DEPARTMENT OF THE INTERIOR 
GOVERNMENT HOSPITAL FOR THE INSANE 
BOOK OF RULES 
'approved by the president of the board 
OF VISITORS FEBRUARY 5, 1912 
ALL EMPLOYEES OF THE HOSPITAL ARE 
EXPECTED TO ACQUAINT THEMSELVES 
THOROUGHLY WITH THE CONTENTS OF 
THIS BOOK. IGNORANCE OF THE 
RULES WILL NOT BE ACCEPTED AS AN 
EXCUSE FOR MISCONDUCT 
THIS BOOK IS THE PROPERTY OF THE INSTITUTION 
AND MUST NOT BE TAKEN AWAY 
WASHINGTON 
GOVERNMENT PRINTING OFFICE 
1912 DEPARTMENT OF THE INTERIOR 
GOVERNMENT HOSPITAL FOR THE INSANE 
BOOK OF RULES 
APPROVED BY THE PRESIDENT OF THE BOARD 
OF VISITORS FEBRUARY 5, 1912 
ALL EMPLOYEES OF THE HOSPITAL ARE 
EXPECTED TO ACQUAINT THEMSELVES 
THOROUGHLY WITH THE CONTENTS OF 
THIS ROOK. IGNORANCE OF THE 
RULES WILL NOT BE ACCEPTED AS AN 
EXCUSE FOR MISCONDUCT 
THIS BOOK IS THE PROPERTY OF THE INSTITUTION 
AND MUST NOT BE TAKEN AWAY 
. WASHINGTON 
GOVERNMENT PRINTING OFFICE 
1912 CONTENTS. 
Page. 
Duties of employees „ 3 
Duties of supervisors and charge nurses 4 
Duties of nurses and attendants 5 
Schedule of wages 6 
Things to be done: 
Supervisors 12 
Nurses and attendants 12 
Things not to be done: 
Supervisors 14 
Nurses and attendants 14 
Special rules for employees in Howard Hall '. 17 
Rules for employees on railroad 18 
Fire rules: 
Precautions against fire 18 
Regulations in case of fire 19 
Regulations for controlling use of electric lights 20 RULES AND REGULATIONS FOR THE GUIDANCE OF 
EMPLOYEES OF THE GOVERNMENT HOSPITAL FOR 
THE INSANE. 
DUTIES OF EMPLOYEES. 
1. On accepting positions at the hospital all employees will be 
required to sign an agreement to obey all the regulations of the insti- 
tution and to abide by the decision of the superintendent in all things 
that affect the duties of their positions. 
2. Uniform courtesy and consideration toward their superior 
officers, their fellow employees, and to those in their care and their 
friends shall be exacted at all times, and of every employee. 
No profanity and no improper language by employees will be per- 
mitted. The use of intoxicating drink of any kind while on duty 
is strictly prohibited, and its use to excess at any time by an employee, 
whether on duty or not, will be sufficient cause for removal. 
3. Two weeks’' notice of intention to leave the service will be 
required of all employees, and such leave will be granted in case it is 
deemed advisable by the superintendent to discontinue such services, 
except that in case of discharge of an employee for violation of any 
rule of the hospital no such notice will be given. 
4. Supervisors, attendants, and nurses, and all employees whose 
work requires them to be on duty on Sunday will be granted permis- 
sion to be absent on each third Sunday, as their duties may permit. 
Absence on holidays will be granted as the requirements of the service 
may make possible. In all these cases permits are to be subject to 
the decision of the superintendent, or his authorized representative, 
and are to be granted in such manner as will prove least detrimental 
to the service. 
5. All attendants who pass the necessary preliminary examination 
will be required to take such course of training as is required to com- 
plete the curriculum of the training school for nurses, such course of 
instruction to extend through two years. At the end of such term 
each nurse who successfully passes such examinations as are required 
will be given a certificate to that effect. Each nurse taking such 
course of instruction and properly answering all its requirements will 
be given an advance in salary of $2.50 per month after the completion 
of the course. . 4 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
6. All employees having in their custody keys to any portion of 
the hospital shall deposit these in the office or leave them in charge of 
the head of the department in which they are employed whenever 
they are absent from the hospital on any leave, and no employee shall 
leave the hospital at any time without special permission to do so. 
All employees will be required to be in their rooms each evening they 
are on duty not later than 10 p. m. Once during each calendar week 
any employee may be granted a permit to be absent until midnight, 
and not oftener than once during each month an additional permit to 
be absent over night. In special cases additional late excuses may be 
granted if a request in writing is presented to the medical officer in 
charge of the department, stating the reason for the request. 
7. Xo one not employed at the hospital will be entertained at the 
institution by any employee without special permission from the 
superintendent. 
8. The superintendent will establish such additional rules and 
regulations not inconsistent herewith, describing and defining the 
duties of the various positions and the hours of service, as from time 
to time he may deem necessary. 
