r REGULATION GOVERNING TOE HOSPITALS JEFS1 UNITED Sir-* /,'..:.' HEA13H i 192O GIFT OF HEALTH LIBRARY Regulations governing the Hospitals and Relief Stations of the United States Public Health Service 1920 Washington Government Printing Office 1920 TREASURY DEPARTMENT, SECRETARY'S OFFICE, Washington, March 5, ^00. To officers of the Public Health Service, collectors of customs, and others concerned: Upon the recommendation of the Surgeon General of the Public Health Service and pursuant to acts of Congress of June 29, 1870, July 1, 1902, August 14, 1912, March 3, 1919, and with the approval of the President of January 23, 1920, the following regulations for the government of hospital and relief stations are hereby promul- gated for the information and guidance of all concerned. All pre- vious regulations inconsistent herewith are hereby revoked. D. F. HOUSTON, Secretary qf the Treasury. (2) CONTENTS. Letter of promulgation Article I. General provisions II. Relief stations III. District supervisors " Reports IV. Hospital organization and adrainistratlon___ Plans of administration Medical officer in charge Executive officer Officer of the day Admitting officer Chief clerk Personnel officer Registrar Materiel officer Dietetic service Professional services Medical service Tuberculosis ward Neuro-psychiatric ward Isolation wards Surgical service - Eye, ear, nose, and throat department Urology Ward surgeons Laboratory service Ward employees Nursing service Dental service Reconstruction service V. Neuro-psychiatric patients VI. Discipline of patients VII. Deceased patients VIII. Transportation of patients IX. Inspection of relief stations Inspections by medical officer in charge X. Beneficiaries Seamen The United States Coast Guard Officers and employees of the Public Health Service The Mississippi River Commission The Engineer Corps, United States Army The Lighthouse Service The Coast and Geodetic Survey Bureau of Fisheries Injured civil employees of the United States beneficiaries of the Federal employees' compensation act Patients of the Bureau of War Risk Insurance Patients for special study and investigation (3) 427133 Pago. 3 10 11 14 16 19 20 20 24 26 27 28 29 29 20 29 32 33 33 37 37 40 40 48 \ 59 59 60 60 60 61 70 Article XI. Officers and enlisted men of the United States Army and Navy, foreign seamen, beneficiaries of the Federal Board for Voca- tional Education , 78 United States Army and Navy '. 78 Foreign seamen 78 Beneficiaries of the Federal Board for Vocational Educa- tion 79 XII. Relief 84 Out-patient relief _" 84 Register of out-patients 84 Fourth-class stations 80 In-patient relief 86 Register of in-patients : 87 Dental treatment 89 XIII. Public property 89 General provisions 89 XIV. Responsibility for property in hospitals 90 XV. Loss or destruction of property 92 XVI. Unserviceable property 92 XVII. Accountability for property 94 Property returns 95 Transfer of property between accountable officers 96' XVIII. Requisitions for property 97 Stationery and blank forms 98 XIX. Special requisitions and purchases 99 Emergency purchases 100 XX. Medical and surgical supplies __ 102 Prosthetic and orthopedic apparatus 103 XXI. Subsistence, proposals, and contracts 104 Leases 107 XXII. Vouchers 108 XXIII. Custodians 110 APPENDIX. Register of patients 113 Supplemental instructions for the preparation of Forms 1971-E and 1971-F 113 Classes of beneficiaries 113 Employees' compensation commission 116 Specimens of supplementary case reports 116 Hernia cases entitled to treatment under compensation act 117 REGULATIONS GOVERNING HOSPITALS AND RELIEF STATIONS OF THE PUBLIC HEALTH SERVICE. ARTICLE I. GENERAL PROVISIONS. 1. The flag of the United States shall be displayed at all stations of the first class from sunrise to sunset. On May 30 the flag should be placed at half-staff or half-mast until noon, when it shall be raised to the top of the staff or mast. When the flag is being raised or lowered all officers and employees who are in the vicinity will face toward the flag and remain at attention until it has reached tho top or bottom of the pole, as the case may be. They will then salute. 2. Each station of the first class shall be entitled to two national ensigns, one of the large size (10 feet hoist) and one a storm flag (5 feet hoist). The former shall be hoisted from a staff, erected over or near the executive building of the hospital, each day from sunrise to sunset, except during stormy weather. Whenever tho weather is too stormy to fly the large national ensign the storm flag may be set in its place. 3. Officers on duty at first-class stations shall report before making their morning rounds, to the chief of the professional service to which they are assigned. 4. A junior officer shall not leave the reservation without the con- sent of the medical officer in charge or the executive officer. 5. An officer, before leaving the station, will record his name, time of departure and destination in a book which will be kept at the station for the purpose. Upon his return to the station, the time will again be recorded. 6. The medical officer in charge, on leaving and returning to the reservation, shall notify the officer next in rank or the executive officer. 7. Stations of the first class shall not be left without the presence of a medical officer, but if exception to this rule is unavoidable special instructions shall be left with the chief clerk. 8. Stations of the first class, when but one medical officer and the chief clerk are on duty, shall not be left without the presence of the medical officer or the chief clerk. 9. Heads of wards and departments must report to their immediate superiors any dereliction of duty on the part of employees. (5) 10. The station office must not be left during the day without the presence of the chief clerk or other responsible employee. 11. Employees will not leave the station reservation without per- mission. They will obtain such permission and report their de- parture and their return under the general rules issued bv the medi- cal officer in charge. The time of departure and return will be recorded in a book kept for the purpose. 12. Testimonials of character to employees after leaving the service are to be given only by the medical officer in charge. 13. The keys of the station shall be in the custody of the officer designated by the medical officer in charge. Keys must never be taken away from the reservation, and when not in use shall be kept in a designated place. 14. Knowledge of the combination of the station safe will be guarded with the utmost care. Combinations and changes in combi- nations will be reported by confidential registered letter to the Sur- geon General attention Finance Section, Hospital Division iden- tifying the safe by its name and number. 15. Xo formula shall be introduced for ward use or for use in the dispensary without sanction of the medical officer in charge. All formulae shall be entered in the formula book kept in the dispensary for that purpose. 16. The 1st of January, the 22d of February, the 30th of May, the 4th of July, the 25th of December, and such other days as may be so designated by Congress or proclaimed by the President of the United States, shall be considered as holidays in the Public Health Service, to be observed by suspension of other than necessary labor in the discretion of the medical officer in charge. 17. At the discretion of the medical officer in charge of stations where State holidays are lawfully established, the same may be ob- served by him at his station in the same manner as a national holiday. 18. Sunda}^ shall be observed at all stations of the first class in an orderly manner. All labor or duty shall be reduced to the measure oJ strict necessity. The religious tendencies of officers and men shall be regarded, and every opportunity consistent with the duties of the station afforded them to attend divine worship. 19. Upon the death of the President or Vice President of the United States, the Secretary or Assistant Secretary of the Treasury, or the Surgeon General, the medical officer in charge shall direct that on the day following, and thereafter until the hour of the funeral, the national ensign shall be set at half-staff or half-mast. The same formality shall be observed at his proper station whenever an officer attached thereto dies. 20. Administrative assistants accountable for property or charged with the custody of the money and valuables of patients shall furnish bond in a reasonable amount for the proper handling of such prop- erty or funds intrusted to their care. 21. Officers and employees of the Public Health Service detailed for duty in connection with examination and medical relief of patients of the Public Health Service will, in so far as practicable, not be assigned additional duties in connection with other functions of the service. 22. Whenever special reports concerning patients of the Bureau of War Risk Insurance are sent by District Supervisors, one copy will be referred to the Surgeon General, United States Public Health Service, and a duplicate to the Chief Medical Adviser, Bureau of War Risk Insurance, notation of both references' being made on both copies. 23. All persons concerned Avill bear in mind the necessity of keep- ing the Chief Medical Adviser, Bureau of War Risk Insurance, fully informed regarding patients of the Bureau of War Risk Insurance. 24. All persons concerned with the enforcement of the provisions of the acts mentioned below will provide themselves with copies of the war-risk insurance act and acts amendatory thereto ; Public Act 326 of the Sixty -fifth Congress ; all acts of Congress relative to the Federal Board for Vocational Education; and all acts relative to the Federal Employees' Compensation Commission. They will thoroughly familiarize themselves with the contents of these laws to the end that ignorance thereof shall not be held to be sufficient excuse for failure properly to carry out their provisions. 25. All persons concerned with the enforcement of these regula- tions will thoroughly familiarize themselves therewith. In order that they may be understood and intelligently obeyed, medical officers in charge of operations under these regulations will instruct the sta- tion personnel therein. 26. The Surgeon General is hereby authorized to make such minor corrections in these regulations as may be necessary for the purpose of correcting obvious errors or clarifying points which would other- wise be obscure. 27. Officers charged Avith the enforcement of these regulations will note in their copies such changes as from time to time may be di- rected by the Secretary of the Treasury or the Surgeon General. ARTICLE II. BELIEF STATIONS. 28. A relief station is a place where an officer or other representa- tive of the service is on duty for the examination or relief of patients of the Public Health Service. 29. Relief stations shall be divided into the following classes: CLASS I. United States Marine and Public Health Service hospitals. This class shall be further divided into the following types : (a) Capacity more than 300 beds; (Z>) capacity 100 to 300 beds; (c) capacity less than 100 beds. CLASS II. All other relief stations in charge of a commissioned officer. CLASS III. All relief stations where an acting assistant surgeon is on duty for the examination or relief of patients of the Public Health Service. CLASS IV. All other relief stations not included in the above classes. 30. The medical and surgical treatment of the patients of the Public Health Service will be under the supervision of the medical officers of the service at all relief stations where such officers are on duty, and they will be required to take direct professional charge of the patients. 31. The outpatient office shall be located at the customhouse when- ever practicable, and suitable office space for that purpose shall be set apart by the custodian of the customhouse building if space is available, subject to the approval of the Secretary of the Treasury. ARTICLE III. DISTBICT SUPERVISORS. 32. The United States shall be divided into districts for the pur- pose of furnishing relief to patients of the Public Health Service. 33. Each district will be in charge of an officer of the service, who shall be designated as the district supervisor. He shall have supervision of the work of providing relief to patients of the Public Health Service in his district. He will furnish information to all persons entitled to relief and provide for their examination, hospital care, and treatment. 34. All service officers will cooperate with the district supervisors in their activities, and will furnish them with such information and aid as may be practicable. 35. Service officers who are not under the direct orders of dis- trict supervisors will cooperate in every way with the officer in charge of their district in order that the work may be accomplished in the most economical and advantageous way. 36. Relief stations of the third and fourth class shall be under the direct supervision of district supervisors. All correspondence, re- ports, proposals, requisitions, vouchers, etc., shall be forwarded to the Surgeon General through the district supervisor who has charge of the district in which the relief station is located. 37. Reports and vouchers shall be prepared at third and fourth class stations and initialed by the medical officer or deputy collector in charge, and when received by the district supervisor will be certi- fied by him and forwarded to the Surgeon General. 38. The District Supervisor should utilize to the utmost all facili- ties in Service hospitals in his district. Patients should not be hos- pitalized in contract hospitals unless it is impracticable to admit them to Service hospitals. 39. The amount to be paid to hospitals under contract for the care and treatment of patients of the Public Health Service will not ex- ceed $3 a day. If a proposal received from a hospital is more than $3 a day, special authority must be obtained from the Secretary of the Treasury, except in cases of emergency, when the Surgeon General should be immediately notified. 40. Whenever the words " patients of the Public Health Service " are used in these regulations, they shall be held to include patients of the Bureau of War Risk Insurance. 41. Hereafter district supervisors and their subordinate personnel shall be held to be the field representatives of the Director of the Bureau of War Risk Insurance and the Surgeon General of the United States Public Health Service. 42. District supervisors will carry on their operations under the conjoint direction of the Chief of the Hospital Division and the Chief Medical Adviser for the purpose of administering the functions listed below connected with the examination and relief of patients of the Bureau of War Risk Insurance, under rules and regulations con- jointly prescribed by the Director of the Bureau of War Risk In- surance and the Surgeon General of the United States Public Health Service, and approved by the Secretary of the Treasury. (A) Bureau of War Risk Insurance. Determination of (a) Eli- gibility to compensation and treatment; (b) service origin, aggrava- tion, nature and degree of disability from injury or disease; (c) ref-< erence for treatment; (d) payment of bills incident to the discharge of the above-mentioned functions. (B) The United States Public Health Service will furnish reason- able medical, surgical, and hospital services and supplies, including prosthetic apparatus, to such patients of the Bureau of War Risk In- surance as may be referred to it for the same and the payment of all bills incident to the discharge of these functions. 43. The Surgeon General will detail in each district a district ex- aminer who, with his subordinate personnel, will operate under the direction of the district supervisor for the purpose of carrying out the provisions of subparagr.aph (A) above. 10 44. The Surgeon General will detail in each district a district relief officer who, with his subordinate personnel, will operate under the direction of the district supervisor for the purpose of carrying out the provisions of subparagraph (B) above. 45. All bills for expenditures incurred for examination of patients of the Bureau of War Risk Insurance to determine their eligibility to compensation and treatment, including X-ray and laboratory bills, shall have the following statement placed upon the face thereof, unless the payee is under contract with the Public Health Service : " For examination to determine eligibility to compensation and treatment." 46. District supervisors shall keep the following record of all ap- plicants or patients examined or treated in the districts under their charge : (1) Out-patient record card, Form 1971-E. (2) In-patient record card, Form I971-F. (3) Card index of all correspondence with all stations in the district, from the Bureau of the Public Health Service, and the Bureau of War Risk Insurance. 47. Forms 1971-E, Out-patient card, and 1971-F, In-patient card, shall each be given a serial number as soon as they are filed in the offices of the district supervisors. Serial numbers shall be consecu- tive and continuous. 48. Upon receipt of an original or completed in-patient or out- patient report card, the district supervisor shall immediately execute two copies, one of which shall be forwarded to the Surgeon General and the other to the Chief Medical Adviser, Bureau of War Risk In- surance. Original cards 011 file in offices of district supervisors may be destroyed as soon as completed cards are received. 49. Upon receipt of completed Form 1934-B, Report of Physical Examination, district supervisors shall immediately execute a copy and forward the same to the Chief Medical Adviser, Bureau of War Risk Insurance. 