CODE OF RULES AND REGULATIONS FOR THE GOVERNMENT OF THOSE EMPLOYED AT THE §J. fj. €itf Ipitufe BLACKWELL’S ISLAND. PREPARED BY T. M. FRANKLIN, M. D., Medical Superintendent. ADOPTED BY THE Board of Commissioners of Public Charities and Correction. DEPARTMENT PRESS. 1880. CODE OF RULES AND REGULATIONS FOR THE GOVERNMENT OF THOSE EMPLOYED AT THE BLACKWELL’S ISLAND. PEEP ABED BY T. M. FRANKLIN, M. D., Medical Superintendent. ADOPTED BY THE Board of Commissioners of Public Charities and Correction. DEPARTMENT PRESS. 1880. NOTICE. No Officer or Employee will leave the Island without the permission of the Medical Superintendent. PRELIMINARY REMARKS. The following items should be pondered and remembered, for upon them are based INFLEXIBLE RULES. This Institution was established and is maintained for the benefit of the insane alone. Insanity is a disease; an affliction; not a voluntary condition. Its varieties are as numerous as are personal peculiarities in the sane. Its subjects are all alike in this, however, that they are irresponsible in law and in fact, as to words and actions however outrageous, and despite any amount of reason they may seem to retain. Insanity, however grave or prolonged, does not empty the mind of all its attributes. Such as may be left are entitled to acknowledgment and respect. The mildly insane and the con- valescent may be, sometimes, justly credited informers. The restored may become competent accusers. All duty among the insane is responsible and respectable, bnt arduous, confining and teasing. The self-indulgent should never undertake it. The mentally or physically unadapted should never be encouraged to continue. The unbendable, the querulous and the shirkers should be cut off. Then all who stay may be trusted, encouraged, advanced. The supervising mind should, as far as possible, act upon knowledge, not supposition. Therefore, no person, locality nor duty should be exempt from inspection; nor any hour deemed inappropriate for visitation. Inspection means suspicion only to the suspicious. An engagement in this Institution will im- ply a disposal, for a price, of entire time and of all right to work for self during hours of regular or special duty. Also to do work as assigned, and to comply with rules and orders in spirit and in letter. Cleanliness everywhere and always. “ Nothing is clean enough if it can be made cleaner.” MEDICAL SUPERINTENDENT. The Medical Superintendent shall be the official head of the Institution, and shall, under the general direction of the Board of Commissioners of Public Charities and Correction, conduct and control its local affairs. He will be the medium of com- 4 inunication between the Board and the attacliees of the Insti- tution. He shall have power to direct, manage and discipline all persons, whether officers or employees, engaged upon the premises. All appointments to the Institution shall be made either upon his nomination or with his approval. He may, for cause, suspend any officer or employee, subject to the action of the Board; but he must, at once, notify the Board in writ- ing of any such suspension; giving his reason therefor and making recommendation in view thereof. He will devote his entire time and energies to the interests of his charge; give to the patients, practically as well as theo- retically, the benefit of his ablest management and kindliest sympathies; obey all legal enactments bearing upon his official movements, and conform to all standing or occasional orders of the Board of Commissioners. In the absence of the Medical Superintendent he will be represented, as far as may be necessary, by the Assistant Med- ical Superintendent. The Assistant Medical Superintendent must be a physician possessed of considerable professional and executive experience in the treatment and care of the insane. He will be, to a great extent, the medium of communication between the officers and employees of the Institution and the Medical Superintendent, and the recipient of ordinary reports and requests. His duties, almost set forth in his title, will be chiefly supervisory, but par- ticularly prescribed, from time to time, by the Medical Super- intendent. He will always be on duty in the absence of the Medical Superintendent, and will, so far as may be necessary, represent him and act with his authority. ASSISTANT MEDICAL SUPERINTENDENT. ASSISTANT PHYSICIANS. Assistant Physicians shall have the immediate control and management of the attendants and wards assigned to them, and the immediate professional and personal care of the patients entrusted to their charge, subject always to direction, general and specific, of the Medical Superintendent. They will seek to familiarize themselves with the names, his- tories and immediate mental and physical condition of their patients. They will commence their morning visits promptly at 0 o’clock. This being the most important visit of the day, each 5 will positively see every individual patient under liis care; no- tice tlie condition, surroundings, dress, general and particular tidiness, &c., of each; examine thoroughly the condition of the halls, beds, rooms, water-closets, cupboards, Ac. A second daily medical visit will be made during the latter part of the afternoon or in