DUTIES OF SUPERVISORS AND CHARGE NURSES 
1. Supervisors will have general charge of attendants and nurses 
in their respective departments. They will note the manner in which 
each one discharges the duties of his position and promptly report any 
violation of the regulations of the hospital. 
2. Under the instruction of the physician in charge and subject to 
his approval they will arrange their time olf duty under the rules, 
and provide such relief service as may be required. 
3. They shall take charge of the keys of all attendants and nurses 
who are olf duty and absent from the hospital inclosure. They shall 
conduct all attendants to their work when they are first employed 
and instruct them in their duties. They shall furnish each with a 
copy of the rules and regulations of the hospital; and when they are 
furnished with a uniform they shall make note in a book provided for 
that purpose of the number of special buttons furnished each therefor. 
These shall be charged to the employee in question and a receipt 
given when they are returned at the time the employee leaves the 
service of the hospital. Settlement will not be made with any em- 
ployee on leaving the service until such receipt is shown the financial 
clerk. 
4. Supervisors will take charge of the patients when they are 
received at the hospital and conduct them to the ward assigned them. 
They shall carefully search each and take charge of all valuables and 
all weapons, accounting for them to the proper authorities. They 
shall take a careful memorandum of all the wearing apparel of the REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
5 
patient and see that it is properly marked and registered and delivered 
to the head attendant of the ward, taking a receipt from him for all the 
articles delivered to his care. 
5. They shall see that each patient is given a bath on the day of 
his admission, and shall examine carefully for the existence of any 
marks or bruises on his body, reporting at once to the physician in 
charge any evidence of such. 
6. They will have general charge of the clothing of patients, 
renewing it as required and noting its condition at all times. They 
will give the necessary instructions for its proper care and see that 
they are faithfully executed. 
They shall have general charge of the housekeeping of the ward in 
all its details and properly apportion the duties among the separate 
attendants and nurses, as directed by the physician in charge. 
7. At least once each week they shall make a thorough inspection 
of all bedding and beds and take all necessary precautions to prevent 
the introduction of vermin. Whenever there is evidence of such in 
the clothing of patients admitted it shall be at once destroyed by 
burning. 
8. Charge nurses will have immediate charge of the nursing of 
patients in their respective wards. They shall instruct the nurses 
and attendants under them in the proper application of all remedies 
and the dressing of wounds, ulcers, etc. They shall see that proper 
ward notes are kept in each case designated by the physician in charge, 
and shall instruct the nurses and attendants under them in the prepa- 
ration of these notes and in the correct noting and recording of all 
necessary clinical observations. 
9. Together with the supervisors they will have general charge of 
the patients, looking after their comfort and care. All shall spend 
as much time as possible among the patients and use every possible 
means to ascertain the occurrence of any neglect, misconduct, or 
violation of the rules on the part of attendants or nurses. 
DUTIES OF NURSES AND ATTENDANTS. 
1. All attendants who shall have successfully completed the 
required course of training at the hospital shall be designated as* 
“nurses/’ and all those who are taking the same course shall be 
designated as “nurses in training.” 
2. All attendants employed hereafter in the service of the hospital 
will be employed on a probation of six months, during which they 
will be given the minimum wages designated in the schedule of wages 
for attendants. Any probationer, however, may be discharged dur- 
ing probation for misconduct or evident unfitness or incapacity. At 
the end of the probation period each attendant will be notified 
whether his services will be longer required, and he can then leave 6 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
the service without prejudipe and without the usual two weeks' 
notice if he so desires. 
3. If the superintendent decides that his services will be continued, 
he may then be required to take a preliminary examination as to his 
fitness for entering the training school, and if successful will com- 
mence the regular. course of training in the training school at the 
earliest convenience of the hospital and complete it in the regular 
manner. 
4. The wages of nurses and attendants will be determined by the 
schedule incorporated in these regulations. Each position will have 
a maximum wage, which will be attained after a definite length of 
service in the position in question. 
5. Wages for attendants, nurses, and supervisors will be as follows: 
(The advances in salary indicated thereon from minimum to maxi- 
mum are made in regular sums at intervals of six months until the 
limit paid by the position is reached.) 
Schedule of wages. 
FOR MALES. 
Attendants !. $20. 00 to $30. 00 
Charge attendants 25. 00 35. 00 
Nurses 25. 00 to 37. 50 
Charge nurses 30. 00 to 45. 00 
Assistant supervisors 35. 00 to 52. 50 
Supervisors 40. 00 to 65.00 
Attendants 15. 00 to 25. 00 
Charge attendants 20. 00 to 30. 00 
Nurses 20. 00 to 32.50 
Charge nurses 25. 00 to 40. 00 
Assistant supervisors 30. 00 to 47. 50 
Supervisors 35. 00 to 60.00 
FOR FEMALES. 
6. Attendants and nurses are the guardians of the patients, and 
they must never lose sight of this responsibility. Their duties are 
most trying and require the highest type of character for their effi- 
cient execution. Their work is exacting to an extreme degree, and 
it demands great self-control and the exhibition of unusual forbear- 
ance and Christian charity. 
