twx *v vi ILL CAt <£*t^ Jv*^. ^-^^^t^Kf MASSACHUSETTS GENERAL HOSPITAL. BY-LAWS OF THE CORPORATION RULES OF THE TRUSTEES. REVISED 1890. BOSTON: The Kakta Press, J48 High Strekt. 1890. MASSACHUSETTS GENERAL HOSPITAL. BY-LAWS OF THE CORPORATION AND RULES OF THE TRUSTEES REVISED 1890. BOSTON: The Barta Press, 148 High Street. 1890. Cig) CONTENTS. PAGE BY-LAWS OF THE CORPORATION............5 RULES OF THE TRUSTEES. Chap. I. Meetings and Committees of Trustees, and Election of Officers.................9 „ II. Visiting Committee..............12 „ III. Resident Physician of the Hospital........12 „ IV. Visiting Physicians and Surgeons.........16 „ V. Physicians and Surgeons to Out-Patients, and other Professional Officers............19 „ VI. Superintendent of the Asylum..........20 „ VII. House Pupils, Externes, and Out-Patient Assistants of the Hospital..............22 „ VIII. Other Officers of the Hospital..........25 „ IX. Officers of the Asylum.............26 „ X. Patients..................27 „ XI. Treadwell Library...............3° „ XII. Warren Prize................31 BY-LAWS OF THE CORPORATION. Article i. The Corporation shall consist of all persons who have been or may be Trustees ; of all who, at any legal meeting of the Corporation, are elected members by ballot; and of all who have given one hundred dollars and upwards, or the equivalent, to the Hospital or Asylum, or to the funds of the Cor- poration. Art. 2. The annual meeting of the Corporation shall be held on the first Wednesday of February in every year, when the following officers shall be chosen by ballot, viz.; a President, a Vice-President, eight Trustees, a Treasurer, and a Secretary, to serve one year, and until others shall be chosen. Of this meeting notice shall be given by the Secretary in one or more newspapers printed in Boston, at least a week previous to the appointed day. Art. 3. The President, and in his absence, the Vice-President, shall preside at all meetings which he may attend, and shall have power to order special meetings, the Secretary giving at least three days' notice in one or more newspapers printed in Boston. Art. 4. The eight Trustees elected by the Cor- poration, together with four others appointed by the Governor of Massachusetts with the advice and con- 6 sent of the Council, shall constitute a board for the immediate management of the institution. They shall meet at least as often as once a month, at such time and place as they shall by vote determine, or as their chairman shall direct ; and all ques- tions before them shall be determined by a majority of the Trustees present and voting thereon ; but the consent of a majority of the Board shall be required for contracts exceeding five thousand dollars, or for the sale or conveyance of any real estate owned by the Corporation. They shall have power to fill any vacancy that may occur between the annual meetings of the Corporation in the office of Treasurer or Secretary, and in that portion of their own number chosen by the Corporation; to appoint physicians, surgeons, officers, assistants, and servants, with such salaries and wages as they may determine; to make rules for the government of said physicians, surgeons, officers, assistants, and servants, and for the admis- sion of patients, and the management of all depart- ments, the said rules being subject to amendment by the Corporation at their annual meeting, or any legal meeting specially called for that purpose. They shall cause a record of all their doings to be kept, and laid before the Corporation at every meeting thereof; and at every annual meeting they shall make a written report on the Treasurer's accounts, and on the general state of the institution; and for this purpose they shall, at some previous meeting, appoint a committee of the Board. 7 Art. 5. The Treasurer shall give bonds with sureties, to be approved by the Trustees' Committee on Finance, in a sum not less than $20,000, for the faithful discharge of his duties. He shall have the custody of money, bonds, notes, deeds, and other property belonging to the Corporation, which he shall hold and manage under the control of the Board of Trustees, or their Committee on Finance. He shall pay no money but by order of the Trustees, or of their committees duly authorized to draw on him, or for the regular salaries of the officers. On the payment, when due, of any debt secured by mortgage, the Treasurer is authorized to acknowledge satisfaction thereof, and to discharge the same on the margin of the record. He shall render an account of the state of his books, and of the property in his custody, when called for by the Trustees or Corporation ; and he shall make up the ac- counts to the last day of December in each year, and lay them before the Corporation at the annual meeting. He shall keep a separate account of all receipts and expenditures on account of each of the funds subject to special provisions; and all unex- pended balances of such accounts at the close of the year shall be carried to the debit of the accounts for the succeeding year. He shall allow such rates of board on account of any beneficiaries of the several trust funds as the Trustees have ordered to be charged to him. He shall keep a book in which shall be en- tered such extracts from all wills devising or bequeath- ing property as affect the institution. 