RULES 
FOR THE 
INTERNAL GOVERNMENT 
OF THE 
HOSPITAL 
OF THE 
UNIVERSITY OF PENNSYLVANIA. 
Approved May 14, 1878. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1 878. EXILES 
FOR THE 
INTERNAL GOVERNMENT 
OF THE 
HOSPITAL 
OF THE 
UNIVERSITY OF PENNSYLVANIA. 
Approved May 14, 1878. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1878. RULES FOR THE GOVERNMENT OF THE HOSPITAL. 
SUPERINTENDENT. 
1. There shall be elected annually, by the Board of Managers, a 
Superintendent, who shall, 
Committee., lurre the general control-of all departments of the Hooptted, 
of all subordinate officers, attendants, and domestics, and the charge of 
the grounds, buildings, and appurtenances. 
2. shall hold his office during the pleasure of the Board; shall 
reside in the building, in apartments .te by the Board for 
that purpose, shall receive such compensation as may be appointed by 
the Board, and shall also receive board and washing free; but shall 
not be allowed any other emoluments, perquisites, or fees whatsoever. 
3>ke shall see that there is no waste or in any depart- 
ment, and shall report to the BouibKui 1 Visiting OomuwTteeT'bmissions 
of duty, or disorderly conduct, on the part of subordinate officers and 
employes. 
shall, under the efrrermn uHdn Buand ufU'fl the Vi,dLUig*Ouni- 
purchase the provisions and stores, including drugs, instruments, 
splints, liquors, and fuel; shall have the charge thereof, and shall be 
responsible for their proper and economical use. He shall make monthly 
retur-fts-of the consumption of fuel, gas, and liquors. 
5. shall keep regular accounts of all moneys received and dis- 
bursed by<4«^Non behalf of the Hospital, in books provided by the 
BQaaLrJ»ifck-a-,fißcar.d-.ef .all contracts, and shall submit the same to the 
Visiting Committee at each meeting. 4&ekshall, also, prepare a state- 
ment of such receipts and disbursements for the Board ofManagers at 
each moating, together with a statement of outstanding bills 
and a requisition for the probable amount required for the current ex- 
penses of the ensuing month. 
6. All bills, together with the pay-rolls, shall be submitted to the 
Visiting Committee at its regular meetings. 
T.$te shall make no purchase exceeding |100, or ofan unusual nature, 
without the sanction of the orfthe Visiting Com- 
mittee- 
8.0&e shall take charge of money or other valuables belonging to 4 
patients, and keep a record of the same; and in case an}r patient dies, 
leaving money or articles of value,"Jim shall take charge of them, and 
shall report the same to the Yisiting Committee, who will give-JSSfc the 
necessary directions for the proper disposal of them. 
9.3te‘ shall keep an inventory of all furniture and other property be- 
longing to the Hospital, and shall make a quarterly report of articles 
injured, destroyed, or missing, 
shall provide meals for the family of the Hospital, including 
himself, his..aamJEamilv, (if he have the Matron, Apothecary, 
-sßesident Medical Staff of the Hospital, at such hours as tl*e Visit- 
in''- Committee may direct; and meals shall not he provided at any other 
in case of sickness. 
shall provide the diet of the patients as may be directed by 
the Medical Staff, and for the persons enmloared jahpllJamish, such pro- 
visioiiAS the Gommtekee on SnppWes may direct. 
12.,T6i[e shall receive all money paid for the board of patients, or from 
other sources, and shall pay it over to the Treasurer of the Hospital. 
13.£ Me shall suspend from duty any subordinate officer or 
of the institution, wilfully disregarding or breaking the rules thereof, or 
refusing to perform his or her proper and necessary duties 
shall immediately report, in writing, such suspension to 
Committee, with the facts of the case. Except as regards the Matron, 
Apothecary, Curator, Resident ha.m. 
the right of summary dismissal, reporting the facts as in other cases 
o - j 
li.Wisi shall appoint such number of nurses and attendants on the 
sick as may be recommended by the Medical Staff, and approved by the 
i In' mum ifrfrffp. All other employes shall be appointed by hfeA^ 
under the direction of the Mrsrtinm CoinmiHoo. 
kitchpn, I‘lillnilTi nlA'wl '™*<~****^'-'*ffi-sti- 
urtinirr 
16.SdAie shall receive all patients admitted to the Hospital, and shall 
see that the proper entries are made concerning them, and shall then 
send them to the wards designated by the attending medical officers. 