the evening. Other visits to halls or individual patients as may be necessary. Irregular and un- expected visits serve to encourage alertness and to discourage improprieties. The ventilation should be noticed upon every, even the briefest call. All orders for medicines to be legibly written in the hall books, under the patient’s name, in prescription form and with plain directions. Positively no medication is to be left to the discretion of attendants. Medicines are to be prescribed in quantities to last through as brief periods as practicable. All unnecessary accumulations of medicines in halls must be pre- vented, and the care of the rest scrupulously watched. The histories of patients must be well kept up by notes in hall books. The most unimportant must receive additions as often as once a month. Forcible feeding and medication, seclusion in room and me- chanical restraint are matters which must, in each case and upon each occasion, devolve upon the physician. Should pressing emergency compel an attendant to use present re- straint, the physician in charge of the patient must give his attention to the matter as soon as notified of the occurrence. An Assistant Physician will make physical examination of every new patient, on admission, for the purpose of discovering if recent injury or urgent disease exist. As many as four Assistant Physicians will be on duty at all times, and not less than two actually present in the main build- ing at any time. Assistant Physicians will communicate frequently and freely with the Medical Superintendent, seeking to know his views for their guidance, and to convey to his mind as much as possible of their own daily acquired information and impressions re- garding the patients individually and collectively, and the movements and interests of the Institution, specially and gen- erally. STEWARD. The Steward shall, under direction of the Medical Superin- tendent, assist in supervising and conducting the non-medical work of the Institution. 6 The general police of the establishment, as to both buildings and grounds, must claim his particular care. He will be re- quired to make such tours of inspection, by day and by night, as may be necessary to the full performance of this duty. Matters appertaining to Work-House help will mainly de- volve upon him. He shall make frequent visits to all buildings, passing through wards, attics, cellars, kitchens, boiler and engine rooms, &c., &c.; see that their proper use and needed repairs are at- tended to and (except where otherwise provided) that cleanli- ness and order are maintained. He shall be the custodian of non-medical property and sup- plies; shall personally attend to their receipt, care and distri- bution ; shall keep records and accounts thereof, and frame, fox- signature, requisitions, ixxventories and repoi-ts in reference thereto. He shall keep time book and make out pay rolls. He shall keep book-record of clothing and other effects brought in by or sent to patients, and carefully enter the occa- sional or final disposition made thereof. He shall, under limitation and direction of the Medical Superintendent, keep all the non-medical records, and prepare, for signature, all other non-medical repox*ts of tlie Institution. All documents presented to the Medical Superintendent for signature must be correct within the personal knowledge of the Steward, and must bear his initials in token of the fact. He shall attend to the removal of the remains of deceased patients upon receiving the certificate of death. The Steward shall perform such other duties as may be, from time to time, directed by the Medical Superintendent. ENGINEER. The Engineer shall, under the general direction of the Supervising Engineer of the Department, and the specific orders of the Medical Superintendent, have the cai*e and management of all the steam machinery, appurtenances and appliances; all water and gas pipes and fixtui*es, and their belongings; the preservation, operation and repair of all these, including fire engine, hose, laundry machinery, and whatever else may be authoritatively committed to his care and management. 7 He shall provide adequate supplies of hot and cold water, and maintain such temperatures, by steam heat, as may be, from time to time, directed by the Medical Superintendent. He will be responsible for the orderly behaviour of his assistants, and for the maintenance of cleanliness in all places under his care. It will be his duty to make frequent personal inspections of every locality occupied by his machinery, pipes or fixtures. MATRONS. The Matrons will, under the direction of the Medical Super- intendent, oversee the entire housekeeping of the Institution and its appendages. The oversight of the meals of the patients as regards their conformity to the dietary table, their prepara- tion and serving will devolve upon them. They will be bound to see that both day and night attend- ants perform their duties properly; that the rules appertaining to them are strictly fulfilled; that the patients are uniformly tidy; that they are made as comfortable as circumstances may permit; that, as far as practicable, they are supplied with work and amusement. The feeble, the sick and the excited will be subjects