8 Art. 6. The Secretary shall notify and attend all meetings of the Corporation and of the Board of Trustees, and shall keep a distinct record of the doings of each body. He shall also audit the accounts of the departments. He shall be sworn to the faithful per- formance of his duties. Art. 7. The departments under the Corpora- tion shall be called " The Hospital " and " The McLean Asylum;" into which shall be admitted all such sick injured, and insane persons as the Board of Trustees, or their authorized committees, shall from time to time determine to be fit subjects for treatment. RULES OF THE TRUSTEES. CHAPTER I. MEETINGS AND COMMITTEES OF TRUSTEES, AND ELECTION OF OFFICERS. Article i. The Board of Trustees shall annually, at their first meeting after the annual meeting of the Corporation, appoint a Chairman and the following Standing Committees, viz.: — A Visiting Committee of two Trustees for each month, and so composed that every Trustee shall serve for two months. A Committee on admitting Asylum patients, who shall admit patients to the Asylum ; fix their rates of board, subject to the approval of the Trustees; super- vise all papers and bonds relating to them, and report to the Trustees annually. A Committee on Finance, who shall advise the Treasurer as to the mode of keeping his books and accounts, the investment of money, and the manage- ment of all money, bonds, notes, deeds, and other property belonging to the Corporation. A Committee on Accounts and Expenditures, who shall have control over all expenditures except such as may be in charge of other Committees; provide for IO the purchase of all supplies, and fix the salaries and wages of all officers and servants not directly ap- pointed by the Trustees. They shall approve all drafts on the Treasurer, examine the accounts of each department quarterly, or oftener, and, with the assist- ance of the Secretary, audit and certify to the correct- ness of the quarterly and yearly financial statements of the Trustees. A Committee on Nominations, who shall receive and report upon all nominations to office. A Committee on Buildings and Repairs, who shall superintend all building and repairs. Whenever the cost of such works shall not exceed one hundred dollars, the Committee shall have full power; in other cases, the consent of the Trustees shall be obtained. A Committee on New Asylum Grounds and Build- ings, who shall have charge of the Waverly estate and improvements thereon. A Committee on Free Beds, who shall call on sub- scribers to renew their annual subscriptions, solicit new subscriptions, and report to the Treasurer. A Committee on the General Library and the Warren Fund, who shall have charge of the Library, and expend the income of the Warren Fund in ac- cordance with the directions of the donor. A Committee on the Book of Donations, who shall enter in the same all donations during the year; and from time to time examine the Book of Bequests to the Hospital, kept by the Treasurer of the Corpora- tion. 11 Art. 2. At said meeting the Trustees shall elect by ballot not more than ten practitioners in Physic or Surgery to constitute a Board of Consultation, a Resident Physician of the Hospital, six Visiting Physicians, six Visiting Surgeons, six Physicians and four Surgeons to out-patients, a Physician to out- patients with diseases of the skin, a Physician to out patients with diseases of the nervous system, two Physicians to out-patients with diseases of the throat, an Ophthalmic Surgeon to out-patients, an Aural Surgeon, a Chemist, a Pathologist, an Artist, and a Superintendent of the Asylum; all of whom shall hold their offices during the pleasure of the Trustees, and until others shall have been chosen. No person shall be eligible as Visiting Physician after attaining the age of sixty-five, or as Visiting Surgeon after attaining the age of sixty-three. Art. 3. At said meeting, or whenever in their opinion it is expedient, the Trustees may appoint any other Committees and officers, with such duties as they may prescribe. Art. 4. There shall be a quarterly meeting of the Board of Trustees at the Hospital on the Fridays preceding the third Wednesdays of January, April, July, and October; and again, at the Asylum, on the Fridays following the said Wednesdays; and at these meetings all reports, accounts, and minutes relative to the Hospital or the Asylum shall be laid before the Board. 