7. Attendants and nurses will have immediate charge of the 
patients and their apartments. They will see that the patients are 
at all times kept as comfortable and clean as their condition will 
permit. They shall keep them comfortably clothed, bathing them 
and changing their clothing as frequently as required for this 
purpose. They shall keep their apartments at all times clean and 
neat, and free from every contamination which is unpleasant or 
injurious to health. They shall look carefully after every portion REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
7 
of the housekeeping, including bed making, sweeping, dusting, bright- 
ening the floors, hardware, plumbing fixtures, etc. Every portion of 
the ward shall be kept well aired and of proper temperature and as 
free as possible from objectionable odor. They shall have especial 
care of the lavatories and toilet rooms, keeping them thoroughly 
clean and instructing and training patients in their proper use. They 
shall provide frequent changes of toweling, and in bathing shall see 
that each patient has clean water of a proper temperature and 
sufficient bath towels to properly dry the body before dressing. 
They shall always be present in the bathroom when patients are 
bathing, unless special permit has been granted the patient from the 
physician in charge to bathe alone. They shall assist patients in the 
bath and in dressing, providing them with clean changes and using 
all precautions to prevent accident during the bath. They shall 
not permit more than one patient in the bathroom at one time and 
not more than two at one time in the dressing room adjoining. 
8. They shall take as many as possible of the able-bodied patients 
outdoors for exercise on each suitable day, once or twice, as directed 
by the physician in charge or supervisors. They shall direct and 
encourage patients to assist in the housework and in such work out- 
side the ward as may be assigned, keeping in mind all the time that 
the work is to be utilized as a feature of the treatment of the patient 
and that its primary object is improvement and restoration to health 
of body and mind. They should always work with patients at any 
work to which they are assigned. 
9. Attendants and nurses sleeping in the wards must arise promptly 
on the ringing of the bell at 6 a. m., and those sleeping at the nurses’ 
homes must report on the wards promptly at this hour and proceed 
as soon as practicable to call each patient and assist him in the 
morning toilet. They shall see that each is properly washed and 
dressed and made ready for the morning meal. 
10. They shall accompany the patients to the dining room, act as 
waiters to them, assist such as require assistance, and keep constantly 
on duty among them during the meal. Refusal of a patient to eat 
or the missing of a meal by a patient for any other reason should be 
promptly reported to the physician in charge. 
11. After the meal they shall return the patients safely to the ward 
and shall remain continuously among them, except as their duties 
may demand otherwise or during the hours when they are relieved 
from duty under the rules. 
12. They are expected to preserve order among the patients, but in 
so doing they are expected to use the mildest possible means to 
accomplish this end. Violent conduct and profane and obscene 
language on the part of the patient must be prevented as far as 
practicable. 
29014—12 2 8 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
13. No kicking, striking, shaking, or choking of a patient will be 
permitted under any circumstances and any evidence of this will be 
sufficient cause for discharge. Patients must not be thrown violently 
to the floor in controlling them, but the nurse or attendant shall call 
such assistance as will enable him to control the patient without injury 
and as far as possible without severe struggling. 
14. Should it be deemed necessary to isolate a patient for his pro- 
tection or to prevent injury or disturbance of others, the fact shall be 
immediately reported in person or by telephone to the physician in 
charge or to the supervisor, together with the reasons therefor, and 
such isolations shall not continue unless it is approved by the author- 
ity to whom it is reported. 
15. No mechanical restraint of any kind shall be used without first 
securing the consent of the physician in charge therefor. 
16. The personal care of patients, including feeding, bathing, dress- 
ing, and undressing, and the administration of medicines must never 
be intrusted to other patients, and no patient shall be taken out of the 
ward or cottage for work unless special permission has been granted 
by the physician in charge. 
17. In wards witli'two attendants or nurses, at least one, and in 
wards with four, at least two shall be always present among the 
patients, and all are expected to spend their time there whenever 
their duties will permit. Loitering or resting in the private bed- 
rooms of nurses or attendants will not be permitted during the hours 
that they are on duty. 
18. Keys shall not be intrusted to patients under any circumstances. 
Nurses and attendants will each be held responsible for the keys'given 
them, and they will leave them in charge of the supervisor whenever 
they leave the hospital inclosure, and shall deliver them to the super- 
visor when they quit the service. 
19. No one not connected with the ward or engaged in necessary 
duties therein shall be permitted to enter it without consent is first 
obtained from the supervisor, or physician in charge, and attendants 
and nurses shall not visit other wards or portions of the hospital, 
except in the transaction of their necessary duties, without first 
obtaining consent so to do from one of these. 