of their particular solicitude. They will be held accountable for faulty care of patients and for culpability of attendants. They will be deemed blameworthy if they fail to chide the neglectful, and inexcusable if they screen the guilty. They will attend to the reception of new patients; their changing of clothing; the examination of their persons and the care of their private clothing. Any money, jewelry or other valuable articles found upon them, must be at once placed in the hands of the Medical Superintendent. They will personally examine the condition of the bodies and heads of patients about to leave the Institution, and make immediate report if anything be found amiss. APOTHECARY. The Apothecary shall have the care of all medicines, appli- ances, fixtures and furniture entrusted to his care. He shall keep the Dispensary and all that appertains to it clean and in order. He shall compound and put up medicines in accordance with written prescriptions of the Physicians, hut without such pre- scription he shall issue nothing'—not even a single dose. 8 He will spend his time in the Dispensary; never permit a patient to enter it; never allow any one inside the gate except Physicians attached to the Asylum. He must never leave the Dispensary for a single instant without fastening the door and window’s. Any Physician, present in the Dispensary, in the absence of the Apothecary, will be held responsible under the precaution- ary clauses of this rule. LAUNDRESS. The Laundress will have charge of the Laundry, of its appliances and fixtures, and of all engaged in its work, and be responsible for the count and care of all clothing from receipt until return. She will permit no person to visit the Laundry except those engaged therein and those holding permits from the Medical Superintendent or his representative. COOK. The Cook will have charge of the Kitchen and its belongings; be responsible for the safe keeping and proper use of supplies passing through his hands; preserve cleanliness in his depart- ment, and order among his assistants. He will allow only those having business to enter the kitchen, and see that their stay be as brief as practicable, and that they do not approach the range. MECHANICS. Each Mechanic will have charge of and be responsible for the proper care of the implements and materials entrusted to him, and will perform such work as may be assigned to him by the Medical Superintendent, without stopping to question whether any of such work be outside the limits of his trade. DAY WATCHMAN. The Day Watchman will be vigilant about the grounds of the Asylum to avert danger, preserve order, prevent intrusion and render casual assistance to attendants. He must report observed violations of rules. His hours of duty shall be lrom (1 A. M. to 6 P. M. NIGHT WATCHMAN. T1 le Night ’Watchman’s hours of duty will be from 6 o’clock P. M. to (5 o’clock A. M. He will spend the first two hours in going about the grounds adjacent to the buildings, to prevent intrusion and preserve order. At 8 o’clock he will commence, and thereafter continue, the following hourly alternating rounds, viz.: — During one hour he will view, throughout their lengths, both sides of each Pavilion, and (without going near enough to windows to startle patients,) absolutely see the niglit-attendant of each Pavilion, and notice her occupation. During the hour next ensuing he will visit the Lodge, going through the lobbies of the three floors, seeing each night-attendant, and noticing her occupation: visit boiler room, dining room, and kitchen of Lodge. Thence to the Retreat, going through the lobbies of first and second floors, seeing and noticing the occupation of night-attendants: visit boiler room of Retreat. In passing through all above-said lobbies his tongue and feet must be as nearly noiseless as possible. At the conclusion of each round he will go to the Steward’s office and write, in a book provided for the purpose, the time of beginning and finishing his round and the results of his ob- servations. As often as four times during the night lie will view the laundry building and its boiler room, kitchen and drying room, also kitchens and pass-ways of centre building. Before going off duty in the morning he will enter upon his book the hours at which night attendants have, personally or by signal, reported to him or his assistant at the office; also, any other noteworthy incidents of the night. CONDUCTRESS. The Conductress will have charge of patients assembled in the Amusement Hall or elsewhere, by order of the Medical Superintendent, for calisthenic exercises, dancing, games, needle-work, Ac. She will seek diligently to keep herself thus employed. If, however, she be at any time not thus occupied, she will report to the Medical Superintendent for temporary occupation in be- half of patients. 10 RULES FOR ATTENDANTS. Deportment.