12 CHAPTER II. VISITING COMMITTEE. Article i. The Visiting Committee shall meet at least once in every week, both at the Hospital and at the Asylum; and if either of the members is unable to attend, he may procure some other Trustee or officer of the Corporation to take his place. They shall visit the wards weekly, and other parts of the houses as often as they may think desirable. They shall, at each weekly visit, receive from the Resident Physi- cian, or Superintendent, a list of the patients, and shall see or obtain an account of each of them. Art. 2. The Visiting Committee shall keep a book of minutes, both at the Hospital and at the Asylum, common to all the committees in succession, in which shall be entered, at each weekly visit, a record of patients admitted, discharged, or deceased, and any further statement deemed proper. These books shall be laid before the Trustees at their quarterly meet- ings. __________ CHAPTER III. RESIDENT PHYSICIAN OF THE HOSPITAL. Article i. The Resident Physician shall give his professional services wholly to the Hospital. Art. 2. He shall reside in the house, and have the immediate superintendence of the medical and surgi- cal departments, except as to the treatment of patients. 13 Art. 3. He shall have power to nominate an Apothecary, a Superintendent of Nurses, and a Matron, to \>e confirmed by the Trustees, and to ap- point other officers, nurses, attendants, and servants, all of whom shall be under his direction. Art 4. He shall have control of the House Pupils, Externes, and Out-Patient Assistants, and see that they comply with the orders of the Visiting Physi- cians and Surgeons in the treatment of patients. Art. 5. He shall purchase, or direct the purchase of furniture, provisions, medicines, surgical instru- ments, and other supplies and materials. He shall collect all dues from patients, and shall keep an ac- count of all his receipts and expenditures, which, with vouchers, shall be presented for approval to the Com- mittee on Accounts and Expenditures quarterly, or oftener if required by the Committee. Before each quarterly meeting of the Trustees at the Hospital, he shall give the Treasurer a statement of all money received or disbursed by him in behalf of the Hospital for the previous quarter, together with a certificate that the same has been examined and audited by said Committee and the Secretary ; and annually, in the month of January, he shall make a similar statement for the previous year. For any money that he may require for the use of the house, he shall draw his draft on the Treasurer. Art. 6. He shall admit patients to the Hospital, and assign them to their several wards. He shall decide the rate to be charged for board, or if any 14 free beds are unoccupied, he may grant admission to one of them. He shall keep a record of the name, age, birthplace, residence, and disease of every appli- cant, and if admitted, the date, and on what terms, the date of discharge, and in what condition, or the date of decease; and this record in a tabular form, with a tabular summary for each quarter, shall be open to the Trustees and the Visiting Physicians and Sur- geons. Art. 7. He shall report to the Visiting Physicians and Surgeons- the names of all paying patients whose time has expired, and of all free patients who have been treated more than three weeks, and shall submit the same weekly to the Visiting Committee; and at every quarterly meeting of the Trustees at the Hos- pital, he shall lay before them a list of all patients who have been in the house over three months. Art. 8. He shall, in the absence of the Visiting Physicians and Surgeons, decide upon the case of any admitted patient, suspected of being affected with small-pox or other contagious disease, and at once remove such patient from the ward, or discharge him from the Hospital; and whenever patients misbehave, or violate any rules of the house, he may remove or discharge them ; but he shall report sue;, cases to the Visiting Committee at their next visit. Art. 9. He shall prepare an order-book for each ward, in which shall be entered all orders for food and articles required in the wards for the use of either p?.