50. A weekly progress report will be submitted by district supervi- sors to the Surgeon General at the end of each week. 51. The following monthly reports will be submitted by district supervisors to the Surgeon General : A tabulated report of number of cases examined, treated, and sent to hospitals in the district and total number for the district; Medical Officer's Report of Relief, Form 1922 ; Monthly Schedule of Encumbrances, Form 1955 ; Vouchers cov- ering expenditures during month. Forms 192C and 1949 ; Pay rolls for all officers and employes in the district ; Report of Pay Patients, Form 1927. 11 52. Special instructions will be issued from time to time, as re- quired, regarding annual reports. 53. District supervisors are authorized to assign an officer to act as State supervisor in each of the States comprising their districts. State supervisors, in their respective States, shall oversee the work of local examiners and act as their advisers and instructors in all matters pertaining to the. examination of claimants. State super- visors shall act as aides to the district supervisor, and shall serve under his orders only. 54. District supervisors are authorized to select strategic centers offering the best hospital facilities in their districts for the care and treatment of patients of the Public Health Service. In each of these centers a staff of attending specialists will be appointed, preference being given to designated examiners who are possessed of the requi- site qualifications, for the examination and treatment or for the su- pervision of treatment of patients of the Public Health Service. Current lists of these centers will be furnished all examiners from time to time. 55. Each of these hospitalization units will be under the imme- diate supervision of an authorized representative of the Public Health Service, appointed for full or part time duty, at a salary commensurate with the needs of the service in the localit}'. 56. In cities where a service hospital is located, the unit may be built around this hospital by the medical officer in charge. In such cases the attending specialists of the service hospital should be avail- able for the treatment of patients in civil hospitals in which service patients are being cared for, thus coordinating the work. 57. The acting assistant surgeon or other officer in charge of the * unit shall require the hospital furnishing relief to forward promptly to the district supervisor the reports required by regulations upon admission and discharge of patients. 58. Patients will ordinarily be referred by examiners to the nearest unit. In cases of emergency, however, examiners are authorized to proceed according to their best judgment, and when the services of an attending specialist are not available to obtain such services. In all such cases a report of the action should be sent to the district supervisor, showing the necessity for the procedure. ARTICLE IV. HOSPITAL ORGANIZATION AND ADMINISTRATION. 59. Type A and B hospitals are maintained for the following purposes : (1) To provide for the hospitalization of large numbers of patients. 12 (2) To afford better facilities than can be provided at the smaller hospitals of the service for the treatment of se- rious, complicated, obscure, or special cases. (3) To afford opportunities for the performance of the more complicated surgical operations, facilities for which may be lacking in the smaller hospitals. (4) To study, diagnose, and finally dispose of cases that have long resisted treatment elsewhere. (5) To instruct and train junior medical officers and internes in general professional and administrative duties. 60. The following tabular statement furnishes a working plan of administration of hospitals of the service : TYPE A HOSPITALS. MEDICAL OFFICER IN CHARGE. EXECUTIVE OFFICER. Professional division : Chief of medical service Medical wards, isolation ward, psychiatric ward, tuberculo- sis ward. Chief of surgical service Surgical wards, operating rooms, dressing rooms, E. N. T. section, eye section, urol- ogy section, orthopedic sec- tion. Chief of laboratory service Chemical and bacteriological laboratory, morgue, X-ray laboratory. Chief of dental service Dental clinic, laboratory. Reconstruction officer Occupational aids, physio- therapy aids, Red Cross. . Chief nurse. Nursing service. Admitting officer- Admission and discharge of patients, observation room. Administrative division: Chief clerk- Correspondence, records, and files. Personnel officer Male employees. Registrar Completed clinical records, war risk insurance records . and reports ; inquiries re- garding patients, patients' effects, post office, register of patients. Materiel officer Transportation, property, dis- pensary, shops, buildings and grounds, laundry. Chief dietitian- Kitchens, dining rooms, sub- sistence storerooms. OFFICER OF THE DAT, 13 TYPE B HOSPITALS. MEDICAL OFFICES IN CHARGE. EXECUTIVE OFFICEB. Professional division : Clinical director Medical wards, isolation ward, surgical wards, tuberculosis ward, genito-urinary ward, operating room, dressing rooms, chemical and bac- teriological laboratory, X- ray laboratory, morgue, dental section, out-patients' section. Reconstruction officer Occupational aids, physio- therapy aids, Red Cross. Chief nurse. Nursing service. Officer of the day Admission and discharge of patients, observation room. Administrative division : Chief clerk- Correspondence, records, and files; male employees, com- pleted clinical records, war risk insurance records and reports, inquiries regarding patients, patients' effects, post office, register of pa- tients. Materiel officer- Transportation, property, dis- pensary, shops, buildings and grounds, laundry. Chief dietitian- Kitchens, dining rooms, sub- sistence storerooms. OFFICER OF THE DAY. TYPE C HOSPITALS. MEDICAL OFFICER IN CHARGE. Professional division: Medical officers. Nurses. Administrative division: Chief clerk. Dietitian. OFFICER OF THE DAY. MEDICAL OFFICER IN CHARGE. 61. The medical officer in charge is in charge of the hospital, its personnel and patients, and shall administer all the affairs thereof. 62. He shall be responsible for the preservation and proper appli- cation of public property, and for the proper condition of buildings and grounds. In type A and type B hospitals he shall leave the de- tails of administration to subordinate officers as far as practicable. He shall make such reports to the Surgeon General as are required by regulations. He shall require a proper performance of duty by the entire personnel of the station and observance of rules by all patients. He shall make and enforce proper regulations for the sanitary, dis- ciplinary, and other internal requirements of the hospital. 14 63. In type A and type B hospitals he shall make a detailed inspec- tion of the wards and departments every Saturday. In addition, in- formal, unannounced inspections of separate wards or departments should be made daily. 64. In type C hospitals he shall visit the hospital wards once eacli day, and oftener, if necessary. The morning sick call shall be made not later than 9 o'clock each day, and the medicines ordered shall be compounded and delivered to the nurses as soon as practicable after the termination of the visit. The evening sick call shall be made at a time fixed by the medical officer in charge between 5.30 and 6.30 p. m. daily by an officer of the staff detailed by the medical officer in charge, and he shall be accompanied by the night nurse and by the day nurse in each ward. EXECUTIVE OFFICER. 65. In type A and type B hospitals a medical officer will be assigned as "executive officer" of the hospital. Under the direction of the medical officer in charge he shall have charge of the correspondence, reports, and various rosters of the service. He shall prepare, verify, and issue all orders, instructions, and details ; keep the records of the hospital, and perform such other duties as are required by regula- tions. He is the representative of the medical officer in charge, and through him the medical officer in charge communicates with the per- sonnel and patients in the hospital. 66. He shall keep accurate rosters of all officers, nurses, and other employees, assigned by the medical officer in charge to the perform- ance of their various duties, and promptly notify them of their as- signment. 67. The executive officer should be courteous to and on friendly terms with the officers of the station, and should avoid all discussion of the orders or the acts of his superiors. He shall endeavor at all times to exert influence belonging to his position, and on proper occasion, aid with his advice the junior officers of the hospital. OFFICES OF THE DAT. 68. The medical officer in charge shall detail each of the junior medical officers in rotation to act as officer of the day. The detail shall be posted daily on the day preceding that on which the officer of the day is to serve. 69. His tour of duty shall be 24 hours, and will commence at an hour to be designated by the medical officer in charge, at which time he shall meet the old officer of the day in the office of the medical officer in charge to receive such instructions as the medical officer 15 in charge may desire to give. Chiefs of service, pathologists, and officers serving in contagious wards shall not be assigned to this duty. 70. The officer of the day shall not leave the limits of the hospital during his tour of duty without the express authority of the medical officer in charge, and only after a proper substitute has been de- tailed. 71. He shall make at least three rounds of inspection of the hos- pital wards and grounds during his tour of duty. On the morning tour of inspection he shall visit all wards and make inquiries of ward surgeons concerning seriously sick patients who may need attention during the night. The hospital grounds and messes will also be inspected on this tour. 72. On the evening tour of inspection he shall see that the watch- men are at their posts, that the nurses and attendants are in their wards, and that they are properly performing their duties. On the night tour his inspection shall be made similar to the second, noting especially if the watchman and night attendants are at their posts and performing their prescribed duties, and when practicable, imme- diately correcting any disorder or neglect. 73. In all inspections it is his duty personally to ascertain that patients are receiving proper attention and to give such emergency treatment as may be demanded, recording the same on the patient's clinical record. 74. In the winter he shall see that the wards are properly heated and ventilated and that care has been taken to shut off the water supply, if necessary, to prevent freezing. He shall give instructions to ward employees to be careful and vigilant with regard to fires. In the event of an outbreak of fire he shall immediately assume charge juntil the arrival of the fire marshal, taking measures in the meantime to sound the alarm and extinguish the fire, if possible. 75. In case of serious illness or death of patients during the night, he is authorized to send a brief official message notifying the rela- tives of the fact. In such event he should use care and discretion, as often, owing to the lateness of the hour, telegrams can not be for- warded until morning, when such message could be sent more ex- pediently by the officer in charge of the reports of patients. 76. In case of death the officer of the day shall immediately exam- ine the body personally, superintend its removal to the morgue, mak- ing a record of the name of the deceased and the address of the nearest relative. He shall remove Form 1971-H from the foot of the patient's bed and attach it to the body of the deceased. On this form must be entered the patient's name, register number, permanent ad- dress, name and address of nearest relative, and the ward in which the patient died. This tag must invariably be attached to the body 16 of the deceased and not to the clothing, and must not be removed until the body has been prepared for burial or shipment. He shall collect all money, valuables, and other effects in the possession of the patient at time of death and deliver them to the officer charged with the custody of the same. In all such cases he shall submit a written report of the death, with all necessary data, to the officer in charge of the records of patients, and also include the same in his written report to the medical officer in charge at the close of his tour of duty. 77. In large hospitals of the service, where a regular admitting officer is detailed by the medical officer in charge, the officer of the day shall relieve him at all times when the admitting officer is not on duty. At hospitals in which no regular admitting officer is de- tailed, the officer of the day will act as admitting officer. 78. Should the officer of the day be in doubt concerning the nature of the illness of an incoming patient he should request the executive officer to arrange for a consultation. In all cases where consultation is not immediately available the patient shall be placed in the obser- vation ward at the admitting station for further examination. 79. When the duties of the officer of the day require him to be away from the admitting station, he shall leave definite instructions with the employee in charge in order that he may be found quickly at all times. He should sleep in a room provided for the purpose in close proximity to the admitting station. He shall at all times, during the night, be available for emergency sick calls from the wards. 80. The duties of the officer of the day are of wide range and most important in character. In the absence of the medical officer in charge and the executive officer, he is in charge of the hospital under the senior officer present. It is his duty to give such orders and make such recommendations as may be to the best interests of the hospital for the time being, and to see that no patient is neglected, and that no irregularities occur which may bring discredit upon the station and upon the service. 81. At the expiration of his tour of duty he shall make a report in writing in the book provided for the purpose in the office of the medical officer in charge, noting the hours at which his inspections were made, and reporting neglects, disorders, deaths, or infractions of hospital rules that may have occurred during his tour, and any other matters which may properly be brought to the attention of the medical officer in charge. ADMITTING OFFICER. 82. The admitting officer shall make a complete examination with- out delay of all patients applying for treatment in the hospital and assign them to the proper wards or departments for treatment. Pa- 37 tients requiring out-patient treatment only will be directed by the admitting officer to the proper place for treatment. 83. The admitting officer will prepare and sign, in duplicate, the upper portion of the first page of the clinical record at the time of admission of each in-patient. The original will be sent to the ward with the patient and the duplicate to the registrar, or to the chief clerk in hospitals where no registrar is assigned. The registrar will use this report for the purpose of preparing original report card form 1971-F. If any unusual circumstances are connected with the admission of the patient, notation will be made of the same on the first page of the clinical record at the time of admission. 84. Each patient will be questioned by the admitting officer with respect to money or valuables in his possession. All money and valu- ables received from patients at the time of admission must be immedi- ately delivered by the admitting officer to the officer charged with the custody of the same. If the patient has no money or valuables in his possession, he will be required to sign a statement to that effect on Patient Property Card, Form 1971-J. In cases of emergency the admitting officer, after administering treatment immediately neces- sary, may send patients directly to their proper wards, delegating to the ward surgeon the responsibility for completing records of admis- sion and receiving money and valuables. 85. The admitting officer shall closely examine all cases for com- municable disease. Such cases shall be sent immediately to the iso- lation ward. Suspects shall be detained in the observation ward at the admitting station until the diagnosis has been verified by consul- tation. Psychotic patients shall be sent immediately to the officer in charge of the psychiatric ward. 86. If a patient is admitted to a hospital as the result of a disease or injury in which there is a question as to his being entitled to treat- ment, the medical officer in charge should be consulted, all facts connected with the case, ascertained, and the question settled at the earliest possible date. Pending definite decision, care and treatment must be furnished to patients in every case. 87. The admitting officer shall be responsible for the proper care and treatment of patients from the time of their admission until the proper ward surgeon has assumed charge. Patients shall always be conducted to the wards by the necessary attendants. 88. In hospitals requiring the same, on account of the large num- ber of patients, a cross index file of locator cards shall be kept in the office of the admitting officer. Two cards shall be prepared for each in-patient. On both copies shall be recorded : (1) Name of the patient; (2) register number; (3) permanent ad- dress; (4) ward to which assigned. 185279 20 2 18 89. Locator cards shall be kept in two files : In file 1, the cards shall be filed alphabetically according to the surnames of the patients; in file 2, the cards shall be filed according to wards. 90. When ward transfers are about to be made, the authorization will be sent to the admitting officer for his counter signature in order that locator cards in both files may be changed to correspond with the new location of the patients. 91. The purpose of file 1 is to enable the admitting officer and the information clerk to determine immediately the location of a patient in the hospital. The purpose of file 2 is to furnish to the admitting officer an accurate record of the number of occupied and available beds in each ward. 92. When a patient is discharged his locator cards may be removed from both files and destroyed. 