—It is of the highest importance that attendants should so demean themselves among their patients as t > acquire their good will and respect; among the officers and employees of the Institution, as to avoid disparaging criticism; among people outside, as not to impair confidence in the Institution nor respect for its appointments. On the halls, cheerfulness is desirable; noisy or unseemly levity culpable. A loud, excited or domineering tone of voice never adds to the influence of an attendant, but may detract from .her good standing. Particu- lar quiet must be maintained after patients are in bed. Mimicking, teasing, ridiculing or nicknaming patients is expressly forbidden. Abuse of a patient subjects the offender to discharge, perhaps to arrest. When an officer enters a hall attendants will rise (if seated) and be ready with any required attention. Should the officer be accompanied by a Commis- sioner or other official, or general visitor, attendants will not gather around them, but immediately scatter among their patients to preserve order and avert annoyance. Dress.—Attendants will wear, when on duty, neat, plainly made dresses, without trail; also white aprons and caps of patterns adopted for the Institution. Hours.—Day attendants will rise at 6.30 o’clock, A. M., be- tween September 1st and March 1st, and at 5 o’clock, A. M., during the remainder of the year, and as soon as practicable thereafter will get patients washed and dressed. Patients to retire between 7 and 9 o’clock, P. M. All lights about the In- stitution, except the duly authorized night lights, to be ex- tinguished by 10.15 o’clock, P. M. Breakfast for patients, from September 1st to March 1st, at 7.30 o’clock, A. M., and at 0 o’clock, A. M., during the remainder of the year. Dinner at 12 M. Tea at 5.30, P. M. Attendants’ meals immediately after those of the patients. Regular morning medical visits at 9 o’clock. Patients to walk immediately after medical inspection. Storeroom issues from 8 to 9, A. M., and from 2 to 3, P. M. Afternoon walks at 2 o’clock from September 1st to May 1st, and at 4 o’clock during remainder of year. Day attendants will go off duty at 8, P. M., but, so far as deemed by the Medi- cal Superintendent to be admissable, each may absent herself for recreation every alternate evening immediately after tea. Night attendants will assume duty at 8, P. INI., and continue until relieved by day attendants. They will also do two hours day duty, under direction, for the relief of day attendants. 11 Duties.—Attendants will not leave the Asylum premises nor their duty without consent of the Medical Superintendent or his representative. Special duties may be assigned to some in a hall, or division of work established, but relative responsibility will still attach to each attendant for the care, safety and wel- fare of the patients. Needless interference with the patients of a neighboring hall will be deemed a fault; but stupidly, neglectfully or maliciously allowing preventable evil happening to any will be considered a crime. No weapon-like article observed ahout building or grounds frequented by’patients should be passed without securing its removal. No orders are to be given to outside help. Workmen sent to halls are not to be directed nor interfered with except for imperative reasons, and in all such last-said cases immediate report is to be made. When mechanical work is going on in a hall patients must be kept away from the mechanics and their tools. No hall must be left, for an instant, without an attendant. Attendants will avoid being unnecessarily in their rooms during hours of duty, but wTill keep their doors locked. They will not employ patients in sewing for them except by proper permission. Nothing, fluid or solid, must be thrown out at windows, neither may window sills be used as clothes horses. All dam- age, destruction or loss of movables or fixtures should be prompt!}7 reported, as also all requirements in way of repairs. Ceaseless vigilance as to fires and lights will be required of all. General Instructions.—Patients are to be counted at each meal. In pavilions they are to be re-counted as they lie in bed when the night attendants take charge, and they are to be again counted when day attendants resume duty. The night and da}7 attendants are to be in accord as to the correctness of the last two counts. Should a patient be missed, instantaneous search must be commenced, and notice immediately sent to the offices of the Medical Superintendent and Steward. New patients are, upon arrival, to be searched carefully to discover if they have any injuries, sores or scars, or if they have vermin upon head, body or clothing, or if they have forbidden or dangerous articles about them. The results of such exami- nations are to be reported to the physician. Patients known to be suicidal should be under constant ob- 12 servation. Their beds, bedding and body clothing should be fre- quently examined. After a walk their clothing should be searched before they have a chance to conceal anything. Where any patients sleep in rooms, their body clothing should, upon tlieir retiring at night, be neatly folded and placed outside the door, and the door securely locked. The door of no room occupied by a patient is to be left unlocked at night without express permission of the attending physician. Itoom doors on all wards occupied by excitable patients must also be kept locked in the day time. No patient is to be out after tea in Summer, nor after sunset in Winter. The use of beds as places of deposit for rags, bundles or clothing is not to be permitted. Attendants must not