20. Nurses and attendants are expected to know the whereabouts 
of their patients at all times. They shall keep accurate account of 
them at each meal and on going out and returning to the ward. They 
shall report promptly to the supervisor or physician in charge the 
absence of anyone as soon as discovered. If a patient escapes through 
the negligence of a nurse or attendant the Superintendent shall require 
the nurse at fault to bear the expense incurred in returning the patient 
to the hospital. It may also be sufficient cause for discharge, as the 
superintendent may determine. REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
9 
21. Patients known to be suicidal shall never be left out of sight of 
a nurse under such circumstances as might permit the execution of 
such a purpose. Patients shall be as frequently searched for con- 
cealed weapons as may be necessary, and bedrooms and beds must be 
carefully examined each evening before the patient retires. 
22. All patients shall bathe at least once each week, and such 
patients as require it shall be shaved once or twice each week, as 
opportunity may offer. The hair shall be kept neatly triremed and 
in good order. 
23. The conduct and conversation of a patient must never be ridi- 
culed or spoken of slightingly or jestingly to visitors. They must 
always be addressed kindly and respectfully, and all proper questions 
must be courteously answered. 
The patient’s symptoms or the question of the chances of recovery, 
or the possible duration of his illness should never be discussed with 
the patient’s relatives or friends. Such questions should be addressed 
to the physician in charge. 
Nurses and attendants must never scold or threaten, and must 
never quarrel or wrangle with patients. They must never ridicule 
the delusions of patients, and must avoid discussing the conduct of 
one patient with the others. 
24. Gossip among attendants and nurses and all unseemly quarrel- 
ing is strictly prohibited. 
25. Patients shall retire at 8 p. m., except in such cases as may be 
given special permission by the physician in charge, in which case they 
may be permitted to -retire at any later hour until 9 p. m., but no 
patient in ordinary good health shall be permitted to retire earlier 
then 7.30 p. m., unless ordered so to do by the physician in charge. 
26. Nurses and attendants will be required to wear such uniform 
as may be designated by the superintendent and officers of the hospi- 
tal, and this shall be worn at all times when on duty. The special 
buttons used in the manufacture of this uniform will be charged to the 
nurse or attendant using them, and shall be returned to the super- 
visor on leaving the service. This uniform shall be procured at the 
end,of the probationary period. 
27. Such division of labor as will best conduce to efficient and econo- 
mical administration of the affairs of the ward shall be arranged by 
the physician in charge, and the supervisor among nurses and attend- 
ants in each ward. It shall be considered the chief duty of the nurses 
to look after the personal care of the patients, including their dressing 
and beds, while the especial duty of the attendants will be to look 
after the care of the ward proper, including clothing rooms, bath- 
rooms, lavatories, closets, and dining rooms. Where nurses and 
attendants are both employed in the same ward, they will be expected 
to cooperate and assist each other whenever possible, and the physi- 10 
REGULATIONS GOVERNMENT HOSPITAL EOR INSANE. 
cian and supervisors will make such distribution of work as shall be 
equitable and fair to each. 
28. In the female department it is hoped that in the course of time 
the work of the wards will be divided entirely between nurses and 
domestics. In such-case the domestics shall go on duty at 6 a. m. 
and remain on duty until after the evening meal is served and the 
dining-room work completed, the same person being allowed two hours 
off afternoon. They will do the scrubbing and cleaning of 
floors, walls, and windows, assist in bed-making, and have charge of 
the work of the closets, lavatories, bathrooms, and dining-rooms. 
The nurse in such case will have full charge of the care and control 
of the patients, including their dressing, bathing, clothing, exercising, 
and everything relating to their personal comfort and safety. 
29. In every ward having nurses the head nurse shall be charged 
with the responsibility of administering the medicines as directed by 
the physician, and on wards where no nurses are employed, the head 
attendant may be given this duty if it is deemed advisable by the 
physician in charge. The medicines, in each ward so designated by 
the physician in charge, shall be kept in a neat case in the room of the 
head nurse or head attendant, strictly under lock, and the nurse or 
attendant in charge of it shall be held strictly accountable for its 
safety and its administration as directed. 
30. Careful and accurate ward notes shall be kept by the nurses and 
charge attendants of every case on their wards. It shall be the duty 
of the chief of the training school to instruct nurses and attendants in 
the proper preparation of these notes, and suitable blanks will be 
furnished for this purpose. 
31. Nurses and attendants will go on duty at the rising hour in the 
morning and remain on duty until the hour for retiring, except that 
one half the number, as nearly as practicable, shall be excused each 
alternate evening after the evening meal is served and the work con- 
nected therewith finished, until 10 p. m., the exigencies of the service 
or sickness of associates excepted. 
All nurses and attendants will be required to be in their rooms at 
10 p. m., except that married attendants who live near the hospital 
may spend their nights at home on such nights as they are off duty in 
the evening, with the proviso that they shall be present in the ward 
for duty at the hour of ringing the bell in the morning. 
32. In addition to these hours, attendants and nurses will be granted 
a half day off duty from 1 p. m. to 10 p. m. each week, or one whole 
day and two half days every four weeks, and each third Sunday from 
7 a. m. to 10 p. m., and in addition thereto 15 clays, to be taken at or 
near the expiration of each year of service. 