- tients or nurses ; and, when diet is ordered, the orders 15 shall designate whether it is to be added to the ordi- nary diet or given as a substitute therefor, and also the time for which the order runs, but not for more than one week in advance; such order shall also be noted on a card at the patient's head. Art. io. He shall, upon the death of a patient, im- mediately give written notice to the family or friends, requesting them to make arrangements respecting the body; and the body shall be in his custody until de- livered to the family or friends, or to an undertaker, to be interred. No body shall be removed until twenty-four hours after death, except at the express request of the relatives. He shall keep a press copy of notices to relatives and friends of deceased patients, and of all official correspondence. He shall also make a return of each death in the Hospital to the City Registrar. Art. ii. He shall see that no autopsy is made within twelve hours after notice of death has been sent, unless with the express consent of the family or friends of the deceased, nor at any time when it shall have been expressly prohibited by the patient, or by the family or friends. He shall enter every autopsy in the Post-mortem Register, giving the name of the deceased, the date of death, notice, and examination, whether the consent of friends was obtained or not, and by whom the autopsy was made. Each entry shall be examined and signed by the Visiting Com- mittee, and the book shall be laid before the Trustees at their meetings at the Hospital. i6 Art. 12. He shall report in writing to the Trus- tees, at each of their quarterly meetings at the Hospital, the condition of the medical and surgical departments during the preceding quarter. This re- port shall exhibit the number of applications for admission, the sex and birthplace of the applicants, the number refused, the number of paying and of free patients admitted, the number discharged, and the number present. At the quarterly meeting in January he shall make an annual report, covering the pre- ceding year. He shall have charge of the General Library, and shall annually report to the Library Com- mittee its condition, the number of volumes received, and if any have been lost or injured, the names and titles thereof. Art. 13. He shall have a vacation every year, upon application to the Chairman of the Board of Trustees; and so far as he may find it practicable, he shall allow a yearly vacation of two weeks to each of the resident officers and employees of the Hospital. CHAPTER IV. VISITING PHYSICIANS AND SURGEONS. Article i. Two Physicians and two Surgeons shall be on duty at a time, during terms of four months. Each shall have the exclusive control and care of the patients assigned to him; each shall render i7 to the other such assistance as may be desired, and if either is prevented from visiting, he shall call upon his associate or one of the other Physicians or Sur- geons of the Hospital. Art. 2. The Visiting Physicians and Surgeons shall cause the Resident Physician to be informed, from day to day, of patients no longer requiring treat- ment, and shall report in writing every week those to be discharged or retained after the expiration of their time. Art. 3. They shall keep a case-book in both the medical and surgical departments, in which shall be recorded by them, or by the House Pupils under their direction, the name, date of admission, and disease of each patient under their care, and the result of treat- ment, together with all important facts in the history of the case. As often as may be deemed advisable, with the consent of the Trustees, a summary or index to the principal points in the case-books shall be pre- pared by some suitable person. Art. 4. They shall nominate to the Board of Trustees, in the manner hereinafter prescribed, a list of applicants suitable for appointment as Externes and House Pupils. Art. 5. The Operating Theatre and adjoining rooms shall be reserved for the use of the Visiting Surgeons daily (except on Sundays), from 11 a. m, till their operations are over. No operations shall be performed on Sunday, without special order from the Resident Physician, to be reported by him to the i8 Trustees, at their next ensuing meeting. The sur- gical instruments given to the Bradlee Ward shall be used only in that Ward and its Theatre. Art. 6. Physicians and Surgeons not in attend- ance shall not have patients in the Hospital without the consent of the Visiting Physicians and Surgeons, and of the Resident Physician, nor shall they have more than one patient in Ward B, and one in other wards, at the same time. Art. 7. Physicians and Surgeons of regular stand- ing may visit the Hospital on making themselves known to the Visiting Physicians or Surgeons, or yD the Resident Physician; but they