1 shall have charge of the correspondence of patients, and shall 
communicate to their friends information of their condition or decease. 
shall cause the bodies of the deceased to be delivered to their 
friends, or, if not claimed by them, to the proper authorities. 
19. JtJLe shall furnish passes to patients on the recommendation of the 
attending medical officer, and shall permit no patient to leave the Hos- 
pital without such recommendation. 
20. In any case requiring the attendance of a Coroner at the Hos- 
pital, it shall be hs?tduty to immediately send a notice to that effect to 
the Coroner’s office. 5 
an~Ajaiih«l He port to the Board of Managers, of all' matters pertaining 
to. lua. office. 
22, Before leaving the Hospital,*he shall notify the jltefeeam, who shall 
discharge during hf&absence. 
23.-‘»e shall perform such other duties connected with life, office fis 
may from time to time be required by lln An mi mil ml' M in iffi'i 
1. There shall be annually elected by the Board of Managers a Matron, 
who shall hold her office during the pleasure of the Board. She shall 
reside in the building, in apartments designated by the Board for that 
purpose, and shall receive such compensation as may be appointed by 
the Board, and her board and washing free ; but shall not be allowed any 
other emoluments, perquisites, or fees whatsoever. 
MATRON. 
2. She shall have, under the Superintendent, the general direction of 
all female nurses and servants, see that they perform their several duties, 
and report to the Superintendent all instances of inattention or neglect 
of duty. i 
3. She shall visit all the wards in the Hospital every day, and shall be 
responsible for the cleanliness, neatness, and order of every part of the 
establishment. 
4. She shall superintend the kitchen and laundry, and cause to be 
kept an accurate account of bedding, clothing, linen, and table and other 
furniture. 
5. She shall have personal charge, under the Superintendent, of all 
hospital stores, unmade linen, blanketing, clothing, the clothing of 
deceased patients, and other similar properties, and shall attend to their 
distribution. 
6. She shall not be away from the Hospital at the same time as the 
Superintendent, and before leaving the building shall invariably report 
to that officer, and again upon her return. 
7. She shall perform such other duties connected with her office as 
may be required by the Board of Managers. 
APOTHECARY. 
1. There shall be elected annually by the Board of Managers, on the 
recommendation of the Medical Staff, an Apothecary, who shall hold his 
office during the pleasure of the Board. He shall reside in the building, 
and shall not absent himself except at such hours as may be authorized 
by the Visiting Committee. Before leaving the Hospital he shall inva- 
riably report to the Superintendent, and again on his return. He shall 6 
receive such compensation as may be appointed by the Board, and his 
board and lodging free; but shall not be allowed any other emoluments, 
perquisites, or fees whatsoever. 
2. He shall, under the Superintendent, have charge of all medicines 
and other articles pertaining to his department, shall make requisitions 
on the Superintendent for their purchase, and shall keep exact accounts 
of their quantities, qualities, and prices, and shall furnish duplicates 
of such accounts to the appropriate Committee of the Medical Staff. 
3. He shall compound medicines and prepare all prescriptions agree- 
ably to the formulae from time to time directed by the Attending Medical 
Officers or Resident Physicians, which shall be recorded in a book, to be 
kept in each ward for that purpose. 
4. He shall also prepare all prescriptions ordered by the medical offi- 
cers in charge of the various departments of the Dispensary Service. 
5. He shall deliver no medicines which are not ordered by the attend- 
ing or resident medical officers, and which are not recorded in the pre- 
scription books, or properly ordered in connection with the Dispensary 
Service. 
6. He shall report monthly in writing to the Visiting Committee a 
detailed statement of the operations of his department, the expenditure 
for drugs, and the consumption of the same. 
7, He shall perform such other duties connected with his office as 
may from time to time be required by the Board. 
MEDICAL STAFF. 
1, The Medical Staff shall be composed, in accordance with the reso- 
lution of the Board of Trustees, of the following members:— 
The Professor of the Theory and Practice of Medicine 
and of Clinical Medicine, 
The Professor of Surgery, 
The Professor of Obstetrics and of the Diseases of 
Women and Children, 
Ex-officio ; 
Ex-officio ; 
A Professor of Clinical Medicine ; 
Two Professors of Clinical Surgery ; 
A Professor of Clinical Gynaecology; 
A Clinical Professor of Diseases of the Eye; 
A Clinical Professor of Diseases of the Ear ; 
A Clinical Professor of Nervous Diseases ; 
A Clinical Professor of Skin Diseases ; 
A Professor of General Pathology and Morbid Anatomy 
2. Special meetings of the Staff may be called at any time by the 
Board of Managers, by the President of the Medical Staff, or by the 7 
Secretary of the Medical Staff at the request in writing of three of its 
members. 