33. Employees are reminded that the business ol such a large insti- 
tution as the Government Hospital for the Insane requires almost con- REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
11 
stant use o± the telephone lines from the hospital to the city for official 
business. General use of these lines therefore can not be permitted. 
Important messages maj’ be left with the operators in the office for 
transmission to the city, and messages may be received by the opera- 
tors and delivered to employees when the lines are not otherwise in use. 
The hospital telephone system connecting the wards, etc., with the 
offices is installed to facilitate hospital work and not for social inter- 
course. The operators at the hospital telephone switchboard are 
directed to make no connections for employees except in matters of 
urgent importance, the nature of which must be explained before the 
connection is made. 
In case of emergency, if permission is granted to use the telephone 
for a long distance call, payment for the same must be immediately 
made to the telephone operator. 
The public telephone stations are provided for the convenience of 
empffiyes and others, but it is not expected that employees will leave 
their duties to use the telephone, except in cases of emergency, in 
which case they must obtain permission. 
34. Nurses and attendants are not permitted to have any transac- 
tions of a business nature with any of the patients, nor will they be 
allowed to give or receive money from them. They are not permitted 
to receive money or presents from relatives or friends oi patients. 
35. Nurses and attendants are cautioned against appropriating 
articles of wearing apparel or other property belonging to patients, 
and any evidence of this will be sufficient cause for discharge. 
36. Nurses and attendants will not be allowed to receive visitors 
while on duty. 
37. Employees on entering the hospital service as attendants should 
endeavor to arrange for entrance to the training school for nurses at 
the commencement of the first session of the school following the date 
of employment. 
The training school is divided into a junior class and a senior class. 
Details in regard to entrance in these classes will be furnished on appli- 
cation to the medical officers. Graduates of the training school 
receive higher compensation and have preference for the higher posi- 
tions. Every member of a training-school class must attend every 
session of that class unless excused by the class instructor. The 
course of instruction will cover two years, and those who complete it 
successfully will receive diplomas as trained nurses and increased com- 
pensation dating from the first of the month following graduation. 
38. Employees will be expected to provide themselves with uni- 
forms and to wear them immediately after the}’' have served their 
probationary period of six months. 
39. Boom occupants will be held responsible for articles of furniture 
destroyed or injured, or for damage done to the building. Gentle- 12 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
manly and ladylike behavior is enjoined and cleanliness and neatness 
are absolute requirements. 
The use of alcohol, oil lamps, candles, ordinary matches, or any form 
of lighting or heating other than that provided by the hospital, is posi- 
tively forbidden. 
Trunks are not to be kept in the employees’ rooms, but must be put 
in the trunk room provided for that purpose. 
Any employee detected in bringing intoxicating liquors on the prem- 
ises will be immediately discharged. 
Food or materials subject to putrefaction will not be allowed in any 
of the rooms. 
All rooms, bureaus, cupboards, etc., in all parts of the hospital will 
be subject to weekly inspection. 
Absence from the hospital beyond the leave granted will be consid- 
ered cause for dismissal. 
It is a part of the duty of each employee to dance with patients 
when requested to at the weekly dances. 
Employees are strictly prohibited from having revolvers in their 
possession at any time while on the premises. 
THINGS TO BE DONE. 
SUPERVISORS. 
1. ALWAYS maintain constant and careful oversight of the pa- 
tients, employees, and hospital property under vour care. 
2. ALWAYS enforce the rules of the hospital in your department 
honestly and fearlessly at all times. 
3. ALWAYS report promptly to the medical officer in charge any 
breach of duty on the part of nurses, attendants, or other 
employees that may come to your knowledge. 
4. ALWAYS have the welfare'of the hospital at heart and strive to 
see that patients are properly cared for and that good order 
is maintained. 
5. ALWAYS report promptly all changes regarding the movements 
of employees in your department to the civil service office. 
Delays in such matters are likely to cause great confusion in 
the office. 
6. ALWAYS furnish the financial office promptly with a report of 
the assignment of any new special attendant. 
NURSES AND ATTENDANTS. 
7, ALWAYS remove white spreads from beds at night. They are 
to be neatly folded and laid aside. 
S. ALWAYS remember that the head attendant and the second 
in rank are not to leave the ward at the same time, unless 
relieved by direction of the physician in charge. REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
13 
9. ALWAYS keep razors, if you have them, safely locked up. 
10. ALWAYS be polite, attentive, and respectful to the officers of 
the hospital, to visitors, to the patients, and to one another 
at all times. 
11. ALWAYS be truthful, trustworthy, and industrious. Your 
whole time belongs to the patients, and it is your duty to make 
every possible effort to add to their comfort and to promote 
their recovery. 
12. ALWAYS remember that you are to treat all visitors politely, 
but always refer them to the office for information concerning 
patients or the management of the institution. 
13. ALWAYS receive new patients kindly, gently, and soothingly. 
14. ALWAYS turn cold water on before hot—always see that the 
bath is of proper temperature before using. 