furnish writing materials nor money to patients, nor make purchases for them, nor visit nor communi- cate with their friends. All these responsibilities will devolve exclusively upon the medical officers. Deaths or startling calamities are to be kept, as much as possible, from the knowledge of patients, by calmness in con- duct and prudence in conversation. All defects in water supply and sewerage, and all unexplained ill odors should be reported at once to the Medical Superin- tendent. Patients are not to be used by attendants as body servants or porters. Patients must positively be prevented from remaining un- necessarily in or about water closets. As some of the insane have the habit of stealing off into out-of-the-way places, all such localities must be frequently in- spected. Management of Patients.—The insane are to be dealt with truthfully and honestly. In no other way can one hope to win their confidence, and confidence lies close at the root of discipline. Patients should never be addressed by titles which their disordered fancies lead them to claim. To yield to them in this would be to encourage their delusions, and, as more than one on the same hall might claim a particular title, quarreling might result. The present comfort, as well as the ultimate benefit of each one, must be constantly upon an attendant’s mind. Let none, then, be forced to sit too long, nor any allowed to walk or stand too much. 13 No individual should be allowed to worry another, nor any two permitted to quarrel. Let such two be kept at opposite ends of hall or room. Force, unfortunately, is occasionally necessary in the manage* ment of individuals among the insane, but prudence, tact and kindness very often avert such necessity, and nearly always influence its character, amount and duration. Excitement and violence generally result from delusions; so a patient’s sus- picion, hatred or terror may be either momentarily or persist- ently increased by even necessary interference. When a given patient is often under restraint while in one hall, and generally quiet while in another, it is to he presumed that the attendants differ in their capabilities. A harsh word used to a patient often results in the disturb- ance of an entire ward for hours, and in fights, lock-ups, &c. Mechanical restraint always, and coercion, except in minor matters, must be resorted to only in the presence of a medical officer or by his specific order, except in cases of imperative emergency, and then immediate report is to be made to the Medical Superintendent. Individuals undergoing mechanical restraint, and those who may be mentally or physically helpless, will require to be particularly protected and attended to. The physical conditions of certain patients may require that they lie down occasionally during the day, but mere lounging upon bed should be discouraged or prevented according to circumstances and instructions. No patient is to leave her ward unattended except by per- mission of a Physician, and none to be on continuous parole except by special direction of the Medical Superintendent, None, not even the paroled, must visit the storeroom without an attendant, and none, however circumstanced, or by whom accompanied, must enter the Dispensary. Nursing and Medication.—The hall-book will be taken to the Dispensary immediately after the medical visit, together with bottles requiring to be replenished, and all unneeded and empty bottles. The nursing, changing and feeding the sick is, under no circumstances, to be left to patients or other helpers. An attendant to whom the care and administration of medicines may be confided will never delegate a single one of such duties to another without permission from a medical officer. Much patience and gentleness, as well as firmness, may be required in the administration of medicines. 14 Refusals to take doses must be promptly reported. Actual forcible medication must be left to a physician. Failure of anticipated effects of medicines must be duly made known, and surprising results immediately reported. No medicine of any sort or in any quantity must, for an instant, be placed in the hands of, or be left accessible to any patient; the recipient of a single dose alone excepted. Bathing.—All the patients are to be bathed at least once a week; and they, are not only to be dipped, but thoroughly washed, and with due use of soap. The water is to be neither so cold nor so warm as to shock or be uncomfortable to the bathers. Dining Boom, Meals, &c.