3. The members of the Medical Staff shall be present when requested 
by the Board of Managers, or by the Visiting Committee, to confer with 
them on the management of the Hospital. 
4. The Medical Staff shall advise the Board of Managers, through the 
Visiting Committee, in all matters pertaining to the sanitary arrange- 
ments of the Hospital and to the health of the inmates. 
5. The Medical Staff shall hold annual examinations to determine 
the merits and qualifications of such graduates of the Medical Depart- 
ment of the University of Pennsylvania as may apply for the position 
of Resident Physician in the Hospital; and shall report, after each ex- 
amination, the names of the two candidates whose grade is the highest 
to the Board of Managers for confirmation. 
6. The Medical Staff shall examine carefully into the qualifications 
of all applicants for the positions of Apothecary, Registrars, and Curator, 
and shall nominate to the Board of Managers suitable persons for these 
posts, whenever vacancies exist. 
7. The Medical Staff shall elect semi-annually, by ballot, two of its 
members, 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 
Staff, as occasion may require. 
8. The Medical Staff shall regulate the diet of the patients, as well 
as their hours of eating, and the modes of cooking their food. Por this 
purpose a regular diet table shall be prepared, which, subject to the 
approval of the Visiting Committee, shall be revised as occasion may 
require, by a Committee of the Medical Staff. 
9, In all cases of death in ■which the Attending Medical Officer regards 
an autopsy as desirable, he shall, unless the immediate relatives raise 
special objections, give a written order for such examination, and shall 
see that it is decently performed. 
REGISTRARS. 
1. There shall be elected annually by the Board of Managers, on the 
recommendation of the Medical Staff, two Registrars, to be called, 
respectively, the Medical and the Surgical Registrar. 
2. The Registrars shall keep a record of all cases admitted to the 
Hospital, with a detailed history of each case. These records and 
histories shall be the property of the Hospital, and shall form part of its 
Archives. 
3. At the end of each year, the Registrars shall present to the Board 8 
of Managers, through the Medical Staff, a general report of all the 
cases admitted during the }rear, with proper classifications, and tables 
of all operations performed in the Hospital during the same period. 
4. The Registrars shall visit the Hospital daily, after the hours of 
admission of patients, and shall then note the previous history and 
actual condition of such patients as have been received since the pre- 
ceding day. They shall submit these notes, eitlxer personally or through 
the Resident Physicians, to the Attending Medical Officers at their next 
visit. 
5. When requested by the Attending Medical Officers, the Registrars 
shall take special observations, make special analyses or examinations, 
etc. 
6. The Registrars shall select from among the students of the third 
year, subject to the approval of the Medical Staff, one Clinical Clerk 
for each ward of the Hospital. These Clinical Clerks shall keep, so 
that they shall always be accessible to the Registrars, ward books con- 
taining daily notes of the progress of all cases in their respective wards ; 
which notes shall be derived from the dictation of the several Attending 
Medical Officers, or, in their absence, of the Resident Physicians, whose 
visits the Clinical Clerks shall follow. The Clinical Clerks shall also 
be present at all autopsies of patients dying in their respective wards, 
and shall note, for the use of the Registrars, the post-mortem appear- 
ances, as dictated the officers making the examinations. 
7. The Registrars shall make requisitions upon the Superintendent 
for such stationery and blank books as majr be needed for the proper 
discharge of their duties. 
8. They shall perform such other duties connected with their office as 
may be directed by the Board of Managers or the Medical Staff. 
CURATOR. 
1. There shall be elected annually by the Board of Managers, upon the 
recommendation of the Medical Staff, a Curator, who shall attend to 
the preparation and preservation of such specimens of morbid anatomy 
as may be designated any of the Attending Medical Officers or by the 
Professor of General Pathology and Morbid Anatomy. 
2. In the preservation of specimens, two categories shall be made, one 
of specimens undoubtedly suitable for permanent preservation in the 
Museum, and another of such as may, in the course of time, lose their 
distinctive characters and interest. These latter shall, from time to 
time, be examined, and from among them shall be selected such as 
belong to the first category, when the remainder shall be suitably dis- 
posed of, in order that there shall be no unnecessary accumulation of 
material in the pathological department. 9 
3. The Curator shall label and catalogue, according to a suitable 
classification, the permanent specimens of the Museum. In the cata- 
logue the specimens shall be sufficiently described to enable them to be 
intelligently used in the illustration of lectures, and when any specimen 
has been described at length in a medical journal or other publication, 
its description in the catalogue shall contain a reference to such publi- 
cation; it shall also name the preservative solution and the strength of 
the same in which the specimen is contained, and the date of mounting. 