15. ALWAYS take off the boots and shoes of a patient who is inclined 
to violence. 
16. ALWAYS report at once any unusual symptom, injury, accident, 
or serious illness to one of the physicians or at the medical 
office. 
17. ALWAYS bathe uncleanly patients whenever they soil their 
clothing or bedding. 
18. ALWAYS count your patients before starting and immediately 
on returning with a walking party. Report escapes at once. 
19. ALWAYS count your patients at meals and at bedtime, and 
report at once if anyone is missing. 
20. ALWAYS when on duty report any unusual occurrence to the 
charge nurse coming on duty for the day. 
21. ALWAYS acquaint yourself with the fire-alarm signals and give 
alarms in case of fire with the utmost promptness. 
22. ALWAYS respond as soon as possible if you hear the fire alarm 
from some other part of the hospital, but first see that your 
patients are properly cared for by other nurses or attendants. 
23. ALWAYS remember that as nurses and attendants you are 
employed to care for patients. This is the first lesson to be 
learned on entering the hospital service, for upon the faithful 
performance of your duties will often depend not only the 
health, but the lives of the unfortunates committed to your 
keeping. 
24. ALWAYS report promptly the loss of knives, spoons, or forks 
in the dining room. 14 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
THINGS NOT TO BE DONE. 
SUPERVISORS 
1. DON’T allow personal friendship with nurses, attendants, or 
patients to influence your treatment of them. Your attitude 
toward all must be uniformly just and impartial. 
NURSES AND ATTENDANTS. 
\ 
2. DON’T wear clothing that has become soiled and untidy. 
3. DON’T appear on duty without a collar and necktie. Men should 
never wear their hats within doors. 
4. DON’T leave your room with the door unlocked. 
5. DON’T allow patients to visit in your room. 
6. DON’T converse through the ward windows with persons outside. 
7. DON’T shout to one another or to patients. Such outcries 
always disturb the peace and quiet of the hospital. 
8. DON’T lose your self-control—giving away to anger is immedi- 
ately fatal to good work, it destroys your influence, makes the 
patients your enemies, and renders you a constant source of 
trouble. 
9. DON’T sit or lounge about when medical officers or visitors are 
passing through the ward. 
10. DON’T spend your time reading or at games when you are on 
duty. 
11. DON’T indulge in smoking when on duty. 
12. DON’T smoke or allow patients to smoke within any building on 
the hospital premises unless you have permission from a medi- 
cal officer. 
13. DON’T idle away your time; industry is always commendable. 
14. DON’T leave vour ward without permission or until you are prop- 
erly relieved—at least one nurse or attendant should remain on 
duty. 
15. DON’T leave your ward at night without seeing that all windows 
and doors are properly closed and secured. 
16. DON’T visit another ward when off duty without permission from 
the medical officer. 
17. DON’T be absent from the hospital beyond the stated time for 
which permission has been granted. 
18. DON’T allow friends of patients or any other strangers to enter 
the ward you have charge of without permission from a medical 
officer, or the supervisor. REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
15 
19. DON’T throw rags, hair, waste paper, fruit skins, or anything else 
except toilet paper into the toilets. 
20. DON’T send clothing or bedding used by a patient suffering from 
a contagious disease to the laundry with other soiled linen. 
See that it is kept separate and marked for sterilizing. 
21. DON’T mail letters for patients or deliver messages or anything 
else to them without the permission of a medical officer. 
22. DON’T allow patients under your charge to visit hotels, saloons, 
or similar places or go to make purchases or mail letters without 
permission from a medical officer. 
23. DON’T visit saloons or other objectionable places when away 
from the hospital for the purpose of transferring patients or on 
any other errand. Visiting such places invites criticism and 
leads to unfavorable comment as regards both you and the 
hospital. 
24. DON’T loan patients money or borrow from them. 
25. DON’T correspond with patients’ relatives or friends. Refer all 
letters of inquiry to the medical officer in charge. 
26. DON’T talk about patients when away from the hospital. Keep 
their peculiarities secret. 
27. DON’T deceive a patient. Deception results in loss of confidence 
on the part of the patient, strengthens delusions, and interferes 
with recovery. Avoid answering an inquiry or refer it to a 
medical officer rather than lead the patient to believe what is 
not so. 
28. DON’T bathe two patients in the same water. The spray bath is 
to be used wherever practicable. 
29. DON’T risk scalding a patient by permitting hot water to run 
when the patient is in a bathtub. 
30. DON’T order patients about—much more can be accomplished 
by mild persuasion. 
31. DON’T allow patients to sit or lounge about in an untidy condi- 
tion. 
32. DON’T allow patients to wear wet, damp, or soiled clothing. 
33. DON’T send new patients to work, to chapel, or to entertain- 
ments until directed to do so by a medical officer. 
34. DON’T allow patients to go out in cold weather without proper 
clothing. Clothing should be adapted to the season. 
35. DON’T allow patients to go out to work when it is excessively 
cold. 