are not to examine the patients or make observations upon their treat- ment, or attend operations except by permission of one of the Visiting Physicians or Surgeons. Students of medicine may be admitted to view the clinical practice of the Hospital by the written per- mission of one of the Visiting Physicians or Surgeons, or of the Resident Physician; Jbut female students, if admitted, shall be placed in classes separate from male students, and shall attend the clinical practice of the female wards exclusively. Art. 8. All professional services in the Hospital shall be gratuitous, and any physician or surgeon ac- cepting an appointment upon the staff shall thereby waive all claim for compensation in money, and per- form his duty as a charity to the sick and disabled patients under his care, and for the advancement of medical and surgical science. 19 CHAPTER V. PHYSICIANS AND SURGEONS TO OUT-PATIENTS, AND OTHER PROFESSIONAL OFFICERS. Article i. The Physicians and Surgeons to out- patients shall arrange among themselves to treat daily such sick and disabled persons among the poor as shall apply at the Hospital. Art. 2. Any one of them requiring an Assistant shall apply to the Trustees for the appointment of such from a list of candidates nominated by the Visit- ing Physicians and Surgeons, to hold office until the first meeting of the Trustees after the annual meet- ing of the Corporation, and not to be reappointed for more than two years successively, except by unani- mous vote of the Trustees. Art. 3. They shall, at each quarterly meeting of the Trustees at the Hospital, present a classified re- port upon the applicants for relief during the preced- ing quarter; and annually, in the month of January, they shall make a similar report for the previous year. Art. 4. The Chemist shall make such chemical examinations as may be desired by the Physicians or Surgeons. Art. 5. The Pathologist shall make autopsies and microscopical examinations, and shall preserve morbid specimens in the Pathological Cabinet. , Art. 6. The Artist shall make drawings of such cases of disease as may be useful for future reference. 20 These drawings shall be preserved in the Pathological Cabinet under the care of the Pathologist. CHAPTER VI. SUPERINTENDENT OF THE ASYLUM. Article i. The Superintendent shall give his professional services wholly to the Asylum. Art. 2. He shall reside in the house, and have the immediate charge of all the departments, and the sole direction of the treatment of patients. Art. 3. He shall have power to nominate two Assistant Physicians, a Pathologist, two House Pu- pils, an Apothecary, a Superintendent of Nurses, and two Supervisors, to be confirmed by the Trustees; and to appoint other officers, nurses, attendants, and ser- vants, all of whom shall be under his direction. Art. 4. He shall purchase, or direct the purchase of furniture, provisions, medicines, surgical instru- ments, and other supplies and materials. He shall collect all dues from patients, and shall charge to the Treasurer such rates of board, on account of benefi- ciaries of special trust funds, as the Trustees may order. He shall keep an account of all his receipts and expen- ditures, which, with vouchers, shall be presented for approval to the Committee on Accounts and Expendi- tures quarterly, or oftener if required by the Com- mittee. Before each quarterly meeting of the Trus. tees at the Asylum, he shall give the Treasurer a 21 statement of all money received or disbursed by him on behalf of the Asylum for the previous quarter, together with a certificate that the same has been examined and audited by the said Committee and the Secretary; and annually, in the month of January, he shall make a similar statement for the previous year. For any money that he may require for the use of the house, he shall draw his draft on the Treasurer. Art. 5. He shall keep a record of the name, age, and residence of each patient, with the rate of board, and the securities therefor; the time when received, discharged, or deceased, and, in case of discharge, the physical and mental condition. He shall keep a record of every important fact in the history of each patient, open only to the medical officers and the Trustees. He shall also record, from day to day, every case of restraint and confinement, specifying the name of the patient, the kind of restraint or confine- ment, when and how long applied, for what reason, and by whose authority; and this shall be examined and signed weekly by the Visiting Committees. He shall also record a minute account of any casualty attend- ing the elopement or death of any patient, to be shown to the Visiting Committee at their first visit