93. Patients being discharged or transferred shall be inspected by the admitting officer, who shall see that they are properly dressed and have all property and valuables belonging to them before their de- parture. He shall also note the physical condition of all patients at the time of discharge, and if there is any who in his opinion is not able to travel, make report of the same to the chief of service concerned. 94. The admitting officer must be notified in advance by chiefs of service of the intended discharge or transfer of all patients. 95. The registrar must be notified by the admitting officer before discharge of every patient, in order that all hospital records may be complete and that the patient may have the records, clothing, and valuables to which he is entitled upon his departure. 96. When patients arrive at the hospital the employee in charge of the admitting station shall immediately call the admitting officer and arrange for the comfort of the patient pending the officer's arrival. He shall personally see that accurate records of admission are made. 97. A suitable room in the admitting station shall be used for the observation and temporary detention of suspected cases of communicable disease. The admitting officer shall be in charge of this ward* and one employee will be detailed, when necessary, as attendant. 98. Persons desiring to visit patients in hospitals shall be admitted onlv through the admitting office, after the location of the patient has been determined by consulting the locator file. If the condition of the patient is such that the visit will not interfere with his care and treatment, a pass signed by the admitting -officer will be given to the visitor, permitting him to enter the public reception room or the ward where the patient is being treated if the patient is unable to come to the reception room. 19 99. Visitors will not be allowed at other than regular visiting hours 011 Tuesdays, Thursdays, and Sundays. Xo passes will be given that will permit visitors to enter contagious disease wards, except that adults over 16 years of age may be given permission to visit tuber- culosis wards. No patient will be permitted to receive more than four visitors at a time in the ward where he is receiving treatment. 100. Women visitors will not be permitted to enter venereal-disease wards. 101. In exceptional cases regulations regarding visitors may be modified as the necessity demands. The admitting officer shall satisfy himself with regard to the character of all visitors, and exclude all undesirables. Visitors having acute colds or other communicable dis- ease will be denied admittance. 102. Persons desiring to enter the hospital wards for purposes other than that of visiting patients shall be referred to the medical officer in charge or to the executive officer. 103. When a junior officer wishes to conduct visitors through the hospital, or to extend an invitation to any hospital event, the con- sent of the medical officer in charge shall first be obtained. 104. Ambulance drivers, except in cases of emergency, will report at the admitting office before departing on a call. A card will be given to the driver, on which will be recorded his name, the name of the patient, the time of departure, and the destination. Verbal instructions must never be allowed to serve in lieu of written instruc- tions except in cases of grave emergency where haste is necessary. 105. The ambulance driver Avill record on the card the time of arrival at destination. He .will also record any unusual circum- stances connected with the call, such as failure to locate the patient, or delays which may have occurred. Upon the return of the ambu- " lance the time will be recorded, and the completed card will be filed in the office of the admitting officer. CHIEF CLERK. 106. At all hospitals an administrative assistant or pharmacist will be assigned as chief clerk. The chief clerk shall be in charge of the preparation and filing of correspondence, reports, orders, and the various rosters of the personnel. 107. The chief clerk shall be charged with all the duties and re- sponsibilities of the registrar, the personnel officer, and the materiel officer in hospitals at which' no registrar, personnel officer, or ma- teriel officer is assigned. 20 PERSONNEL OFFICER. 108. In type "A" hospitals, when especially authorized by the Surgeon General, an administrative assistant or pharmacist shall be assigned as personnel officer. He shall have immediate charge of the assignment of all male employees in the hospital, supplying such details temporarily or permanently to the several wards or departments as may be directed by the medical officer in charge. He shall be responsible for the discipline, instruction, quartering, and proper keeping of accounts and records of all such employees. REGISTRAR. 109. In type "A" hospitals a pharmacist or administrative assist- ant will be assigned as registrar. He shall have charge of the com- pleted clinical records, the register of patients, all other medical and surgical records, and all reports pertaining to patients of the Bureau of War Risk Insurance and other classes of patients in the hospital. He shall be charged with the custody of the money, valuables, and other effects of patients. All inquiries concerning patients shall be referred to his department. 110. Whenever the condition of a patient becomes critical he shall notify by official telegram the nearest relative or friend, and there- after, if requested, daily reports may 'be sent by telegram at the expense of the person who requested the same. Upon the death of a patient he shall notify, by official telegram, the nearest 'relative or friend of the deceased. 111. Upon the admission of each patient a search will be made in the index to register of inpatients for records of former admission. In the event of previous admission the clinical record in the case shall be sent to the ward surgeon for his information, who will enter a brief of previous admission on the current history of the case, and return the original clinical record to the registrar's office. The regis- trar shall keep a check of such records to insure their safe return. 112. When a patient undergoing treatment in the hospital is absent without leave, the registrar shall immediately notify the medical officer in charge. In the event that a patient has been absent and returns to the hospital a like report shall be made. 113. When information is requested by any person regarding the disease for which any patient of the service has been under treat- ment, the registrar shall furnish such information only by direction of the medical officer in charge. _. 114. No clinical record or copy of the same shall be withdrawn from the files of the hospital or furnished to any person except upon the written order of the Surgeon General. 21 115 The registrar shall place the money and valuables of each patient in envelope, Form 1970, which shall be sealed and deposited in the hospital safe. He shall keep an accurate record of all such transactions, and shall receipt for the articles on Patient's Property Card, Form 1971-J, upon the admission of each patient, and obtain like receipt for all articles delivered to the patient or to his legal representative on discharge from the hospital. 116. The registrar shall have charge of the storeroom for patients' effects. The employee on duty in the patient's property room under the direction of the registrar shall be responsible, for the safe-keeping and care of all property in the storeroom, and the preparation of all records pertaining thereto. 117. The articles shall be enumerated on Form 1971-J, Patient's Property Card, which shall be prepared in duplicate. The original shall be placed on file and the duplicate given to the patient. Pa- tient's Property Card, Form 1971-J, will be kept in three files: (1) The current file, consisting of cards of patients who are being treated in the hospital; (2) the permanent file, consisting of cards of pa- tients who have been discharged from the hospital and whose effects have been returned; (3) the suspended file, consisting of cards for deceased patients and patients who have left the hospital without their effects. 118. Efforts should be made to dispose promptly of the effects of deceased patients and effects left in the storeroom by patients who have left the hospital. When proper disposition has been made, cards in the suspended file will be transferred to the permanent file. 119. Except in emergency, all effects of patients not needed in the hospital will be delivered to the registrar at the time of admission. One or more separate compartments shall be used for each patient's effects. Patient's Claim Check, Form 1971-1, will be attached to all effects before storing in the compartments. The outer half of the check will be removed and given to the patient. Each check will be numbered to correspond with the number of the compartment in which the property is stored. The check numbers for each patient w y ill be entered upon the patient's property card. 120. In cases of emergency where valuable effects go to a ward at time of admission with a patient who is unable to care for his effects, the ward surgeon shall be responsible for the same until they are delivered to the storeroom authorities. 121. Clothing and baggage will be removed from the storeroom only by order of the registrar, and the person removing such bag- gage must sign a receipt therefor on the patient's property card. 122. During the temporary absence of the registrar from the hos- pital, the admitting officer will receive the money and valuables of 22 any incoming patients and sign for the same on patient's property cards. In such cases the admitting officer will immediately deliver the funds to the medical officer in charge for deposit in the hospital safe. Upon the return of the registrar to the hospital the transac- tion will be verified and the registrar will assume the custody of the funds and sign for the same on patient's property cards. 123. The officer of the day will assume the custody of the money and valuables of incoming patients at all times when the registrar and admitting officer are not on duty. In such event the officer of the day will deliver the funds to the registrar the next morning. 124. If the registrar departs from the station on leave of absence for a period exceeding one week, he will regularly transfer the money, valuables, and other effects of patients intrusted to his care to another custodian, detailed for the purpose by the medical offi- cer in charge. In making such transfer an invoice will be prepared from the patient's property cards in the current, file and checked against the funds and effects deposited in the safe and storeroom. The invoice will be signed by the registrar, and the new custodian will receipt for the funds and effects under the signature of his predecessor. 125. Unless a United States postal station has been established upon the reservation, the registrar shall have charge of the receipt and delivery of all mail to the patients and personnel of the hospital. 126. One employee of known probity and good habits will be de- tailed in charge of the hospital post office, under the supervision of the registrar, and will be assisted by the necessary numjjer of other employees. He will be held responsible for the prompt and safe de- livery of all mail to the proper persons. 127. All registered, insured, and special delivery mail must be de- livered by an employee of the post office direct to the addressee. He will be required to obtain proper receipts for the same. A record of all registered, special delivery, and insured articles shall be kept in a book provided for the purpose at the post office, showing the receipt and delivery of all mail f this class. 128. A book containing the forwarding address of all patients who have left the hospital will be kept in the hospital post office. MATERIEL OFFICER. 129. In type "A" and type "B" hospitals, an administrative as- sistant or pharmacist will be assigned as materiel officer. 130. The materiel officer will be charged with the following duties : Periodical accountability for all property; requisition for property; issue of property to responsible officers; responsibility for all prop- erty in his custody; making of authorized purchases of property; 23 transportation ; repair and upkeep of buildings; repair, upkeep, and operation of mechanical equipment; upkeep and care of grounds; disposal of waste; issue of all prescriptions from the dispensary to wards and out-patient offices; laundering of all washable materials. 131. The materiel officer will be in charge of the garage, stables, shops, and hospital gardens. 132. He will be responsible for the care and upkeep of all vehicles and for their neat and cleanly appearance. He will instruct all chauffeurs with regard to the observance of speed limits, and other rules of the road. He will keep an accurate account of oil and gaso- line consumed by motor vehicles. He will exercise strict supervision over their use in order that they may be used for authorized pur- poses only. He will not permit a motor vehicle to be taken apart or otherwise tampered with except by a competent mechanic. 133. The care of the hospital grounds, the cleanliness of the various shops and warehouses, all grass, together with the collection and disposition of all waste, will be in charge of the material officer. All territory within the hospital reservation will be thoroughly cleaned each morning and maintained in this condition throughout the day. 134. A qualified druggist will be in charge of the dispensary, under the direction of the materiel officer, and will be responsible for its ]) roper operation. 135. All prescriptions will be written on form 1921-A and will be signed by a medical officer, except w extreme emergencies. Should such emergency arise, a written order, signed by a medical officer, will be obtained later. 136. The materiel officer will satisfy himself that regulations with regard to care of alcohol and narcotic drugs are observed. Prescrip- tions for alcohol or alcoholic beverages and habit-forming drugs must be signed in ink. 137. All prescriptions compounded will be placed in two separate files, as follows: (1) Prescriptions for alcohol or alcoholic bever- ages and for medicines containing opium or any of the salts, deriva- tives, or preparations of opium or coca leaves; (2) all other pre- scriptions. 138. Prescriptions will be numbered serially in each file. Pre- scription files will be subject to inspection by inspectors and the medical officer in charge at all times. 139. In connection with file 1, an alcohol and narcotic record will be kept of the dispensary receipts and expenditures of each article specified therein. A separate slip will be kept for each form in which the liquor or drug is supplied, as " Cocaine hydrochlorate powder " 24 or "Coaine hydrochlorate 10-mgm. hypo, tablets." The date of receipt thereof from the storeroom and the amount will be noted. The expenditure will be noted by entering the prescription number and the amount expended in compounding the prescription. At least once a month the slips will be balanced, and the quantities remaining on hand will be verified by the materiel officer and the facts noted over his signature. Form 1903-B will be used for this purpose. 140. A competent employee will be in charge of the laundry, under the direction of the materiel officer. He will see that a proper system of linen exchange is in operation and that all soiled linen delivered to the laundry is carefully checked. He will require all soiled linen to be properly listed by ward employees before its delivery to the laun- dry. Employees will attend to this exchange, and not delegate the work to patients. Laundry hampers in the various wards will be used for the storage of soiled linen and for carrying the same to the linen room. Clean linen will not be put in these hampers for return to wards. 141. The laundry office will always have an ample reserve supply of clean linen on hand for the purpose of exchange. When launder- ing is not done in the hospital, a careful check will be made and a receipt obtained before its delivery to the contract laundry. A second check will be made upon its return. 142. The hospital laundry comprises: (1) The linen, clothing, and bedding belonging to the Public Health Service ; (2) the underwear, hosiery, and handkerchiefs of patients under treatment in the hospi- tal; (3) the underwear, hosiery, and handkerchiefs of employees en- titled to laundering under the terms of their appointments; (4) the white and khaki service uniforms which are soiled in the course of official duty; (5) the hospital uniforms of nurses, dietitians, and aides. 143. Soiled blankets, spreads, and other heavy pieces should not be allowed to accumulate, but should be Avashed a few at a time as they become soiled so as to equalize the work. 144. A list will be made in duplicate of each patient's clothing by an employee in the ward and delivered to the employee in charge of the linen exchange room, who will receipt for the same. The dupli- cate list will then be filed with the patient's clinical record and checked against the clothing upon its return. DIETETIC SERVICE. 145. The medical officer in charge will maintain constant super- vision over the various messes. On account of the large transactions incident to the conduct of the hospital messes and the opportunities afforded by them for irregular or dishonest practices, he should take 25 the most painstaking care when detailing employees to mess manage- ment to choose only those of known probity and good habits. For the same reason he should see that creditors are of good repute and require their bills to be promptly rendered at the end of every month. Although the mess may be under the direction of the chief dietitian, he should exercise diligence by frequent inspections to see that waste and wrongful expenditures are not permitted, and that the messes are so managed that neither patients nor personnel shall have just grounds for complaint concerning the character, preparation, and quantity of their food. 146. When the chief dietitian is authorized to make purchases of subsistence supplies, she shall be held strictly responsible for their proper disposition and for the quality and quantity of food supplies in the hospital. 