36. DON’T try to control a violent patient alone; call assistance. 
37. DON’T leave a fellow attendant alone with a violent patient. 16 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
38. DON’T allow patients to quarrel. Many assaults may be averted 
if quarrelsome patients are separated in time. 
39. DON’T ever kneel or jump or fall on a patient. 
40. DON’T try to lift a fallen patient to his feet until you have ascer- 
tained that he has no broken bones. 
41. DON’T promise patients privileges that you know you have no 
authority to grant. 
42. DON’T allow feeble patients to go up or down stairs alone or 
without assistance. 
43. DON’T try to hold an epileptic patient while in a convulsion. 
Let him lie down with a pillow under his head. If you observe 
an attack is coming or has begun, place the patient gently on 
the bed or the floor. 
44. DON’T leave an epileptic alone while recovering. 
45. DON’T let an epileptic stand on a table, climb a ladder, or get in 
any place where he may fall and injure himself if he has a 
convulsion. 
46. DON’T allow sheets to remain wrinkled or wet under bedridden 
patients—bedsores are often caused in this way. 
47. DON’T lift up the head of a fainting patient. Let him lie quietly 
on the floor until consciousness returns. 
48. DON’T attempt to feed a patient while he is lying down unless 
liis head and shoulders are elevated and well supported. 
49. DON’T administer medicine without first carefully reading the 
instructions on the bottle or cup. 
50. DON’T keep poisons or medicines, the character of which you do 
not know, in your medicine closets. 
51. DON’T allow anything inflammable to remain on the ward 
when not actually in use; for example, turpentine, oiled rags, 
etc. 
52. DON’T walk and visit with a fellow attendant when you are 
accompanying a walking party of patients. 
53. DON’T allow patients out walking to converse with strangers. 
54. DON’T forget that the excessive use of electric lights means 
excessive burning of coal in the boiler house. Turn off electric 
lights when they are not needed. 
55. DON’T let lights shine in the eyes of patients at night. Have the 
lamps shaded and call the ward physician’s attention to the 
fact. 
56. DON’T fail to read and thoroughly familiarize yourself with the 
fire regulations of the hospital. 17 
57. DON’T forget that you must return your book of rules when you 
leave the service of the institution. If not returned, a charge 
of 15 cents will be made for same. 
58. DON’T forget that you must return your keys when you leave 
the service of the hospital. A charge of 10 cents for each key 
will be made if not returned unless relieved of that responsi- 
bility by the physician in charge of the service. 
59. DON’T under any conditions appropriate the clothing of patients 
to your own use. 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
SPECIAL EXILES FOE EMPLOYEES IN HOWAED HALL 
1. No attendant is allowed to open any of the doors leading to a 
patient’s room, unless there is at least another attendant present in 
the ward at the time. 
2. No attendant is allowed to take any patient out of the building 
without permission from the physician in charge. 
3. No attendant is permitted to have any transaction of a business 
nature with any of the patients. 
4. No attendant is permitted to mail any letters for patients, or 
deliver any letters to them. Letters written by patients must go 
through the supervisor’s office. 
5. No attendant is permitted to buy anything for patients or to 
sell any articles to patients. When a patient desires to make a pur- 
chase this must be made through the supervisor’s office. 
6. When patients are placed in their rooms for the night, the 
attendants must remove their clothing from the rooms and leave it 
outside the door. 
7. The keys leading to Howard Hall Building are never under any 
circumstances to be taken out of the hospital grounds, but must be 
turned in to the supervisor’s office as soon as the attendant goes 
off duty. 
8. Attendants must refrain from keeping in their offices or living 
rooms in Howard Hall any instruments, tools, knives, or razors. 
Special permission must be obtained from the physician in charge 
for the possession of any of the above-mentioned articles. 
9. The rooms of patients must be thoroughly searched at least 
once in two weeks, and any objects of the nature of weapons or tools, 
if found, must be immediately removed and turned over to the 
physician in charge. 
10. The night attendants shall be on duty promptly at 8 p. m. and 
report to the supervisor’s office before going on duty. They shall 
make a written report of the occurrences in the ward during the 
night in a specially prepared report book. This book is to be left in 
the supervisor’s office in the morning. 18 
REGULATIONS GOVERNMENT EIOSPITAL FOR INSANE. 
11. The general night watch of Howard Hall shall report to the 
night physician by phone every hour during the night. He shall 
make rounds through the building every half hour during the night 
and receive a report from the various night attendants at these times. 
12. The outside watch of Howard Hall shall report to the general 
night watch every hour during the night. In case of any unusual 
occurrence, such as an attempt on the part of the patients to break 
out, or in case of fire, he shall immediately notify the operator at 
the switchboard, from the nearest telephone, either in Garfield Base- 
ment or West Lodge. His duties shall be to make a tour of the 
Howard Hall Building at least once every half hour between the 
hours of 8 p. m. and 6 a. m. He shall report to the supervisor when 
going on and off duty. 