after the occurrence, and thereafter laid before the Trustees. Art. 6. He shall, upon the death of a patient, im- mediately inform the friends and give the notice re- quired by law to the proper officer. Of this and all other official correspondence, he shall keep a press 22 copy. He shall cause the body to be kept until ap- plied for by the friends, or, after a reasonable time, .he shall deliver it to an undertaker to be interred. In case of any violent death, he shall cause a Medical Examiner to be summoned. Art. 7. He shall report in writing to the Trustees, at each quarterly meeting at the Asylum, the con- dition of the Asylum during the preceding quarter, and at the quarterly meeting in January the report shall cover the preceding year. Art. 8. He shall have a vacation every year, upon application to the Chairman of the Board of Trustees ; and so far as he may find it practicable, he shall allow a yearly vacation of two weeks to each of the resident officers and employees of the Asylum. CHAPTER VII . HOUSE PUPILS, EXTERNES, AND OUT-PATIENT ASSISTANTS OF THE HOSPITAL. Article i. Out-Patient Assistants to the Phy- sicians and Surgeons shall be elected by the Resident Physician, in concurrence with said officers, from ap- plicants who (1) shall have studied at least two years, and (2) shall bring certificates of qualification from the Medical School of Harvard University, or an equivalent; and (3) in preference, from those who, being otherwise qualified, shall express in writing a desire to be considered candidates for the office of 23 Externes or House Pupils. They shall each serve not more than two months continuously with any Physi- cian or Surgeon, and not more than four and not less than two months in any year. They shall perform such services and keep such records of cases as the officer with whom they serve shall require. Art. 2. Before nominating candidates for Externe3, the Visiting Physicians and Surgeons shall confer with the Out-Patient Physicians and Surgeons as to the qualifications of their Assistants, and shall give preference to such Assistants, if in other respects qualified, among the candidates. With these nomi- nations, the Resident Physician shall obtain and sub- mit to the Trustees, the standing of all the candidates in the Medical School, the relative rank given them by the Out-Patient Staff, and the result of their exam- ination by the Visiting Staff. Art. 3. Five Externes, one for the medical and four for the surgical department, and three House Pupils, one for the medical and two for the surgical department, shall be chosen by the Trustees from a list of applicants nominated by the Visiting Physicians and Surgeons at the April and October quarterly meetings at the Hospital. They shall begin service respectively on the first of August and the first of February following. Art. 4. They shall, before beginning service, sign a certificate that they have read the rules of the Trustees, and pledge themselves to the faithful per- formance of such as pertain to them; and they shall 24 then be under the control of the Resident Physician, subject to the orders of the Visiting Physicians and Surgeons. The House Pupils shall reside in the house, the Externes out of the house. Neither shall leave their posts without permission from the Resident Physician, and they shall make no exchange of their respective duties without the consent of the Visiting Physicians and Surgeons and the approval of the Trustees. Art. 5. The Externes shall serve six months in attending the daily visits of the Physicians and Sur- geons. They may then be promoted to be Junior House Pupils. Art. 6. The House Pupils shall be classified as Junior and Senior, and serve six months in each class. They shall prepare patients for the regular medical and surgical visits; attend upon the Visit- ing Physicians and Surgeons during the visits ; re- port the condition of the patients to them; and receive, record, and carry out their orders and pre- scriptions in respect to the treatment of the patients. The surgical House Pupils shall see that patients are prepared for operations; that those whose cases require it are seasonably dressed ; and that the surgi- cal instruments are ready for use before, and taken care of after operations. Art. 7. The House Pupils shall keep, under the direction of the Visiting Physicians and Surgeons, a daily record of every important fact in the history of the patients, and enter it in the case-book of their de- 25 partment. They shall record all prescriptions of the Visiting Physicians and Surgeons, and transmit a copy of the same, properly attested, to the Apothecary. They shall also see that the daily orders are duly