147. All supplies Avill be delivered to a suitable storeroom, where they will be properly checked upon their receipt by a competent employee.. Issues from this storeroom to the various messes will be made daily at a designated hour on requisition properly signed by the employee in charge of the mess concerned. No supplies will be issued at any other time except in extreme emergency. Supplies so issued will be listed on the requisition, giAdng the quantity and price of each article and the total value of food supplies furnished daily. 148. The employee acting as storekeeper for the central supply room under the direction of the chief dietitian will keep a daily record of the total articles purchased and issued. The medical officer in charge should inspect this record at frequent intervals with a view to keeping constantly informed in this respect. 149. Food supplies for the preparation of between-meal nourish- ment will not be issued to wards in excess of 24-hour requirements. Bread and butter for bed patients will be issued to wards with each meal. 150. The chief dietitian in general charge of the hospital mess will be responsible for the condition and cleanliness of the kitchens and Booking utensils in the various messes, the discipline of the kitchen force, the cleanliness of the dining rooms and discipline of patients and personnel therein, the serving of meals to ambulant patients and the distribution of food to the various wards, the cleanliness of the napery and table utensils used in serving the food, and the proper sterilization of such equipment upon its return from wards contain- ing patients suffering from communicable diseases. 151. All kitchen and dining room employees shall be examined before being placed on duty, or as soon thereafter as practicable, to determine whether they are carriers of disease. 152. A ration report will be prepared at the end of every month and submitted by the chief dietitian to the medical officer in charge. 26 153. The chief dietitian in charge of the hospital mess shall have authority over all personnel employed in that department, and over all ambulant patients in dining rooms of the hospital. 154. The chief dietitian will prepare menus for all messes in the hospital, and will submit them to the medical officer in charge for his approval. Menus should be submitted one day previous to their use in order that the necessary changes can be made before diets are pre- pared. 155. The officer or dietitian responsible for the purchase of sub- sistence stores shall be furnished if possible with motor transporta- tion for the purpose of proceeding to markets to make such purchases. 156. The status of the chief dietitian will be the same as that of the chief nurse. In all matters pertaining to conduct and discipline, dietitians will observe the same regulations as nurses and aides in the hospital. 157. Dietitians will be furnished with quarters in the hospital if such quarters are available for women. After the chief nurse, the chief dietitian will be given preference in this respect, as it is neces- sary that she be on duty at an early hour. PROFESSIONAL SERVICES. 158. In type "A" hospitals the professional work of hospitals will be divided as follows: (1) Medical service; (2) surgical service; (3) laboratory service; (4) dental service. Each of these departments will be under the supervision of a chief of service. 159. In type " B " hospitals all professional work of the hospital will be under the supervision of one medical officer, who will be desig- nated as the clinical director. He will be charged with all the duties and responsibilities of chiefs of service in type "A" hospitals. 160. In type " C" hospitals the professional work of the hospital will be under the immediate supervision of the medical officer in charge. 161. Chiefs of service and clinical directors will be responsible for the efficient regulation of their services,, and will have charge of the personnel assigned to them. They will keep a roster of all officers as assigned, submitting reports to the medical officer in charge as required on the conduct and efficiency of such officers. They will assign their assistants to their duties, and will arrange for the ad- mission of patients to suitable wards and their proper care and treat- ment therein. They will make frequent visits and inspections of the wards and departments comprising their services and consult with, instruct, and advise their junior officers. 162. Chiefs of service and clinical directors are assistants and ad- visers of the medical officer in charge, and will freely consult with him 27 in all mutters affecting the policy, administration, and conduct of their services. They will confer with him regarding all cases of unusual occurrence and any matters that might bring discredit upon the station and the service, and will exert every effort to aid in con- ducting the hospital efficiently and in accordance with regulations. A list of seriously ill patients will be kept by chiefs of service for reference, and an immediate report to the officer in charge of the records of patients will be made in all cases of critical illness or death. 163. In type "A" hospitals all communications between chiefs of service not strictly professional in character will pass through the office of the executive officer, and all communications or reports from wards and junior officers to other departments will pass through the chiefs of service concerned unless otherwise directed. 164. Chiefs of service will be considered as general consultants in type "A" hospitals, and will render such service in all cases where their advice may be required. In type " B " and type " C " hospitals, as a general rule, the services of local physicians appointed as at- tending specialists will be utilized. MEDICAL SERVICE. 165. The medical service will include the general medical wards, tuberculosis ward, isolation ward for contagious diseases, and the neuro-psychiatric ward. The professional personnel of this service will consist of a chief of service and the necessary number of ward surgeons and internes. TUBERCULOSIS WARD. 166. All hospitals of the service shall be prepared to receive at least for temporary periods, tuberculous patients, and no such patients shall be refused admission to any hospital of the service because of lack of special facilities, nor discharged for that reason. An officer known to be skilled in the recognition and interpretation of the physical signs upon which physical diagnosis is based shall be in charge of the tuberculous patients. NEURO-rSYCHIATRIC WARD. 167. An officer especially qualified in the work will be detailed in charge of the neuro-ps3 7 chiatric ward. If it is found that the treat- ment of certain psychopathic patients in a general hospital is inad- visable, request will be made to the Surgeon General for their trans- fer to one of the special-service hospitals for patients of this class. The care and treatment of neuro-psychiatric patients is prescribed in detail in article V. 28 ISOLATION WARDS. 168. Employees detailed for duty with contagious disease in isola- tion wards will sleep in separate quarters from other employees. Their meals will be served at their quarters by an employee detailed for the purpose. Dishes will be thoroughly sterilized before being returned to the kitchen. Nurses on duty with these cases will be segregated as much as conditions demand, under the direction of the chief nurse. All dishes, silverware, and other food containers in the isolation wards will be kept in such wards and not allowed to return to the main kitchen. Diets will be delivered to the door of the ward by the personnel on duty in the- patients' mess and trans- ferred to the containers kept in the ward for this purpose. The original containers will be returned to the general mess to be ster- ilized before further use. All patients' clothing will be disinfected before being sent to the main clothing room. Patients and person- nel, upon finally leaving an isolation ward, will be given such course of disinfection by the ward surgeon as the case demands. Upon the vacating of a room by a patient with a contagious disease, the ward surgeon Concerned will order such disinfection and cleaning as may be deemed necessary. 169. No person except employees and nurses on such duty and med- ical officers of the hospital will be allowed to enter isolation wards. Ward surgeons will require a strict enforcement of this rule, and will permit no loitering in these wards. Officers not on duty in isolation wards will not be permitted to enter the same without the permission of the chief of the jnedical service. 170. Nurses and attendants will not be detailed for duty in the surgical service for at least 10 days after their relief from duty with cases of scarlet fever or erysipelas. Nasal and pharyngeal cul- tures will be made twice weekly from medical officers, nurses, and employees on duty with cases of meningitis and diphtheria. If a positive culture is found at any time the person will be isolated and appropriate treatment given until three successive negative cultures are obtained. 171. In addition to the methods employed in the segregation of highly contagious diseases, all cases of whatever character in which the disease is communicated by the secretions of the nasal, oral, pharyngeal, or bronchial mucous membrane will be so separated in wards by sheets or screens as to prevent cross infection. This will also be done in cases of empyema and other surgical infections. 172. Patients with communicable diseases shall not be permitted to handle food, dishes, or other articles used by other patients. 29 SURGICAL SERVICE. 173. The surgical service will include the sections of general sur- gery, eye, ear, nose, and throat, orthopedic surgery, and urology. The personnel in this service will consist of^a chief of service and the necessary number of ward surgeons and internes. 174. The chief of service will ordinarily act as surgical consultant and as operating surgeon under the direction of the medical officer in charge. He will be responsible to the medical officer in charge for the performance of all operative procedures, and will forward a report to the officer in charge of the records of patients in every case before operations dangerous to life are performed. He will be responsible for the proper conduct of all sections included under this service, and will make such inspections and require such reports as may be necessary. 175. No medical officer on the surgical staff will actively participate in any post-mortem. 176. Before operative procedures are instituted, the written consent of the patient shall be obtained in every case and filed as a part of his clinical record. 177. The general operating room will be available for immediate use at all hours. EYE, EAR, NOSE, AND THROAT DEPARTMENT. 178. In type "A" hospitals this service will be conducted under the separate sections of ophthalmology and oto-laryngology, with suit- able officers in charge of each section. 179. In type "A" hospitals this service will be conducted under the separate section of urology, with an officer especially qualified in this work in charge. He will give such instructions to employees and to patients, and initiate such procedures as are considered helpful in the control of venereal diseases. 180. All patients suffering from venereal disease shall be segregated with respect to wards, mess halls, and toilet rooms. Dishes used by venereal patients will be kept separate until sterilized. WARD SURGEONS. 181. Ward surgeons will be assigned by their immediate profes- sional chiefs, and under their authority will have charge of the wards to which assigned. They will be responsible for the treatment, in- 30 struction, care, and well-being of all patients therein ; for the proper performance of duties of nurses and other employees and a strict compliance with regulations ; for the proper equipment of the wards and for the public property therein; for the condition of such property and the economical use of all Government supplies and ma- terial; for the preparation of complete and accurate clinical records in all cases ; and for the discipline and general conduct of the ward. 182. Patients received in a ward will be examined at once by the ward surgeon. He will note on the clinical record the exact hour and minute his first examination is made. 183. In the event that the effects of a patient have not already been cared for, the ward surgeon will personally take charge of all money and valuables, deliver the same to the officer in charge of patients' effects, and obtain a receipt for the patient. He will see that the clothing of patients is properly cared for by the head nurse. 184. Clinical records of all cases will be begun as soon as practi- cable after admission. They must show an accurate and concise record of the patient's past history, condition on admission, daily notes upon condition and treatment while in the hospital, and condi- tion upon the close of the case. Such additional pages will be used as the importance and nature of the case demand. Records of labo- ratory, physiotherapy, occupational therapy, and all other procedures will be attached in their proper places. All orders for treatment will be in writing, and will be initialed by the officer prescribing the same. 185. Form 1971-F will be used by ward surgeons for reporting changes of diagnosis. The patient's name and register number will be recorded, and the words " Change of diagnosis " inserted under " complication, etc." The new diagnosis will be stated by name and number, and the report properly signed by the ward surgeon will be immediately forwarded to the chief of service, and forwarded by him in turn to the officer in charge of the records of patients. A like report will be made by ward surgeons upon the occurrence of a com- plication, sequela, intercurrent disease, operation, or death, the fact in each case being recorded under the appropriate heading. No condition should be recorded as an intercurrent disease which is in any way dependent upon the original cause of admission. 186. Ward surgeons will designate the diet for each patient and will see that the same is noted on the clinical record by the head nurse. The total amounts for 24 hours will be stated on liquid und semiliquid diets. 187. When patients are sent to appear before boards or other de- partments of the hospital for examination, diagnosis, or treatment, the necessary charts and clinical records will be forwarded to the officer concerned, who will enter the findings and treatment on the clinical record before its return. 31 188. In case of transfer from one ward to another, the record will be completed to date, the exact time and the ward to which trans- ferred Avill be noted, and history so completed will be sent with the patient in the care of an employee. Under no conditions will patients be permitted to handle their own clinical records. 189. When a patient dies, is discharged, or transferred to another hospital, all sheets of the clinical record will be completed, arranged in proper sequence, and fastened together. The ward surgeon will sign the record in the proper place and forward it to the chief of service, who will make a careful check of all entries and forward it in turn to the officer in charge of clinical records. 190. Clinical records will not be removed from the ward where a patient is receiving treatment except by authority of the chief of service. . 191. Ward surgeons will not transfer patients from one ward to another without the authority of their immediate chiefs. After such transfers have been approved, the approval shall be countersigned by the admitting officer before the transfer is made. 192. Under immediate necessity emergency transfers may be made by ward surgeons OT the officer of the day, but a report of the action taken must be made at the earliest possible moment to the chief of service concerned and to the admitting officer. Emergency transfers will not be made except for sound and justifiable reasons. In type "A" hospitals the transfer of patients from one service to another will be made only with approval of both chiefs of service. 193. All cases of serious illness will be reported to the chief of service for consultation. A daily report of all patients likely to need treatment during the night will be made by ward surgeons to the officer of the day. In all cases liable to germinate in death, the name and address of the relative or persons to be notified in case of emer- gency will be verified. 194. When a member of the personnel oil duty in a hospital is ad- mitted to a ward as a patient, the ward surgeon must report the fact to the admitting officer and to the personnel officer. It will not be necessary in emergency cases to actually take such patients to the admitting station, but the necessary data must be furnished to that office promptly so that the patients may be taken up in the proper manner. 195. Ward surgeons will be responsible for the correctness and prompt delivery of ward reports to the chief of service for transmis- sion to the officer in charge of the records of patients. 196. Upon the death of a patient, the ward surgeon shall immedi- ately notify the officer of the day. 32 197. If autopsy is desired, a -written request for the same, approved by the medical officer in charge, will be forwarded to the officer in charge of the laboratory service, after consent of the nearest relation shall have been obtained. 198. Death certificates for local authorities shall bear the initial of the ward surgeon in charge of the case, but shall be signed by the medical officer in charge. 