13. The outside day guard’s duties shall be to patrol the building 
during the day, making a tour of same at least once every half hour. 
He shall report to the supervisor when going on and off duty. 
RULES FOR EMPLOYEES ON RAILROAD. 
1. The engineer is expected to operate all trains with the greatest 
care and regard for the safety of life. 
2. In rounding curves the bell is to be constantly rung. 
3. In pushing cars a brakeman must be stationed on the front 
end of the train. 
4. In switching and shoving cars the brakeman must run ahead 
and see that the track is clear and warn those who may be near the 
track. 
5. All employees whose business calls them to cross the railroad 
track or to work on same must be careful to see that the way is 
clear before crossing or working on same. 
FIRE RULES. 
PRECAUTIONS AGAINST FIRE. 
1. Safety matches only will be permitted on the premises of the 
hospital. Empty boxes must be returned before others are issued. 
2. No patient will be allowed to have matches in his possession 
except as special permission may be granted by the physician in 
charge. 
3. No smoking will be permitted in or near any of the hospital 
buildings, including the stable and dairy barns, except at such places 
as may be designated by the superintendent or the physician in 
charge. 
4. All employees, and particularly all heads of departments, must 
use every precaution in removing all inflammable materials, such as 
greasy or oily cloths, paint pots, shavings, and dust. REGULATIONS GOVERNMENT (HOSPITAL FOR INSANE. 
19 
5. Supervisors and those charged with the care of the chapel and 
amusement hall and the supervision of entertainments must use 
every precaution against sources of fire, such as lanterns, lime c}din- 
ders, holiday decorations, etc. 
6. The carpenters, painters, tinners, and engineers will be responsi- 
ble for the care of their shops and must use all care to see that no 
dangerous materials are left about after working hours and that the 
shops are carefully locked on leaving. 
7. A fire drill will be held once each month. The signal will be the 
continuous ringing of the bell, and all those designated for fire duty 
who can be spared will assemble at the engine room for such practice 
as the fire chief may direct. 
8. It will be the duty of the fire chief to test every valve and 
hydrant once each month and to instruct the attendants and other 
employees in the use of the extinguishers and hose. lie shall also 
see that all apparatus is kept in order and all necessary tools kept in 
place and ready for immediate use. 
9. These rules must be read by each employee carefully and at 
frequent intervals in order to thoroughly familiarize themselves with 
their requirements. 
REGULATIONS IN CASE OF FIRE. 
1. In the event of the occurrence of fire in any part of the hospital 
report must be at once made by telephone to the central telephone 
office by the employee first discovering it. 
2. The operator on duty at the central office shall immediately 
notify the pumping station and the stable. 
3. The fire chief shall designate the duties of the different members 
of his force and they shall all repair at once to the engine house. 
The bell shall be rung by one to notify all the employees. 
4. The engine shall be promptly gotten ready and the hose reels 
run to the location of the fire. The wrenches for the fire plugs must 
be kept always at hand and the hose promptly connected. 
5. The outside employees must report and render all assistance 
possible. They shall be under the general direction of the fire chief. 
6. Supervisors, attendants, and nurses near the scene of the fire 
will apply as quickly as possible the means provided for its extinc- 
tion. The location of the nearest chemical extinguisher and the 
nearest hose line must be kept in mind and these promptly utilized. 
The first duty of the supervisors, head attendants, and head nurses 
must be to get each patient in line ready to march from the ward, and 
as soon as this is done they must be quietly marched out of danger. 
7. The second attendant and second nurse will have immediate 
charge of the fire apparatus and must see that it is used at the earliest 20 
REGULATIONS GOVERNMENT HOSPITAL FOR INSANE. 
moment. The other attendants and nurses in wards near the fire 
shall assist as directed by the head attendant and head nurse. 
8. Attendants and nurses in wards not threatened will repair at 
once to the scene of the fire, whenever they can be spared-from tile 
care of their own patients, and assist in such manner as the super- 
visors or fire chief may direct. 
9. The superintendent and other officers shall have general charge 
as at other times and give such general directions as may be required. 
REGULATIONS FOR CONTROLLING USE OF ELECTRIC LIGHTS. 
1. All officers and employees are requested to use every effort 
possible to reduce to the minimum the amount of lights used through- 
out the hospital. 
2. It is particularly the duty of all night watches and night nurses 
to see that all unnecessary lights are turned out and that all employees 
observe these regulations. 
3. All night lights shall be reduced to the smallest number consist- 
ent with safety. All lights in tunnels, passageways, and in and about 
employees’ rooms shall be promptly turned off at 10 o’clock. 
, 4. Attendants and nurses are particularly cautioned to turn off 
lights promptly of mornings, and to keep no more lights during the 
day than conditions require. 
5. It is made the duty of supervisors, head nurses, and heads of 
departments to see that regulations are enforced. ' 
6. All employees are cautioned not to handle electric wires. Any 
trouble connected with same at once notify the electrical department. 
7. Electrical employees must be careful not to handle high-voltage 
wire except with rubber gloves.