—The dining room, with its append- ages, furniture and fixtures, must always be an illustration of the possibilities of cleanliness. Dividing the food is never to be entrusted to patients. All are to be in presentable condition at meal times; all who can are to go to the table; all are to be seated; the going and re- turning are to be orderly. Deficiencies, excesses, bad quality or faulty cooking of able supplies to be reported. The condi- tion of some patients may require that they be fed at table. These must be carefully attended to. Paralytics may over- crowd their mouths to their hazard. These must be watched. The poor eaters must be encouraged, and the gluttonous con- trolled. Judicious discrimination in these, as in many other things, distinguishes the capable attendant. With the exception of one attendant left, when practicable, upon the hall, all, save those on night duty, are to be present at each meal. Waste is, as far as possible, to be avoided. Un- handled pieces of bread are to be returned to the kitchen for use in soup. No refuse allowed in house. No accumulations of food upon dressers, nor in cupboards, nor drawers. Break- ages to be at once reported, but no broken pieces of anything to be stowed away. Doors to dumb-waiters are never to be open except when guarded by an attendant. None but reliable patients to be employed as dining room helpers or allowed to enter the dining rooms between meals. Cooking and water boiling upon pavilion stoves is expressly forbidden. Knives, forks, scissors, pokers, bricks, glassware, bits of iron, cords, matches, and every other article confessedly dangerous in the hands of ah insane person, no matter by whom such articles may be owned or used, must be kept scrupulously out of the 15 reach of patients. No exception can be made to this rule by other than the Medical Superintendent. Knives and forks, thus permitted to be used by patients or attendants, must be counted when taken from under lock aud key; unremittingly watched while in use; re-counted when gathered; washed under super- vision of an attendant and again counted and locked up. Beds and Bedding.—Each bed is to be kept properly filled and levelled, and is to be furnished with two sheets, one pillow case, and from one to four single blankets, according to season and individual necessity. Each bed is to have at least one clean sheet and one clean pillow case weekly. Spreads to be changed when soiled. Ticks to be replaced as needed. Rubber sheets are to be used where and when required. All wet or soiled beds must be promptly taken out of the hall. Soiled Clothes must not be kept in the halls, but taken to the place provided for their reception. Clothing found filthy must be immediately sent to the laundry. Walks.—Attendants walking with a party of patients must never keep together. Patients to be put in line—two abreast. One attendant must be at the head and another in rear of the line, and, if there be a third or fourth, they must walk on one or both sides of the line. Should the party, for a while, be seated, the attendants will, as a general rule, station themselves between the patients and the river. Sitting on the ground when it is damp ; straggling; picking; talking to outsiders; throwing off hats, shoes or required wraps; needless exposure in spots of extreme heat or cold; all are to be prevented as far as possible. The selection and classification of patients for out-door exercise will devolve upon the medical officers, but, in the absence of any special order, the suicidal, the persistent elopers and the slow moving lame and aged, must not go out with regular parties. These will require special walks in accordance with specific directions. Work, Occupations and A m moments. —These three words, ex- pressing to the steady toiler widely different ideas, may be convertible terms to the unemployed, and are often synonyms to the enforced idler. Employed under judicious direction, these three things bring to the insane, in a superlative degree, similar results—relief, comfort, pleasure, benefit. Patients are, as a general rule, less noisy, less irritable and even less filthy when employed ; the halls are more cleanly and the nights more quiet. Attendants will be expected, then, to give much and persevering attention to practicing tlic mental and physical powers of those under their care. Books, papers, games, Ac., will he provided as circumstances shall permit. Transfers of patients from one ward to another are to be made only by order, in each case, of the Medical Superintendent. Visitors, whether to patients or attendants, whether resident upon the Island or not, must report at the office before approaching a ward, as none such must be admitted among the patients except by written permit of the Medical Superin- tendent or his representative. No basket, bag nor package to be admitted to halls except specified on the permit. Patients are to receive their friends in places designated, and are to be protected, as far as possible, from intrusion and annoyance. Attendants will superintend the unpacking of all packages, and take charge of surplus food; also take all improper articles, such as knives, scissors, stimulants, tobacco, matches, medicines, stationery, money, Ac., Ac., require visitors to take away with them such forbidden articles, and report at office such occurrences. General visitors are to be prevented from conversing with patients, or giving anything to, or receiving anything from them; letters particularly herein included. Attendants, while treating such visitors courteously, are not to gratify curiosity about individual patients even by giving their names. Attendants will make early and, in urgent cases, instant report of any improper conversation or behaviour of visitors. Loungers and sight-seers must be warned away from windows and walking parties. No visitor will be allowed to eat or sleep upon the premises without special permission of the Medical Superintendent. Keys.