entered in the order-books of the several wards. Art. 8. Both Externes and House Pupils shall perform all other duties which the Resident Physician, the Visiting Physicians and Surgeons, or the Trustees may require. At the termination of their service, pro- vided it has been satisfactorily performed, House Pu- pils shall receive a certificate to that effect, under the seal of the Corporation. CHAPTER VIII. OTHER OFFICERS OF THE HOSPITAL. Article i. The Apothecary shall reside in the house. He shall make purchases as the Resident Physician may direct, and have the immediate care of drugs, medicines, wines, and liquors used in the house. He shall make up all prescriptions of the Physicians and Surgeons. Art. 2. The Superintendent of Nurses shall have direction, under the Resident Physician and the Visiting Physicians and Surgeons, of the nurses and servants in the wards and the Nurses' Building. She shall make requisitions, to be signed by the Resident Physician, for all articles needed in the wards. 26 Art. 3. The matron shall have direction, under the Resident Physician, of the servants not in the wards or Nurses' Building. She shall oversee the dining-room, kitchen, laundry, and store-rooms. She shall have charge of the bedding, linen, and other household articles, and shall supply the requisitions of the Superintendent of Nurses approved by the Resi- dent Physician, and perform such other duties as he may require. __________ CHAPTER IX. OFFICERS OF THE ASYLUM. Article i. The Assistant Physicians and Pathol- ogist shall reside in the house, and devote themselves to the patients, under direction of the Superin- tendent. Art. 2. The House Pupils shall reside in the house, and serve under similar rules to those govern- ing the House Pupils of the Hospital, and perform all duties which the Superintendent or the Trustees may require. Art. 3. The Apothecary shall reside in the house. He shall make such purchases as the Superintendent may direct; take care of drugs, medicines, and instru- ments, and make up the prescriptions of the Superin- tendent and Assistant Physicians. Art. 4. The Superintendent of Nurses shall have direction, under the Superintendent of the Asylum, of the nurses and attendants, with special reference to 27 the treatment and comfort of patients. She shall also perform the general duties of a matron in housekeep- ing and the oversight of female servants. Art. 5. The two Supervisors, one for each wing of the Asylum, shall act as head attendants, with the immediate supervision of attendants and servants in their respective departments. CHAPTER X. PATIENTS. Article i. No fee or gift from patients is allowed to be received by any officer or employee of the Hos- pital or Asylum. Art. 2. The services of the Physicians and Sur- geons are gratuitous. It must be an acknowledged condition on the part of every patient accepting the same that no payment shall be made for them, and that no claim of any nature consequent upon them, from any Physician or Surgeon upon any patient, or from any patient upon any Physician or Surgeon who has attended him or her in the Hospital or Asylum, can be made outside. Patients, or their friends, who desire to express their obligations to the professional staff, can contribute to the charities of the Hospital and Asylum under either of the following heads, viz.: General Fund, Permanent Free-Bed Fund, Annual Subscription to Free-Bed Fund, Convalescent Fund, Surgical Instrument Fund, Library Fund, or any fund for the benefit of patients. 28 Art. 3. The regular charges to paying patients are as follows: in the Jackson Ward, fifty dollars a week ; in the Bigelow, Townsend, and Bradlee Wards, twenty-five dollars a week ; in the General Wards, ten dollars a week. These rates covering only expenses of board and lodging, may be increased or abated in individual cases by the Resident Physician. Rates for the Asylum are fixed by the Committee on admit- ting patients with consent of the Trustees. Art. 4. Paying patients may be required to give an obligation, with surety, for the payment of Hospital or Asylum charges, or such security in money as the Trustees or their representative may deem sufficient. If a corporate town in this Commonwealth is princi- pal, the obligation may be signed by any overseer of the poor of said town, who shall file with the obliga- tion a certified copy of a vote of said town or over- seers authorizing him to execute the same. Art. 5. Patients unable to pay may be placed upon free beds, the number of which shall be fixed by the Trustees at the beginning of each quarter. The Visiting Committee, on recommendation of the Visit- ing Physicians and Surgeons, may continue the