199. Ward surgeons will exercise economy in their ward prescrip- tions and, if possible, limit the quantity of the mixture or drug to 100 grams at a time, excepting liniments and lotions. 200. Convalescent patients may be permitted to perform such light duty about the wards as may not be injurious to their health. Ward surgeons will designate such patients and the duties they may per- form, the head nurse noting the same on the patient's clinical record. 201. Patients will not be given passes to leave the hospital except by permission of the ward surgeon concerned, under the general rules instituted by the medical officer in charge. 202. The duties and responsibilities of ward surgeons \vith regard to service property are prescribed in Article XIV. LABORATORY SERVICE. 203. The chief of this service in type "A" hospitals will have charge of the entire laboratory service, including the chemical, bacte- riological and X-ray laboratories and the morgue. 204. The laboratory will make such examinations of specimens as are requested by ward surgeons or other officers, and the results will be reported directly to the officer requesting the same, on the proper page of the clinical record. A duplicate of the finding will be retained in the laboratory in every case. 205. The chief of the laboratory service will detail a medical officer in charge of the morgue, who will act as pathologist. This officer will be held responsible for the proper conduct of all autopsies and for the records pertaining to the same. The officer in charge of the morgue will be responsible for all bodies from the time they, are delivered to the morgue until they are turned over to the undertaker. All bodies will be examined immediately after their delivery to the morgue to see that they have been properly tagged for identification. 206. A report of the findings of each autopsy, signed by the officer conducting the same, will be inserted in the proper place in the clini- cal record of the deceased. A duplicate of this report will be kept on file in the morgue. A triplicate copy will be fonvarded to the Chief Medical Adviser when the deceased is a patient of the Bureau of War Risk Insurance. 207. All medical officers on duty at a station shall be present at post-mortem examinations so far as their duties will permit. 33 208. The X-ray section will be under the immediate charge of a medical officer or qualified roentgenologist, who will be assigned for this work by the Surgeon General. Requests from ward surgeons for X-ray examinations will be submitted upon the proper page of the clinical record, and such requests will be sufficient authority for the use of the apparatus, but due judgment will be exercised in for- warding such requests to avoid waste of material. All X-ray records will be properly filed for ready reference. WARD EMPLOYEES. 209. Ward employees will act as assistants to the head nurse in all wards in which female nurses are on duty. They will be responsible for the prompt execution of all orders given by the head nurse or by the ward surgeon. They will assist in every way possible in the dis- cipline and care of patients, the proper cleanliness of the wards, and any other duties that may be required. In wards in which no female nurses are assigned the duties of ward employees w r ill be the same as those of nurses. In such wards male nurses especially qualified will be detailed to have charge of the nursing service. Male nurses in charge of wards will be responsible to the ward surgeon for the pub- lic property therein. NURSING SERVICE. CHIKF NUKSE. 210. The chief nurse will be under the immediate orders of the medical officer in charge of the hospital. 211. The chief nurse will have general supervision of the nursing service in all wards, operating rooms, and dressing rooms in which nurses are on duty. 212. The chief nurse will familiarize herself w 7 ith service regula- tions, and Avill instruct the nurses under her supervision in such regu- lations as refer to them and in the duties peculiar to service hospitals. When required by the medical officer in charge, she will supervise the instruction of employees on duty in wards in practical nursing. 213. The chief nurse will exact the proper performance of their duties by all nurses. She will be in charge of the nurses' quarters. Although the chief nurse, chief dietitian, and chief aide are on the same basis of authority so far as control in their respective depart- ments is concerned, in matters pertaining to conduct and discipline in the nurses' home the chief nurse is in charge of all dietitians and aides as well as nurses. She will report at once any serious breach of discipline upon the part of nurses, aides, and dietitians to the medical officer in charge. 185279 20 3 34 214. All complaints, resignations, and other matters concerning the nurses will be transmitted to the medical officer in charge through the chief nurse. 215. It shall be the duty of the chief nurse to see that the nurses under her supervision cooperate in every way possible with the chief dietitian and render every assistance to make the dietetic service successful. 216. The chief nurse will be responsible for the comfort and gen- eral well-being of the nurses under her charge, and will promptly report to the medical officer in charge any matters which unfavorably affect the same. She will bring to his attention at once any case of illness among the nurses. 217. The chief nurse will arrange the hours of duty and assignment of all nurses,, and will be responsible for the execution of all orders relating to such assignments. She will keep a roster of the assign- ment of nurses, and furnish the same to the medical officer in charge for his approval. 218. The chief nurse shall prepare an efficiency report of all nurses at the station on the last day of each month, such report to include estimates of the nurses' professional work, physical fitness, and apti- tude for the service. Special attention should be paid to nurses' effi- ciency reports during the first six months of their service, which should include statements as to the executive ability shown by the nurses. She will render this report to the medical officer in charge for his approval and transmission to the Surgeon General. SUPERVISING NIGHT Nt'RSE. 219. When necessary, the chief nurse will detail a nurse to super- vise the nursing service of the hospital at night. 220. Ward nurses on night duty will respect the orders of the super- vising night nurse accordingly. They will apply to her for instruc- tions and will inform her at once of all emergency cases arising in the wards. 221. The supervising night nurse on being relieved will report to the chief nurse any unusual incidents of the night's work and any derelictions of duty on the part of night nurses and ward employees. HEAJ> NUKSES. 222. The chief nurse will designate one nurse for each ward to act as its responsible nursing head. 223. The head nurse will be in charge of the nurses, the employees, and the patients in her ward, under the direction of the ward sur- geon, and will be respected and obeyed accordingly. 35 224. The head nurse will receive from the ward surgeon all orders relating to the care and treatment of the patients in her ward, and will record them for the guidance of both day and night nurses. In carrying out written instructions from ward surgeons the nurse Avho executes the order should place her initials on the order for any future reference that may be necessary. 225. The head nurse will be responsible in her ward for the proper nursing of patients, the proper serving of food in the ward, the administering of medicine, and other treatment prescribed, the clean- liness and order of the ward, and, under the ward surgeon, for the public property therein. 226. The head nurse will be responsible to the chief nurse for the conduct and work of the ward nurses, will advise the chief nurse concerning their efficiency, and will report upon the efficiency of other employees in the ward to the proper authority. 227. The head nurse will secure such medicines from the dispensary daily as are directed by the ward surgeon, except alcohol, alcoholic beverages, and habit-forming drugs. These must be drawn by the ward surgeon or other medical officer personally, and delivered to the head nurse, except in an emergency, in which case the ward sur- geon must later visit the dispensary and verify the transaction. The head nurse will keep the above-mentioned class of drugs under lock and key at all times, retaining the key in her personal possession. 228. The head nurse will keep an accurate account of all receipts and expenditures of alcohol and alcoholic beverages and habit-form- ing drugs. This account will be balanced monthly, showing the bal- ance on hand. The ward surgeon shall verify and sign this account monthly, and report any discrepancies to the medical officer in charge. 229. The head nurse will supervise each morning the collection of all soiled linen and its delivery to the laundrj^ office at the required hour, receiving therefrom clean articles in exchange. Bedding will be hung out to air once each week. 230. Patients will be given appropriate admitting baths on arrival at the ward, and will be bathed at least twice weekly thereafter. Bed patients will be bathed not less than every second day. 831. Nurses and employees on duty in wards will have no financial dealing with patients, and should the head nurse discover any valu- ables or money belonging to a patient, she will report the matter to the ward surgeon, who will take charge of the same. 232. In the event that surplus clothing has not been delivered to the storeroom for patients' effects, the head nurse will collect and check the same as soon as possible after the arrival of the patient in the ward, and will prepare patients' property slips in duplicate us required by regulations. She will be responsible for the safe de- 36 livery of the clothing and property slips to the officer in charge of patients' clothing room. 233. The head nurse will assist the ward surgeon in his monthly check of property in the ward. The linen storeroom in each ward will be kept in a clean and orderly condition and will be locked at all times with the key in her possession. 234. All temperature books, order books, and other ward records will be prepared under the direction of the head nurse. 235. Form 1971-H, containing the name of the patient, register number, permanent address, and name and address of nearest rela- tive, shall be attached by the head nurse to the foot of each bed. 236. The head nurse will exercise care to prevent special diet cases from going to the mess hall with ambulant patients. She will see that no food delivered to the wards is eaten by the nurses or other employees on duty therein. 237. The head nurse will prepare daily Form 1920-A, Consolidated Diet Slip, which will be signed by the ward surgeon and forwarded to the dietitian at a designated time. 238. No food supplies will be kept in wards in excess of 24-hour requirements. Requisition for necessary ingredients for the prepara- tion of between-meal nourishments will be included in the Consoli- dated Diet Slip each morning. When emergency diet slips are sent to the dietitian, they must be accompanied by an explanation, signed by the ward surgeon. NUESES. 239. The duties of nurses shall be such as is usually performed by trained nurses in civil hospitals of like character. So far as practi- cable their tour of duty shall not exceed eight hours a day. They will not be required, except under stress of emergency, to serve more than one month in three on night duty. 240. Day nurses are at all times responsible to head nurses for the proper service in the wards. Night nurses are responsible during the night to the supervising night nurse, if there is one ; otherwise they are directly responsible to their respective head nurses for the night service in the wards. In either event the night nurses on being relieved by the day nurses will make written reports of their work to the head nurses. 241. A nurse will not be permitted to absent herself from duty until her relief nurse has arrived, nor will any nurse be allowed to return to the wards during her hours of leave, except with the per- mission of the chief nurse, which must be obtained in every instance. No nurse will be permitted to absent herself from the ward during meal time without proper relief. 242. In their relations with patients nurses will at all times main- tain a strictly professional attitude. 37 DENTAL SERVICE. 243. The personnel of this service in type A hospitals shall consist of a chief of the dental service, and the necessary number of officers and assistants. The chief of the dental service will ordinarily act as consultant on all oral conditions, and as operating dental surgeon ' under the immediate direction of the medical officer in charge of the hospital. He shall be responsible to the medical officer in charge of the hospital for the proper conduct of this service and for the per- formance of all operative proeedures. He shall make such inspec- tions and require such reports as may be necessary. The necessary dental employees will be detailed for duty in the various operating rooms and laboratories. 244. Dental officers shall be responsible for the treatment, instruc- tion, care, and well-being of all patients assigned to them; for the proper performance of duties by nurses, assistants, and other em- ployees; for a strict compliance with regulations ; for the proper care of equipment ; for the proper use of dental supplies and equipment ; and for the preparation of complete and accurate dental clinical records of cases assigned to them by the chief of the dental service. 245. When the amount of work justifies the same, a trained dental assistant or graduate nurse shall be assigned to each officer. The duties of this assistant or nurse shall be the sterilization of instru- ments, and such prophylactic measures as shall be ordered by the offi- cer to whom she is assigned. 246. The patient upon entering shall receive a dental record chart from the employee in charge of dental records. A dental officer will examine the patient, execute the dental record chart, and be respon- sible to the chief of the dental service for further disposition of the case. 247. Records of dental procedure shall be full and complete and must be entered upon the dental record chart at the time the opera- tion is performed. 248. The original dental record chart with all radiographic diag- noses attached shall be forwarded to the Surgeon General, and a copy of the chart will be returned to the hospital to become part of the patient's clinical record. RECONSTRUCTION SERVICE. 249. The reconstruction service will be responsible for the admin- istration and supervision of the proper application of all curative measures, other than the actual medical and surgical treatment, of all patients in the hospitals of the service. 250. This will embrace all branches. of physiotherapy, occupational therapy, which includes manual handicrafts and mental work for functional and diversional employment, and the amusements and recreations of the patients and other activities under the direction of the Red Cross. 251. It is the duty of the reconstruction service to coordinate and identify the reconstruction work with that of the medical officer re- sponsible for the medical and surgical treatment of the patient, in order that the best possible morale may be established and the resto- ration of the patient to functional and economic usefulness may be . hastened. BECONSTRUCTION 'OFFICER. 252. A reconstruction officer will be assigned for duty at the sev- eral hospitals of the service. Under the direction of the medical officer in charge he will be in charge of all reconstruction activities and reconstruction personnel at the station. He will be either a qualified medical officer or a qualified special instructor of the re- construction service. 253. If a medical officer, he will, at the request of and in consulta- tion with the ward surgeon, carefully examine each patient requiring physiotherapy in any form and record the nature and degree of dis- ability. He will reexamine the patient at intervals and record the findings over his signature on the clinical record. 254. He shall cause a survey to be made on each patient witli a view of determining the social and economic status of the patient and the possible occupations and diversions for functional restora- tion and diversional employment that will be of most interest and benefit. 255. The reconstruction officer will keep a record of all reconstruc- tion personnel and activities of the hospital. He will see that a daily record is made of the number of patients enrolled in the several ac- tivities of the reconstruction service. The name of the patient, the nature and number of treatments or time in hours of instruction de- voted to each activity, the name of the instructor or aide, and such other facts as may be of interest will be recorded. 256. He shall make a weekly report of reconstruction activities and a monthly report of reconstruction personnel, including an effi- ciency report to the medical officer in charge for transmittal to the Surgeon General. He shall supervise the preparation of the daily re- ports of the aides and the records of the patients. He shall also make such other reports as may be required by the medical officer in charge. SPECIAL INSTRUCTORS. 257. Special male instructors will supervise and administer the several branches of treatment in physiotherapy or shall supervise, teach, and work in the several technical trades, or kindred subjects, 39 considered under the head of occupational therapy. They shall keep u daily record of the work done by them or under their direction. CHIEF AIDES. 258. The chief aide shall assist the reconstruction officer with the administrative and executive duties of the reconstruction service, and will act in all matters of discipline concerning reconstruction aides subject to the supervision of the chief nurse. HEAD AIDES IN PHYSIOTHERAPY. 