—A green worsted cord will be furnished each attend- ant. To this the hall keys are to be attached, and the cord is to be worn securely fastened around the waist during all hours of regular or special duty, whether within doors or out on tin* grounds. At no time, and under no circumstance, will an attendant lend her key or lay it down where another may pick it up. She will be held personally and severely responsible for the safe keeping and proper use of her keys during the entire' time of her service, except during regularly permitted absence from the Island, when they must be in the hands of the Medical Superintendent, as provided for elsewhere in this Code. After using a key to lock a door an attendant should always try the knob to make sure that the door is fastened. 17 NIGHT ATTENDANTS. Upon these devolve heavy responsibility. They have, more than others, opportunities to misspend their time and neglect their duties. Let each one feel, then, when receiving such appointment, that her honor is particularly engaged. While on duty they will wear dresses that will not rustle, and slippers that will not make a noise. When their voices must be used, they should be as nearly inaudible to those not addressed as possible. They must keep their helpers awake and vigilant. Reading or sewing, except for a few minutes at a time, and principally to keep them wakeful, will be deemed gross neglect of duty. Night attendants in pavilions will, immediately on going upon duty each evening, count their patients and compare the count with that of day attendants; recount and compare again in the morning when surrendering charge. Should an empty bed be discovered at night, diligent search must be made until the whereabouts of the missing patient be discovered. The important matters of temperature and ventilation are to be carefully watched under general medical instructions. Wet and soiled bedclothes are to be changed without loss of time; also used night vessels promptly emptied. Filthy patients are to be taken to water-closets once, twice, or even three times during the night, as may be necessary, to avoid trouble from their habits. The water-closets in pavilions, being out of sight from halls, and therefore hatching places for mischief, are to be visited as often as twice an hour. No responsibility can be shared by helpers. Suicidal patients must be constantly on the mind and under watch. Punctuality and care must be observed in the administration of night medicines and food as directed. When really necessary, day attendants may be summoned to the assistance of night attendants. A physician is always to be notified when his services are needed. All lights are to be extinguished by night attendants at day break, if then on duty. Day attendants are to be awakened at the prescribed hour ; but patients are not to be called up by night attendants. A report of each night service is to be written, on the fol- lowing morning, in a book provided for that purpose. Two hours day duty may be required of each night attendant. 18 PASSES FOR ATTENDANTS. Atendants may be granted absence of 24 consecutive hours once a fortnight. No credit given for unused hours. Special passes deducted. The hall physician must always be consulted before applica- tion is made for a pass, as said pass is a privilege, not a right. No pass will become the property of an attendant until it shall have been entered in the book. No pass shall be delivered by book-keeper or other person (unless otherwise authoritatively ordered,) until near the time of departure of the applicant, and then only upon the delivery of the hall keys. Upon returning from pass, attendants must report at the of- fice and receive, (not take,) their keys. Patients are never to be sent for either passes or keys. CHAPLAINS. It shall be the duty of Chaplains to conduct religious ser- vices at the Asylum, on Sundays, for the benefit of all resident at the Institution, and to give what attention they can to any who, from time to time, in consequence of sickness or other good cause, may desire their professional attention. In pur- suance of these duties they shall have such access to and religious intercourse with patients and employees, individually and collectively, as their own sense of duty may dictate, pro- vided that neither the well-being of the patients, nor the order nor discipline of the Institution be, in the judgment of the Medical Superintendent, injuriously affected. They may, with the approbation of the Medical Superin- tendent, procure such assistants and substitutes as they may, from time to time, deem advantageous or find necessary. NOTICE. The Officer or Employee to whom this pamphlet is pre- I sented will receive the same m an official capacity, and its contents as an official notification of the duties that will be required of all. After this pamphlet has been received, ignorance of the rules of the Institution will not be admitted as an excuse upon the part of any officer or employee for dereliction of duty. The recipient of this pamphlet will be required to pre- serve it in good order, to deposit it in the office for in- spection as often as they go upon pass, and, in the event of their resignation or dismissal, to return it to the Med- ical Superintendent.