time of patients for two weeks, or place them tem- porarily on free beds, subject to the action of the Trustees at their next meeting. No free patient shall be continued more than three months without special permission of the Trustees. Art. 6. A subscriber of one hundred dollars may nominate a patient to a free bed for a year, and a sub- 29 scriber of five thousand dollars to a free bed for one life, with right upon nomination to extend the same to two lives. Railroad and other corporations may secure a free bed for one year by paying five hundred dollars, and for twenty-five years by paying ten thou- sand dollars. All free beds are subject to the ap- proval of the Trustees and the rules of the Hospital. Art. 7. None who are able to pay for professional advice shall be received as Out-Patients. Such as are received shall pay only for medicines or sup- plies furnished at the Hospital, and these may be furnished gratuitously at the discretion of the Resi- dent Physician. Art. 8. Applications for admission of patients to the Hospital will be received between the hours of 9 and 11 a. m., and 3 and 4 p. m., except on Sundays, and at other times in urgent cases. Out-Patients will be received between 9 and 10 a. m., except on Sundays. Applications from the country must be made to the Resident Physician by the attending physician of the patient. Art. 9. Patients with incurable or contagious diseases or syphilis are not entitled to admission. Art. 10. Applications for the admission of pa- tients to the Asylum may be made at the Asylum, or to either member of the Committee on admitting Asylum patients. In all cases, a certificate that the patient whose admittance is requested is insane, to- gether with the statement prescribed by law, shall be required. 3° Art. ii. No inebriates shall be admitted as Asy- lum patients, except by express order of the Trustees. Art. 12. No Asylum patient believed to be suicidal shall ever be left without an attendant, if any means of self-destruction are at hand; and at no time, except during the night watch, shall any ward be with- out an attendant actually present. A night super- visor shall pass through each ward every hour during the night, from 10 p. m. to 6 a. m., and a watcher shall be constantly present wherever needed. Art. i 3. All patients must comply with the rules of the Trustees and the directions of the Resident Phy- sician, or Superintendent, or those acting under them. Art. 14. No visitors shall be admitted to the Hos- pital without the sanction of the Resident Physician. Except on Sundays, they may be admitted from 2 to 3 o'clock to the wards, or to the private rooms at any hour allowed. In all cases the Resident Physician has discretionary powers as to excluding visitors. Art. 15. No visitors shall be admitted to the Asylum without the sanction of the Superintendent. The stated times for visits are on Wednesday and Saturday afternoons. In all cases the Superintendent has discretionary powers as to excluding visitors. CHAPTER XI. TREADWELL LIBRARY. Article 1. The Visiting Physicians and Surgeons of the Hospital, and such other persons as they by 3i joint vote may authorize, are empowered to use the Treadwell Library of the Hospital, subject to the fol- lowing conditions : i. That they give a bond to the Trustees, in the sum of one hundred dollars each, for the faithful per- formance of the several requisitions contained in the will of Dr. Treadwell respecting the Library. 2. That they appoint a Guardian, to have the special custody of the Library, make rules for its use and safe keeping, and submit the same to the Trustees for their approval. 3. That they cause the Library to be examined, and, at the first quarterly meeting in January, an- nually report in writing to the Trustees its condition, the number of volumes on hand, the number of volumes lost, injured, or missing, and the number of volumes added or procured in place of those which have been lost. CHAPTER XII. WARREN PRIZE. Article i. The accumulated interest of the fund provided for this purpose shall be appropriated every third year for a prize, to be called the Warren Prize, in memory of the late Dr. John C. Warren. This prize shall be awarded by the Physicians and Surgeons of the Hospital to the best dissertation considered worthy on some subject in Physiology, Surgery, or Pathological Anatomy. Whenever no dissertation is 32 offered, or none is thought worthy of a prize, the interest shall be added to the original fund. Art. 2. The Resident Physician shall give suit- able notice, through the Medical Journals, of the sub- ject selected by the Physicians and Surgeons, and of the time when the dissertations should be presented.