259. Under the direction of the reconstruction officer, head aides in physiotherapy shall instruct and supervise the physiotherapy aides in the performance of their duties, and shall administer the treatments of physiotherapy whenever circumstances require. AIDES IN PHYSIOTHERAPY. 260. Under the immediate direction of head aides, aides in physio- therapy shall administer the treatments of physiotherapy, and shall keep a daily record of the work done by them. IN PHYSIOTHERAPY. 261. Under the supervision of the head aide, pupil aides in physio- therapy will assist in administering the 'treatments of physiotherapy. SPECIAL EMPLOYEES. 262. Special male employees will be assigned to administer special treatments of physiotherapy and instruction in occupational therapy, and shall keep daily records of the work done by them. UDES IN OCCUPATIONAL THERAPY 263. Under the direction of the reconstruction officer, head aides in occupational therapy shall instruct and supervise the occupational aides in the performance of their duties, and shall give instructions in occupational therapy whenever circumstances require. AIDES IN OCCUPATIONAL THERAPY. 264. Under the immediate direction of the head aides, aides in occupational therapy shall give instructions in occupational therapy, and shall keep a daily record of the work performed. 265. Under the supervision of the head aide, pupil aides in occupa- tional therapy shall assist in giving instructions in occupational therapy. 40 ARTICLE V. NETTBO-PSYCHIATBIC PATIENTS. 266. Persons suffering from psychopathic disorders entitled to the benefits of the service may be admitted to the psychopathic ward of a general hospital or to a special hospital maintained. by the service for the care and treatment of such cases, or, with the approval of the Surgeon General, they may be admitted to a State institution of the State in which the beneficiary resides. In the latter instance the laws governing the admission of such cases to those institutions must be strictly adhered to. 267. A mentally disturbed patient who is a beneficiary of the serv- ice may be cared for temporarily in the observation ward of a local hospital, pending the approval of the Surgeon General for transfer to a hospital maintained by or under contract with the service. Imme- diate report of such action, in duplicate, must be submitted to the Surgeon General, giving the reasons therefor. 268. Inasmuch as many of the neuro-psychiatric ailments are of long duration, and sufferers therefrom will require hospitalization for a considerable period of time, district supervisors, medical offi- cers in charge of hospitals, and others concerned will exercise due care, before a neuro-psychiatric patient is admitted to hospital, that his eligibility to treatment "is established by satisfactory evidence. Special care must be taken to exclude alien paupers and others not entitled to relief. 269. Drug addicts and mental defective patients of the Bureau of War Risk Insurance will not be treated at stations of the service un- less evidence is submitted that they have received an award of com- pensation. 270. When an irresponsible patient is to be admitted to hospital,* his relatives should be informed, if practicable, and their acquies- cence in the arrangements and statement of preference of place of treatment secured. 271. The medical officer in charge of the hospital to which the patient is being transferred should be notified in advance. 272. The term " shell shock " will not be used in reporting diag- noses of neuro-psychiatric disorders. Mild mental disorders are fre- quent sequelae of cerebrospinal meningitis, gassing, and other con- ditions. Great care should be exercised in the observation, treatment, and hospitalization of all such cases. 273. It is of great importance that careful study be made of every case of peripheral nerve injury with a view to accurate diagnosis and appropriate treatment. 41 274. When a patient has recovered his normal mental state he may be paroled from the hospital for a period of three months or longer if necessary. 275. During the period of this parole the former patient shall re- port to the medical officer in charge of the hospital, either in writing or in person, his general physical and mental condition, his ability to get along in the community, and other personal data pertaining to his condition. 276. No patient of the Public Health Service who is suffering from a mental disorder shall be paroled or discharged into the com- munity until by conference the majority of the medical staff of the hospital shall acquiesce in writing as to the suitability of such a case for parole or discharge. Furthermore, patients shall not be paroled or discharged to the custody of any person unless that person is the proper one to assume such a responsibility. 277. No patient of the service shall -be paroled or discharged from any neuro-psychiatric hospital or psychopathic ward until the medi- cal officer in charge has satisfied himself that the locality to which the patient is going is suitable in environment for such a patient. More- over, the medical officer in charge of the hospital shall see that all patients who are paroled or discharged from his care are properly and seasonably clothed and furnished with necessary and proper transportation facilities. 278. The organization of psychopathic hospitals, with respect to administrative personnel, shall conform to that of general hospitals of the same bed capacity. 279. The organization of psychopathic hospitals with respect to professional work shall correspond in general to that of type B hospitals of the service, regardless of bed capacity. 280. The clinical director in psychopathic hospitals shall serve as a general professional assistant to the medical officer in charge, and shall supervise, with the approval of the latter, such medical, moral, and physical treatment as in his judgment will be best adapted to the good of the patients. He shall obtain, or cause to be obtained, as far as possible, a complete clinical history of each patient in the hospital. Pie shall act as chief of the medical staff and have super- vision and control, with the. approval of the medical officer in charge, of all employees who have to do with the care and treatment of patients. He shall also preside at the regular staff meetings. 281. Ward surgeons in psychopathic hospitals will inform nurses and attendants of suicidal, homicidal, or otherwise dangerous tend- encies in the patients. Thejr shall make a full physical and mental examination of each patient within 24 hours after he enters the hospital, and prepare such data as are necessary to present the case . 42 at the regular meeting. In the examination of such cases special reference shall be made to all bruises and marks appearing on the patient at that time. 282. Ward surgeons are expected to assist in devising employment and recreation for their patients and to do everything possible to make their patients comfortable and promote their recovery. They will keep a record of each individual case, stating conditions from time to time, and noting anything that may be of particular interest concerning the case either mentally or physically. All cases of forced alimentation must be personally attended to by the ward sur- geon and all unnecessary diets and medicines promptly discontinued, It shall be the duty of ward surgeons to be present at all amusements and entertainments, and to attend chapel exercises unless excused by the medical officer in charge. 283. The duties of all nurses and other employees of the hospitals maintained for the care and treatment of psychopathic disorders are responsible and strictly confidential, and most cruel wrongs may be inflicted by imprudent disclosures of the conduct of any of the patients. Gossip concerning patients, the hospital, or its employees to persons not connected with the institution will be considered suffi- c^ent grounds for dismissal. 284. It shall be the duty of every person employed to check, as far as possible, all conversation or allusions on the part of patients to subjects of obscene or improper nature, also false impressions in the minds of patients concerning their treatment. 285. No one shall assist a patient in any clandestine correspondence or fail to report same, should it come to his knowledge. 286. Xo one shall assign a patient for detail \vork without the ap- proval of the ward surgeon, and should such approval be granted it is not to extend beyond the instance specified. Employees de- tailed for such duty are expected to work with their patients, and to report those not properly or seasonably clothed. 287. All articles which may be considered of a dangerous character must be removed from the person of an insane patient and delivered to the officer in charge of patients' effects at the time of admission. 288. Many patients entering the hospital for the first time have fears of bodily harm. Everything possible should be done to dispel such fears, and nurses and employees must be cautioned to be exceed- ingly careful both in manner and language toward patients. 289. Everything about insane patients that might lead to danger- ous consequences should be safely guarded. Dumb-waiter doors, bath- room doors, dust-flue doors, and everj^thing of this character must be kept locked. Xurses and emplo3'ees should be especially vigilant that patients have nothing in their possession that can be used as a 43 weapon, or that would aid in their escape. Patients suspected, or those known to be in the habit of carrying dangerous implements, or matches, should be searched and their rooms also searched. 290. It is the duty of nurses and employees to take all nonparole patients out for exercise in suitable weather, unless they are excused from going by the ward surgeon. It is required that nurses and em- ployees taking patients out for exercise count them upon leaving the ward, and again upon returning. 291. In taking nonparole patients out of the hospital buildings care should be exercised to guard them from the curious eyes of strangers and visitors to the institution. In case strangers approach, it is the duty of attendants to request their departure to some other part of the grounds. In case of refusal, the fact should immediately be reported to the medical officer in charge. 292. No patient shall ever be permitted to remain in a ward with- out the presence of a nurse or employee ; and, if unable to go out for exercise, or meals, the fact should be reported to the head nurse, and the patient left, temporarily, in a ward where there is a nurse or em- ployee. It is strictly forbidden that nurses or employees make going out with patients a pretext for doing errands or calls for themselves. 293. The escape of a nonparole psychotic patient without the knowledge of nurse or employee, or without being promptly reported to the medical officer in charge, will be treated as culpable negligence. Any patient who may cause trouble while out for exercise or who may attempt to escape should be immediately returned to the ward in as gentle a manner as possible. 294. Nurses and employees are not permitted to use forced feeding or forced medication unless an officer is present. 295. Psychopathic patients should be encouraged to take an interest in some occupation, and those persons responsible for such occupation should work with them. Nurses should strive in every way to provide amusement and employment for their patients. When attending amusements, chapel exercises, or any other gathering, the nurses and employees must retain charge of their respective patients, keeping with them at all times and exercising the same supervision over them as if they were with the patients in the ward. 296. When restraint is required, it should be applied as gently as possible. It is not to be used without the consent of the ward surgeon, unless a patient should become violent and be in danger of hurting himself or others, then immediate restraint may be applied and tha ward surgeon notified. No day or night nurse or employee is ever justified in applying restraint alone. When patients are placed under restraint or in seclusion the action taken shall be recorded on the clinical record over the signature of the clinical director. 44 297. Patients are not allowed to work on the ward without the presence of an employee. Clothes-room doors and bath-room doors should be kept locked, except when an employee is present. 298. The ward employee's place of duty is on the ward with his patients. During the time the patients are out of their rooms, em- ployees are not permitted to be in theirs, except for a momentary errand. No employee shall leave his ward while on duty without permission from the ward surgeon or head nurse. 299. While on duty during the day, nurses and employees are ex- pected to make the care of their patients, their clothing, and the condition of the wards their exclusive business. When patients receive visitors, nurses must see that such patients are properly clothed for the interview. When patients are called to the reception room, it is the duty of the nurse to remain during the interview, unless excused from doing so by the ward surgeon. Such excuse will apply only to the instance specified. 300. People visiting the grounds of the psychopathic institutions will not be allowed to loiter about the windows or talk to the pa- tients from the outside. Nurses noticing that patients are attract- ing the attention of visitors about the windows of the hospital will report the same to the hospital office at once. 301. Nurses and ward attendants are required to remain constantly in the dining room during each meal. When it is necessary to feed psychotic patients outside the dining room, knives and forks are not to be given them. The greatest care should be exercised that knives and other articles are not taken from the dining room by these pa- tients. As a precaution, knives, forks, and spoons should be col- lected by the attendant and counted after each meal before patients leave the table. Should an article be missed, all patients should be searched before leaving the dining room. 302. Every precaution must be taken to guard against fire. Carry- ing matches about the. building is exceedingly dangerous, and only safety matches will be allowed in psychopathic hospitals. 303. In case of fire, the head nurse on the ward must report the fire to the administration office and assemble her patients in the hall of the ward. Special care should be exercised to see that no one is left in the rooms and that the room doors are locked. If there is no immediate danger, the duty nurse or employee on the ward will report to the office for instruction, the head nurse always re- maining with the patients. 304. Psychotic patients must always bathe in the presence of an employee, and the room must never be left for an instant by the em- ployee until the patients are out. Patients should never be permitted to enter the bath tub "until the water has been tested as to tempera- ture, and has been turned off. The hot water must never be turned on 45 while the patient is in the tub. If, at any time, the temperature of the water or room is not suitable, bathing should be discontinued and the fact reported to the hospital office. Each patient must be properly dried before putting on his clothes. At the time of bath- ing special attention should be given to trimming toe and finger nails. 305. The hair of male patients should be cut sufficiently often for good appearance. The hair of female patients should never be cut short, and permission from the Avard surgeon must be obtained in every case. 306. No psychotic patient is permitted to shave, bathe, feed, or dress another, or in any way assist in preserving order or discipline among his fellow patients. 307. During the sleeping hours of the night the safety of the in- stitution and its property are committed to the fidelity of the night nurses. To their faithfulness, discretion, and watchfulness, great importance is attached. All should strive to give their full atten- tion to their duty that they may guard the affairs of the institution and promote the welfare of its patients. 308. The night supervising nurse shall patrol each ward once every hour during the night and report to the chief nurse any events of unusual interest during the night service. Night nurses must care- fully guard any patients who are supposed to be suicidal, and never fail to report attempts at suicide. Special report shall be made to the supervisor of all patients unusually restless or troublesome, and those in restraint or seclusion, or requiring special treatment. ARTICLE VI. DISCIPLINE OF PATIENTS. 309. Patients of the Public Health Service, Avhen undergoing hos- pital or sanatorium care, will conform with the usual orders, rules, and usages of such institutions. Failure to do so will constitute reason for dismissal, but as they are wards of the Government they should not be discharged for trivial reasons. A patient may be dis- charged at any time for disregard of hospital rules or insubordina- tion provided mild disciplinary measures have failed and the pa- tient is not seriously sick and is physically able to leave the station. Before the discharge of a patient for insubordination, an investiga- tion should be made as to his mental condition. In the case of pa- tients of the Bureau of War Risk Insurance, the Chief Medical Ad- viser will be informed by telegram of the contemplated discharge, with an outline of the facts in the case, 24 hours before it is carried into effect. 46 310. In all cases of dismissal for insubordination a report shall be sent to the Surgeon General and to the supervisor of the district from which the patient was received, giving the patients register number, name, age, date of admission, date of discharge, and the reasons in detail for the dismissal. The causes leading up to the discharge must be investigated by a board of two medical officers detailed for the purpose by the medical officer in charge, and the report shall be signed by both members of the board. If the patient is a beneficiary of the War Risk Insurance Bureau, a like report will be sent to the Chief Medical Adviser, so that other hospitalization may be arranged should it be necessary. 