4. The Curator shall be one of the assistants of the Professor of 
General Pathology and Morbid Anatomy, and shall, with him, attend 
all autopsies made in the Hospital, taking notes of the post-mortem ap- 
pearances at his dictation, and in his absence acting as his substitute. 
The notes of post-mortem examinations shall be copied in a book kept 
for that purpose, which shall be carefully preserved, and shall be the 
property of the Hospital. 
5. The Curator shall also make a microscopic examination in every 
case in which it shall be deemed desirable by the medical officer under 
whose care the deceased patient has been, or by the Professor of General 
Pathology and Morbid Anatomy, and shall append the result of such 
examination to the record of the autopsy. 
6. He shall perform such other duties connected with his office as 
may be directed by the Board of Managers or the Medical Staff. 
RESIDENT PHYSICIANS. 
1. There shall be elected annually by the Board of Managers, on the 
recommendation of the Medical Staff, two Resident Physicians, gradu- 
ates of the Medical Department of the University of Pennsylvania, who 
shall serve for the term of one year. They shall, on receiving notice of 
their election, sign an obligation to serve their full term unless relieved 
by the Board of Managers. Each shall serve six months in the medical 
and six months in the surgical ward. 
2. They shall reside in the Hospital, and, in addition, shall receive 
their board and washing free, but shall not be allowed any other per- 
quisites or fees. 
3. They shall not be absent from the Hospital at night, nor during 
the day except at such hours as may be authorized by the Visiting 
Committee. Before leaving the Hospital they shall invariably register 
their names and the hour of day in a book, to be provided and kept by 
the Superintendent, and again upon their return. They shall under no 
circumstances both be absent from the building at the same time, and 
shall, subject to the approval of the Visiting Committee, arrange and 
observe a roster, specifying on which days each must remain in the 
House. 10 
4. Leave of absence, when requested I)}' either of the Resident Physi- 
cians, may be granted by a majority of the Attending Medical Officers 
in charge of the wards in which he is on duty, who shall also appoint a 
substitute to serve during his absence. In cases of emergency, leave of 
absence for not over twelve hours may be granted by the Superin- 
tendent. 
5. They shall visit all the patients under their charge every morning 
and evening, and as much oftener as may be necessary ; and, in the ab- 
sence of the Attending Medical Officer, shall administer to their relief, 
conforming to the views of such officer, and reporting their action at 
his next visit. 
6. They shall accompany the Attending Medical Officers in their 
visits, report to them all new cases, and faithfully carry out their direc- 
tions. They shall copy all prescriptions in the ward-books kept for that 
purpose, and shall send them to the apothecary immediately after the 
visit. 
7. All diet orders, liquor and extra orders for patients, must be 
signed either by the Attending Medical Officer or by the Resident Phy- 
sician or Surgeon. 
8. The Resident Surgeon shall, under the Superintendent, have charge 
of the surgical instruments, splints, etc., and be responsible for their 
being kept ready and fit for immediate use. He shall in no case lend 
any instrument or splint belonging to the Hospital. He shall keep an 
inventory of the instruments, and at the expiration of his terra of ser- 
vice shall deliver this to his successor, certified by the signature of the 
Superintendent, together with the instruments. When any instrument 
or instruments shall require to be put in order, he shall, through the 
Superintendent, send the same to the instrument-maker or cutler author- 
ized by the Visiting Committee, making due entry of the facts of the 
sending and return, on a pass-book to be kept for that purpose. When 
new instruments, splints, etc., are required, he shall make a requisition 
on the Superintendent for their purchase. He shall promptly notif}7 the 
Attending Surgeon of the admission of any case of injury involving 
risk to life or limb, and shall administer such temporary relief as the 
urgent symptoms may demand, but shall perform no surgical operation 
except such as may be designated by the Attending Surgeon. He shall 
personally apply the necessary surgical dressings to the patients under 
his charge, as directed by the Attending Surgeons, and shall not dele- 
gate this duty to the nurses. 
9. The electrical instruments shall be in the charge of the Resident 
Physician, subject to the same regulations and restrictions as in the 
case of the instruments in charge of the Resident Surgeon. 
