refuse treatment, such patient shall be reported to the Warden, who shall enforce the rules of the Hospital, and report the case to the Commissioners. 6th. No patient shall be out of his ward after dark, or before breakfast in the morning. CHAPTER XV. Of Admission of Patients. 1st. Any Commissioner, Physician, or Surgeon of the Hospital, may recommend patients to be admitted, but the Board of Commissioners may refuse to admit patients, so recommended, at their discretion. 2d. In any pressing case, where great inconvenience would result from waiting for the approbation of the 37 » Board of Commissioners, any Commissioner, or member of the Medical Board of the Hospital, may have a patient re- ceived immediately. And in case of sudden accidents, the Warden may receive patients without recommendation. But he must give early information of every such case to the Commissioners. 3d. Young children shall not be received with their parents, unless such children are also patients, and have a, special permit of admission from the Commissioners. 4th. Only patients who are unable to pay for their board and maintenance, are to be received. 5th. In any case where a Physician or Surgeon of the Hospital desires to have admitted into the Institution, a patient to be treated by him, who may be unable to pay for medical or surgical treatment, but able to pay board, a special application in all such cases must first be made direct to the Board of Commissioners, setting forth the tacts on which admission is asked for, and the Commis- sioners will decide each case so presented on its own merits; and the granting of a permit for the admission of any such patient is not to be deemed or taken as a pre- cedent for the admission of any similar case. CHAPTER XV J. Of the Curator. 1st. There shall be appointed by the Board of Commis- sioners of Public Charities and Correction, on nomination by the Medical Board, a Curator, and a Librarian, and a Microscopist of Bellevue Hospital. 6 38 2d. It shall be the duty of the Curator to preserve and take charge of all books, papers, and pathological speci- mens which may come into his hands, as the property, of the Hospital. He shall be present at, and as far as may be practicable, preserve records of all post-mortem exami- nations of patients dying in the Hospital. 3d. The Hospital Cabinet, consisting of preparations in healthy and morbid anatomy, of casts, models, delineations, paintings, ,and prints, illustrative of anatomy and other branohes of medical science, shall be under the general care and superintendence of the Museum Committee, and under the immediate charge of the Curator. 4th. It shall be the duty of the Curator to collect, pre- pare, and deposite in the cabinet, all such cases occurring in, or are presented to, the Hospital, each with its appro- priate label. He shall keep an analytical catalogue of all the preparations and other articles in the cabinet, and shall therein briefly note the most important facts, so far as ascertained, in relation to each specimen, with further reference, wThen necessary, to the case book of the Hos- pital. 5th. All pathological specimens occurring in the Hos- pital shall be at the disposal of the Curator, who shall loan them, when required, to the Attending Physicians and Surgeons, with, the understanding that the specimens be returned uninjured within forty-eight hours. He shall keep a book in which he shall enter a statement of all specimens lent, and to whom, and when returned. 39 6th. All preparations and other articles received for de- posit in the cabinet, shall be considered the property of the Hospital, but such of them as are presented, shall be marked by the name of the donor, or that of the individual by whom they were prepared or collected. 7th. The cabinet shall at all times be accessible to the Commissioners, to the Physicians and Surgeons, and to the Warden of the Hospital, and shall be open to other visitors at such times only as the Museum Committee shall direct. Sth. All specimens by private patients shall be subject to the disposal of the Physician or Surgeon presenting them. , 9th. An appropriation of $250 per annum may be made, subject to the disposition of the Medical Board, for the necessary expenditure for the purpose of preserving such specimens in the Museum as are deemed proper for the uses of the Hospital. CHAPTER XVII. Of the Library, 1st. Before the Librarian enters on the execution of his office, he shall give sufficient security, to be approved of by the Committee of Inspection, in a sum not less than 250 Dollars, that he will indemnify the library for any loss or damage which may be sustained by his negligence or misconduct as Librarian. 40 2d. The Librarian shall keep every work in the library plainly numbered on a label on the back, and also on the inside of every volume ; and he shall cause to be written or printed on the title-page of each volume, " The Property of Bellevue Hospital." 3d. He shall keep an accurate catalogue of the books in the library, containing the title, author's name, size, number, and number of volumes of each work. He shall keep a book containing printed receipts, and every per- son who shall borrow a book from the library, shall sign a receipt for the same. 4th. The Librarian shall annually account for the library to the Commissioners and to the Medical Board, and shall at the same time report to the Medical Board and to the Commissioners an account of all books then out of the library, to whom and when they were lent. oth. T Books may be taken from the library on such days only as the Committee of Inspection shall direct; but a Commissioner, Physician or Surgeon of the Hospital may borrow books from the library at any time. 6th. If a book shall not be returned within three months, it shall be considered as lost, and the person who took it out shall forfeit his deposit, if he has made any. and if not, then a sum equal to what the deposit would have amounted to, if any had been made. 41 CHAPTER XVIII. The Microscopist. It shall be the duty of the Microscopist to take charge of the microscope, and all articles relating to his depart- ment and be responsible for the care, of the instrument, and all the preparations and specimens, and keep the in- strument in perfect order. CHAPTER XIX. The Eegister. 1st. There shall be appointed by the Board of Com- missioners of Public Charities and Correction, on the recommendation of the Medical Board, a Register for the Hospital. 2nd. It shall be the duty of the Register to attend daily at the Hospital for at least three hours each day, in a room to be provided for him by the Board of Com- missioners, and he shall take charge of all the Division and Ward History Books of the Hospital, and record and enter in such books the history of all cases occurring in the Hospital, which shall be reported to him by the House Physician and House Surgeon. 3d. At the request of the Attending Physician or Surgeon and the Committee of Inspection, he shall prepare for publication any impoi'tant case which may be deemed of interest to the Medical or Surgical Profession. 42 4th. He shall keep the Books of Record of Cases, and they shall at all times be open to the inspection of the Commissioners and Members of the Medical Board. CHAPTER XX. Each ward and apartment of the Hospital shall be num- bered, and the departments classified and divided, as near as may be, as follows, viz. 1st. The Surgical Department, in two divisions : First—Surgery, from accidents or sudden injury. Second—Rendered necessary from disease. 2d. Consumption. 3d. Fevers and their subdivisions. 4th. Female Diseases. 5th. Lying-in Department. 6th. Miscellaneous Diseases. 7th. Rheumatism and Chronic Diseases. 8th. Delirium Tremens. CHAPTER XXI. 1st. All rales to be subject to such changes as the Com- missioners of Public Charities and Correction may direct. 2d. The foregoing rules and regulations, so far as the same can be made to apply, are to be the rules and regu- lations for the Island and other Hospitals under the charge of the Commissioners. * ;+- * ^/$£*^ as ■ IP