311. In case it is believed necessary to take advantage of dis- ciplinary action authorized under the war-risk insurance act, or its amendments, particularly with respect to the payment of compensa- tion, the case should be laid before the Director of the Bureau of War Risk Insurance with full report and recommendations. 312. A patient may be discharged from a hospital at his own re- quest at any time before recovery. In such event a statement in writing should be obtained from the patient to the effect that he has been discharged at his own request contrary to the advice of the medical officer in charge. 313. If a patient refuses to submit himself for, or in any way obstructs any examination, the case will be reported to the Bureau of War Risk Insurance for appropriate action. . ; ',.. ARTICLE VII. DECEASED PATIENTS. 314. The body of a deceased patient shall under no circumstances be removed from the bed until a medical officer has pronounced him dead. Upon the death of a patient while under the charge of the service an official telegram will be sent to the nearest relative of the deceased, advising him of the fact. 315. Medical officers in charge shall detail an officer to inspect bodies of deceased patients that have been delivered to an under- taker. Officers so detailed shall make a careful inspection for the purpose of determining that the body is properly clothed and pre- pared for burial or shipment, and shall report the results of their inspection to the medical officer in charge. 316. The money, valuables, and other effects of the deceased will be collected by the officer in charge of patients' effects, who will for- ward the same to the legal representative of the deceased. Money and valuables must always be sent by registered mail or express, and only after consent of the legal representative. Duplicate copies of the patient's property slip, Form 1971-J, with a space provided for 47 receipt by the legal representative will be inclosed with the envelope containing the money and valuables, and when the receipt has been returned it will be filed at the station. 317. The money and valuable effects of deceased seamen whose heirs reside abroad shall be delivered to the proper consular officer, and the money and valuable effects of officers or enlisted men of the Army or Navy dying while under the care of an officer of the service shall be held subject to the order of the commanding officer of the nearest Army or Navy post, a receipt being taken in each case and filed. All receipts shall be in duplicate and the duplicate copy forwarded to the Surgeon General. 318. Patients who die in hospitals or sanatoria of the United States Public Health Service may be buried at the stations at an expense not to exceed $100, chargeable to the service. At relief stations at which contracts for burial are in effect, the service shall be performed by the service contractor under the terms of his contract and at the contract price, otherwise the cost of burial must be commensurate w r ith the service rendered, and vouchers for the same must bear upon their face a satisfactory explanation as to the reasonableness of the charge. Although a maximum of $100 is set, it is not the intention that $100 should be paid in each instance. 319. When a disabled person to whom compensation is payable under the provisions of Article III of the war risk insurance act is sent by the direction of the Bureau of War Risk Insurance to a hos- pital or sanatorium for treatment, as provided in paragraph 3 of section 302 of said act, and dies in said hospital or sanatorium, the reasonable and necessary expense of transporting the body of the deceased person to his former home may be paid by the Bureau of War Risk Insurance, but only when the return of the body to the former home of the deceased is requested by a person entitled to the custody of the body for the purposes of interment. The amount so payable shall include the usual charges for transportation of the body and any additional expense that may be incurred in order to conform to the regulations of the carrier and the health laws of the State where death occurred or of the States through which the body will pass, in respect to the preparation of the body for transportation and the character of the container of the body. If under the regula- tions of the carrier or under the health laws, an attendant must ac- company the body, the necessary and reasonable expenses of such at- tendant, in going to and returning from the former home of the de- ceased, may be included. 320. When friends or relatives claim the body and assume charge of the funeral arrangements of a deceased patient not a beneficiary of the Bureau of the War Risk Insurance, no part of the expenses of the same will be paid by the Public Health Service. 48 321. Moneys and valuable effects of deceased seamen remaining unclaimed for three months after endeavor has been made to comply with the provisions of paragraph 316 shall at the close of each quarter be delivered by the medical officer of the service to the proper cus- toms officer. 322. The customs officer will sign triplicate receipts for such moneys and effects deposited by officers of the service, and will for- ward the original to the Secretary of the Treasury ; the duplicate and triplicate will be forwarded to medical officer in charge of the hos- pital concerned, who will transmit the duplicate to the Surgeon General, and retain the triplicate as his personal voucher. In for- warding the duplicate, the medical officer in charge will accompany it with a letter of transmittal, accompanied by a descriptive list of the deceased. Customs officers will deposit money so received to the credit of the Secretary of the Treasury, Special Deposit Account No. 3. 323. The valuable effects of deceased seamen deposited with the customs officer, as provided in paragraph 321, which shall remain un- claimed for a period of one year, shall be sold at public auction by the customs officer when authority has been obtained from the Secre- tary of the Treasury, and the receipts accruing from such sale shall be deposited by the customs officer as provided in the preceding paragraph. 324. At third and fourth class stations the customs officer (or act- ing assistant surgeon, if in charge of the station) shall at the end of each quarter report to the department the name and description of any and all patients of the service who may have died leaving either money or valuables, or both, in their custody which have remained unclaimed after three months. ARTICLE VIII. TRANSPORTATION OF PATIENTS. 325. In the interest of economy and the welfare of beneficiaries, the Surgeon General is authorized to order the transfer of patients in the care of necessary attendants from one station to another and to all hospitals for the insane, together with expenses incident to the transfer of both patients and attendants. 326. Great discretion must be exercised in authorizing travel on Government requests for transportation. Officers who have been em- powered by the Surgeon General to grant this privilege in connection with the treatment of beneficiaries of the Public Health Service shall investigate with particular care each case before a decision is reached to allow transportation at the expense of the Government. 327. The issuance of transportation requests shall be under the im- metliate supervision of the officer signing these requests, and he shall 49 consider himself personally responsible for the justification of every request issued. 328. In order to be valid, transportation requests must be counter- signed by the issuing officer. Unused transportation requests must be carefully preserved under lock and key, and any loss immediately reported to the Surgeon General. The names and designation of the additional persons not given on the face of the request shall bo written in full on the back of the transportation requests (as, John Doe, patient; James Smith, attendant). It is very important that this be done in order that the accounts may be properly audited. 329. The travel expenses of a patient of the Bureau of War Risk Insurance to the place of examination, and his expense in returning to his home are payable by the Bureau of War Risk Insurance. 330. The travel expenses of a patient of the Bureau of War Risk Insurance from one hospital to another, after he begins to receive treatment is chargeable to the Public Health Service. 331. Travel expense for patients leaving service hospitals contrary to advice or who are discharged for insubordination will not be paid by the Public Health Service. 332. When persons suffering from psychopathic disorders are transferred from one hospital to another, a sufficient number of nurses or attendants must be supplied to conduct them safely. Such attendants should be familiar with the care of psychopathic cases and provided with appropriate equipment and transportation facilities, in order humanely to surround the patients with the necessary safe- guards. When three or more patients are transferred at any one time, a medical officer shall accompany them. 333. When a mentally disordered female patient of the service is being transferred, she must always be accompanied by a female nurse, specially trained in the care and management of psychopathic disorders. 334. Officers and others, when furnishing transportation to bene- ficiaries, shall inform the receiving officer in advance by mail or tele- graph when the patients may be expected to arrive and whether an ambulance will be required. ARTICLE IX. INSPECTION OF BELIEF STATIONS. 335. All relief stations of the service shall be inspected at least once a year by one of the commissioned officers detailed by the Sur- geon General to the Inspection Service. Officers in charge of stations shall be prepared to submit to the inspecting officer, at any time, all information and data mentioned in the Synopsis for the Instruction of Inspectors of the Public Health Service. 185279 20 4 50 336. Inspection of stations of the first, second, and third class will be made wherever practicable by a senior officer, but, as occasion may require, any officer regularly detailed by the Surgeon General as a general inspector has authority, when so detailed, without re- spect to seniority, to inspect any station. 337. Inspections shall be made under special orders defining their object, which Avill be shown to medical officers in charge whose sta- tions are to be inspected; and such medical officer in charge and others on duty at that station are required to afford every facility and assistance to the inspecting officer during his inspection. 338. Officers detailed to inspect relief stations of the first class shall conduct inspections in the uniform prescribed, and in accord- ance with the Synopsis for the Instruction of Inspectors of the Public Health Service. The inspecting officer shall, accompanied by the medical officer in charge, personally visit every part of the sta- tion, and shall make such notes during this tour as may be necessary to enable him to prepare a report, in accordance with regulations. Upon completion of the inspection, the inspecting officer shall note in the journal of the station the fact of such inspection, signing such entry with official title. 339. The methods of procedure during a general inspection shall be under the direction of the inspecting officer, and he shall have authority to require the assistance of all officers and others on duty at the station to furnish information, and to require the production of all books and other records of the station. 340. Inspecting officers shall inform themselves fully as to the con- duct of the service and the observance of the regulations at each sta- tion inspected, and shall carefully examine the books, reports, register of patients, clinical records, files, correspondence, money accounts, cash on hand, local hospitals under contract, and the buildings and property for which the medical officer in charge is responsible. 341. The inspecting officer shall not give orders unless specifically authorized to do so. It shall be the duty of the inspecting officer, however, to call the attention of the medical officer in charge to any infraction of the service regulations or to the existence of any condi- tion which may be contrary to the best interests of the service. 342. Before his departure from the station the inspecting officer should deliver in writing to the medical officer in charge such recom- mendations as he may deem advisable. If this is impracticable before departure from the station, recommendations may be for- warded from the next station visited by the inspecting officer. These should embody such subjects as seem to demand immediate attention, and as authority for their execution the medical officer in charge shall cite the report of the inspecting officer with the date of in- spection. 51 343. Should the medical officer in charge radically disagree with any of the recommendations offered, the inspecting officer will note such difference of opinion in his report, and the execution of those particular recommendations shall await the approval of the Surgeon General. 344. Reports of inspecting officers shall be rendered in accordance with the directions contained in the Synopsis for the Instruction of Inspectors of the Public Health Service, and no detail shall be omitted, excepting where clearly inapplicable to the station under inspection, but in such cases this fact will be stated. The data in the report shall be paragraphed and headed by the name and num- ber to which it corresponds in the Synopsis for the Instruction of Inspectors of the Public Health Service. Whenever information is furnished upon a subject Avhich does not appear in the synopsis it shall be included under "Remarks" or appended to the report under an appropriate heading. 345. The reports of inspecting officers shall be made separately for each station and in quadruplicate and forwarded to the Chief of In- spection Service who will review and submit to the Surgeon General as soon as practicable after the completion of the inspection. 346. Whenever, in the opinion of the inspecting, officer, immediate action is imperative and additional authority is required, his recom- mendations may be forwarded by telegraphic night letter, or in such other manner as the exigencies of the case demand. 347. Reports of inspecting officers will be considered confidential, and under no circumstances will copies be furnished to the medical officer in charge of the station inspected except when specifically authorized by the Surgeon General. , 348. Inspecting officers shall report at once to the medical officer in charge any conditions which require immediate correction. Full reports of same, whether corrected during the visit of the inspecting officer or not, shall be forwarded to the Surgeon General in the report of the inspection of the station. 349. The inspecting officer shall personally examine the financial accounts of the officer in charge, and of any subordinate accountable officers at the station, and for this purpose the inspecting officers shall be supplied with all the information available and such clerical assistance as may be required. 350. The inspecting officer shall examine such unserviceable prop- erty as may be presented by the officer in charge, and, in order to facilitate such examination an inventory containing a full descrip- tion of such property shall be always in readiness. When, in the opinion of the inspecting .officer, property presented for condemna- tion is capable of repair and further use, he shall so state upon the 52 inventory, and the officer in charge shall take steps at once to reclaim such property. 351. The inspecting officer shall personally examine all requisitions rendered since the last inspection, and any that may be pending or contemplated, and he shall express his opinion in the report as to whether or not due economy has been practiced in the use of sup- plies and whether or not the items on contemplated requisitions are actually needed. 352. Pie will make a thorough inspection of the supplies on hand in the warerooms and prepare a list of supplies which, in his opin- ion, are in excess of the needs of the station. He will forward this list to the Surgeon General with his report. 353. Upon the arrival of an inspecting officer, medical officers in charge will cause to be conspicuously published the fact of the visit, with the information that any officer or employee on duty at the station shall be afforded an opportunity to meet the inspecting officer for the purpose of making any justifiable complaint. 354. The inspecting officer shall, particularly inquire into the firt hazards, both within and adjacent to a station; he shall also care- fully note the location and condition of all fire-prevention apparatus. At each station there should be conspicuously published complete fire regulations, and every officer, employee, and patient shall be as- signed in such regulations to a definite post or exit in case of fire. The inspecting officer will satisfy himself that this requirement is fully met. 355. The inspecting officer shall cause to be tested in his presence any fire-protection apparatus which, in his opinion, may require such scrutiny. Fire axes, crowbars, and other implements of like character must not be kept in wards or corridors. The inspecting officer will call to the attention of the medical officer in charge any infraction of this rule in order that the location of such implements may be changed to place them out of reach of the patients. INSPECTIONS BY MEDICAL OFFICERS IN CHARGE. 356. Once a week the medical officers in charge of hospitals shall make a thorough inspection of the buildings and grounds of the station. All wards, quarters, operating rooms, dressing rooms, laboratories, offices, warehouses, shops, garages, kitchens, dining rooms, etc., shall be inspected in detail. 