10. The Resident Physician and Surgeon shall not engage in any other 
business than that of the Hospital, nor shall they practice out of the 11 
House. They shall have the privilege of attending all the clinical lec- 
tures delivered in the Hospital, and of assisting at operations, provided 
that their services are not at the time required by any of the Attending 
Medical Officers in the wards. 
11. They shall keep such clinical records of the cases in their charge 
as may be directed by the Attending Medical Officers. 
12. They shall further perform such duties connected with their office 
as may be directed by the Board of Managers or the Attending Medical 
Officers. 
NURSES. 
1. All Nurses shall be appointed and discharged by the Superintend- 
ent, as above provided. 
2. The Nurses shall attend faithfully to the patients under their charge, 
and shall obey implicitly the directions of the Attending Medical Offi- 
cers and Resident Physicians in regard to them. 
3. The Nurses shall see that patients behave with propriety and 
observe all the regulations of the Hospital, and they shall report any 
irregularity or breach of rules to the Resident Physicians and Superin- 
tendent. 
4. They shall see that all sick persons under their charge shall change 
their linen at least twice a week ; and that the soiled bed and body 
linen is promptly delivered to the laundry, with an inventory of the 
articles. 
5. They shall give receipts to the Laundress or Matron for all bed 
linen or clothing issued to their wards, and shall be furnished with an 
acquittance for the same on returning the pieces to the laundry. 
6. They shall carry the ward prescription book to the apothecary im- 
mediately after the visit of the Attending Medical Officer, and shall 
return for the same at the hour directed by the apothecary. 
7. They shall carefully attend to the administration of all medicines, 
and shall return to the apothecary all vials in which medicine has been 
sent. 
8. They shall pay strict attention to the diet ordered by the Attend- 
ing or Resident Physicians. 
9. They shall keep a list of all money and articles of value, not in use, 
belonging to patients, and shall place all such property in charge of the 
Superintendent. 
10. They shall keep an inventory of all furniture, bedding, and other 
articles, in their wards, and shall make a weekly return of the same to 
the Matron. 
11. The Nurses and Assistants shall always obtain permission from 
the Resident Physicians and the Superintendent before leaving the 
Hospital. 12 
12. In no case shall the Nurse and Assistant of any ward be both 
absent at the same time. 
13. They shall perform such other duties connected with their office 
as may be required. 
ADMISSION AND DISCHARGE OF PATIENTS. 
1. All cases of recent accident, occurring in the State of Pennsyl- 
vania, which are brought to the Hospital within twenty-four hours after 
their occurrence, shall be admitted at any hour of the day or night. 
*2. Other patients shall be admitted daily at 12 M. They must apply in 
person at the waiting-room, where they will be examined and admitted 
by the Attending Medical Officers, or the Resident Physicians. 
3. An}r member of the Medical Staff may send to his own department 
of the Hospital an}1, patient that he may see fit, with a written order for 
admission, provided that there is a free bed vacant in that department. 
4. There shall be posted in the office daily the number of vacant beds, 
both free and pay, in each department of the Hospital, for the informa- 
tion of the examining physicians. 
5. The Resident Physicians shall fill up the proper admission-blank 
and bed-card within twelve hours after the admission of each patient. 
6. No patient affected with smallpox shall be admitted. 
7. Pay patients may be admitted to the extent of the capacity of the 
Hospital for that purpose, at a rate of not less than $7 per week. 
8. In cases where separate apartments, or articles not usually fur- 
nished in the Hospital, are provided, such payment shall be paid there- 
for as the Visiting Committee may deem reasonable. Patients occupy- 
ing private rooms shall be entitled to receive the professional services 
of the Resident Physicians without extra charge, but shall have no 
claim upon the services of the Attending Medical Officers without pro- 
per compensation, as maybe agreed upon in each instance, unless such 
patients consent that their cases shall be utilized for purposes of clini- 
cal instruction as with patients in the general wards. No charge for 
medical or surgical attendance shall be made to ward-patients. 
9. No patient who is not likely to recover shall be retained on the free 
list of the Hospital for more than three months. 
10. No patient having acute venereal disease, or mania-a-potu, shall be 
admitted as a charity patient, but shall be charged such rates for board 
as the Visiting Committee may determine. 
11. No patient shall be discharged from the Hospital, except by the 
Superintendent; nor, unless in case of misconduct, without the written 
order of the Attending Medical Officer.