357. As the weekly inspection is an important duty devolving upon the medical officer in charge, it is not expected that he will delegate its performance to a junior officer, except in cases of urgent necessity requiring his absence. 53 358. The weekly inspection of the medical officer in charge shall be held on Saturday, and he should be accompanied by the following persons during his inspection : (1) By the officers in charge of medical and surgical services while inspecting wards, operating rooms, and dressing rooms. (2) By the chief nurse while inspecting wards, operating rooms, dressing rooms, and the nurses' quarters. (3) By the chief dietitian while inspecting subsistence store- rooms, kitchens, and dining room. (4) By the materiel officer throughout the entire inspection. 359. Informal unannounced inspections of the various buildings, wards, and departments of station shall be made by medical officers in charge at frequent intervals and at any time during the 24 hours. Medical officers in charge should devote a portion of each day to this purpose. ARTICLE X. BENEFICIARIES. 360. The following persons are entitled to the benefits and facilities of the hospitals and relief stations of the service under special rules hereinafter prescribed. (1) Those employed on board in the care, preservation, or naviga- tion of any registered, enrolled, or licensed vessels of the United States, or in the service on board of those engaged in such care, preservation, or navigation. (2) Seamen employed on yachts, provided the said yachts are en- rolled, licensed, or registered as vessels of the United States. (3) Seamen employed on United States Army transports or other vessels belonging to the United States Army, when not en- listed men of the Army. (4) Officers and enlisted men of the United States Coast Guard. (5) Officers and employees of the Public Health Service. " (6) Seamen employed on the vessels of the Mississippi River Com- mission. (7) Seamen employed on the vessels of the Engineer Corps of the Army. (8) Officers, crews of vessels, keepers, and assistant keepers of the Lighthouse Service. (9) Officers and seamen on vessels of the Coast and Geodetic Sur- vey. (10) Civil employees of the United States who are injured while in the performance of their duties. (11) Officers and crews of vessels of the Bureau of Fisheries. (12) Patients of the Bureau of War Risk Insurance. (13) Patients for special study and investigation. 54 361. No person employed in or connected with the navigation, management, or use of canal boats engaged in the coasting trade shall, by reason thereof, be entitled to any benefit or relief from the service. 362. In case of doubt as to the fact of registration, enrollment, or license of a vessel, the officer to whom application for relief is made shall request information of the collector of customs at the port as to the character of vessel on which the seaman is employed, and the said collector of customs shall furnish Such information, if practi- cable. 363. Seamen taken from wrecked vessels of the United States are entitled to the benefits of the service if sick or disabled, and will be furnished care and treatment without reference to the length of time they have been emploj^ed. 364. Seamen employed on merchant vessels of the United States returned to the United States from foreign ports by United States consular officers, if sick or disabled at the time of their arrival in a port of the United States, shall be entitled to the benefits of the serv- ice without reference to length of service. 365. A sick or disabled seaman, in order to obtain the benefits of the service, must apply in person, or by proxy if too ick or disabled so to do, at the office of the Public Health Service, to an officer of that service, or to the proper customs officer acting as the agent of the said service at stations where no medical officer is on duty, and must furnish satisfactory evidence that he is entitled to relief under the regulations. 366. Masters' certificates and discharges from United States ship- ping commissioners, made out and signed in proper form, shoAving that the applicant for relief has been employed for 60 days of continu- ous service " in a registered, enrolled, or licensed vessel of the United States," a part of which time must have been during the 60 days im- mediately preceding his application for relief, shall entitle him to treatment. The phrase " 60 days continuous service " shall not bo held to exclude seamen whose papers show brief intermission between short services that aggregate the required 60 days, provided that such intermission does not exceed 60 days. 367. The certificate of the owner or accredited commercial agent of a vessel as to the facts of the employment of any seaman on said ves- sel may be accepted as evidence in lieu of the master's certificate in cases where the latter is not procurable. 368. Masters of documented vessels of the United States shall, on demand, furnish any seaman who has been employed on such vessel a certificate of the length of time said seaman has been so employed, giving the dates of such employment. This certificate will be filed in the Public Health Service or marine hospital office or office of the 55 customs officer when application is made for relief if relief is fur- nished. 369. When an applicant's claim for relief is rejected, a copy or copies of the master's certificate or other papers in the case must be made, and the cause or causes for such rejection indorsed on said copy or copies, which shall then be placed on file at the station. 370. Any master of a vessel or other person who shall furnish a false certificate of service Avith intent to procure the admission of a seaman into any marine hospital shall be immediately reported to the nearest United States district attorney for prosecution. 371. When an interval has occurred in the applicant's seafaring- service by reason of the closure of navigation, such interval shall not be considered as excluding him from relief. 372. During the season when navigation is closed at any port, sea- men applying for relief at such ports shall be entitled to same, pro- vided they present the documentary evidence in paragraph 366, which must show that the applicants were employed within 60 days immediately preceding the said closure of navigation. 373. The time during which a seaman has been under treatment in hospital as a patient of the service shall not be reckoned as absence from vessel in respect to debarring him from further relief. 374. Whenever an applicant for relief presents himself at a* Public Health Service or marine hospital office or at a customhouse without a master's certificate or shipping commissioner's discharge, and it is impracticable to obtain such certificate, the affirmation of the ap- plicant as to the facts of his last employment, stating names of ves- sels and dates of service, may be accepted as evidence in support of his claim for the benefits of the service. 375. When the period of the seaman's service as shown by his cer- tificate on last vessel is less than 60 days, his affirmation as to pre- vious service may be accepted. 376. In cases of doubt, reasonable effort shall be made to verify the genuineness of masters' certificates and shipping commissioner's discharges, and of the signature to the same. Due care shall also be exercised to identify the persons presenting masters' certificates. 377. When a reasonable doubt exists \vhether the applicant is en- titled to relief under the regulations, the application, accompanied by a statement of the facts, shall be immediately referred to the Sur- geon General for decision, and when the seaman is in such condition that immediate medical or surgical attendance is necessary, he will be placed under treatment pending the decision and the action in the case by the officer shall be reported. 378. When a seaman applies for relief after an absence of 60 clays or more from his last vessel and it satisfactorily appears that it was 56 impracticable for him to apply to the proper officer for treatment or that he obtained treatment at his own expense, a statement of the facts, together with a copy of the application and other papers in support of same, shall be filed and the seaman admitted to hospital. 379. Any seaman who is able to write will be expected to sign his name upon the face of the master's certificate issued to him before said certificate is signed by the master of the vessel, and the officer receiving such certificate shall require the applicant to verify the signature in his presence. 380. When patients are admitted for hospital treatment pending the decision of the Surgeon General, the usual report on Form 1971-F shall be forwarded to the district supervisor, and the authority re- corded on the patient's record card as soon as it is received. If relief is not authorized, the applicant shall be discharged and the disap- proval recorded on the completed report card and on the record card. 381. When a seaman who has received continuous treatment at the out-patient office for a period of two months applies for further treatment he must, to entitle him to treatment, furnish a new cer- tificate of service showing that he is still following his vocation as seaman, or give satisfactory evidence that such service has been prevented by closure of navigation or by sickness, the latest dates of serrice, and, in case of lack of recent servicej its explanation, to appear on his record card. 382. The expenses of caring for sick and disabled seamen incurred during a voyage will not be paid by the service. 383. The expenses for the care and treatment of patients suffering from contagious diseases, who are entitled to the benefits of the serv- ice, and who, in accordance with the State or municipal health laws and regulations are taken to quarantine or other hospitals under charge of the local health authorities, will not be paid unless such patients were admitted at the time by the request of an officer of the service. 384. In no case shall money be paid to a seaman or to his family or friends by the service as reimbursement for expenses incurred during his sickness or disability. 385. Seamen who may be injured in street brawls or while com- mitting a breach of the peace, and are, therefore, confined in jail or taken to civil hospitals by the local authorities for such acts, shall not receive treatment at the expense of the service. Such seamen should, however, be furnished treatment if brought to service or con- tract hospital. 386. Seamen taken sick or injured on board or ashore while actu- ally employed on a documented vessel shall be entitled to treatment at relief stations without reference to the length of their service. 57 387. A certificate of discharge may, at the discretion of the officer in charge of the case, be given to a hospital patient, but such certifi- cate, when presented at another relief station, shall not be taken as sufficient evidence of the applicant's title to hospital relief, but may be considered as collateral to other satisfactory data submitted by the seaman. 388. Temporary relief only is contemplated, and admission to hos- pital is not intended to permit an indefinite residence therein for cause other than actual disease or injury. 389. The Surgeon General is authorized to issue orders for the temporary care and treatment of sick seamen at minor stations and for the transfer of patients, including necessary expenses, whenever the interests of the service demand such transfers. THE UNITED STATES COAST GUARD. 390. Commissioned officers of the United States Coast Guard shall receive the same hospital and out-patient relief as provided by law for commissioned officers in the Army. 391. Officers of the United States Coast Guard on leave, on sick leave, or retired will be furnished relief by the Public Health Service at Public Health Service and marine hospitals operated by the service and dispensaries conducted by the service, provided no bills for the same are incurred. Officers on leave, retired, or on waiting orders may sign their own certificates. 392. The noncommissioned officers and enlisted men' of the United States Coast Guard will receive hospital or out-patient treatment, as hereinafter provided, on certificate signed by the commanding officer or executive officer of a Coast Guard cutter, without regard to length of service. The certificates shall contain a description of the appli- cant for relief. Officers on leave or waiting orders may sign their own certificate. "393. Any officer, warrant officer, or enlisted man on active duty whose condition absolutely requires hospital treatment will be ad- mitted to hospitals at stations of the first class and to all hospitals under contract with the service. At places where no specific arrange- ments for treatment in hospital are made the regulations governing emergency admissions at fourth-class stations will be enforced. At places Avhere no specific arrangements for hospital treatment are made, officers in the United States Coast Guard may, when absolutely necessary, in case of injury or severe illness, procure treatment in hospital for officers, warrant officers, and enlisted men on active duty, and shall immediately report to the district super- visor of the Public Health Service, forwarding as a part of this 58 report the statement of the attending physician certifying the neces- sity for immediate treatment and the probable duration of treatment required. Vouchers, on proper forms, duly certified by said com- manding officer and receipted by the person rendering the bill, shall be forwarded to the district supervisor of the Public Health Service. 394. Enlisted men of the United States Coast Guard shall be en- titled to medical relief for a period of 60 -days after having been discharged from said service, as is granted to seamen of the merchant marine. The presentation of a certificate of honorable or ordinary discharge and satisfactory identification of the applicant shall be considered sufficient authority for such medical relief. 395. Officers and enlisted men or surfmen of the United States Coast Guard shall be admitted to hospital only in cases where the gravity of the disease or injury from which they suffer is such as to require hospital treatment, in the opinion of an officer of the Public Health Service, or of a reputable physician designated by the depart- ment to act at a place where no officer is stationed, or one temporarily employed, as provided for in paragraph 393. 396. Patients shall be promptly discharged upon the termination of the necessary hospital treatment, but, at stations of first class, pa- tients may be held pending the return of their vessel. 397. Out-patient treatment will be furnished at all stations where an officer of the Public Health Service is on duty. At all other sta- tions out-patient relief will be granted only in cases of emergency and under the provisions of the regulations relative to fourth-class (emer- gency) stations. When absolutely necessary in case of serious injury or illness, the temporary attendance of a physician may be procured by the commanding officer of a Coast Guard vessel, who shall immedi- ately report his action to the district supervisor, forwarding as part o$ this report the statement of the attending physician certifying the necessity for immediate treatment required. Vouchers on proper forms, duly certified by said commanding officer and receipted by the person rendering the bill, shall be forwarded to the district super- visor. 398. At ports where there is a station of the first class, when an officer or member of a crew of the United States Coast Guard, on account of injury or illness, requires the immediate attention of a physician, and on account of the exigency of the case it is impossible to convey the patient to the hospital or out-patient office, temporary provision for medical attendance or care may be made by the com- manding officer, who Avill immediately report his action to the proper Public Health Service or marine hospital representative at the port and the treatment thereafter will be conducted by the Public Health Service if in the judgment of the proper officer of the Public Health Service it can be done without detriment to the patient. 59 399. The bills for the emergency treatment will be forwarded to the Surgeon General through said officer for approval and payment. Unreasonable charges for relief furnished in emergency cases will not be allowed by the department. 400. Commissioned medical officers and acting assistant surgeons of the Public Health Service will render professional aid to officers of the United States Coast Guard residing at the port, at their resi- dences, when said officers of the United States Coast Guard for any reason can not avail themselves of the accommodations offered by marine or Public Health Service hospitals, and when they are physi- cally unable to present themselves at a hospital office. The medi- cines or appliances prescribed shall be' furnished from the dispensary of the Public Health Service when practicable. 401. Station conveyances may be used to convey officers engaged in treating Coast Guard officers at places other than the hospital sta- tion, and when such conveyances are not available the officer will be allowed necessary traveling expenses. OFFICERS AND EMPLOYEES OF THE PUBLIC HEALTH SERVICE. 402. Commissioned officers and pharmacists, and those employees of the service devoting all their time to field work, when taken sick . or injured in line of duty, may be given necessary relief at first, second, and third class relief stations of the service. When they are physically unable to present themselves at such hospitals they shall be entitled to treatment in their homes by commissioned officers or acting assistant surgeons of the service. The medicines and appli- ances prescribed shall be furnished from the dispensary of the Public Health Service when practicable. THE MISSISSIPPI RIVER COMMISSION. 403. Masters, officers, and crews of vessels in the service of the Mississippi River Commission shall be entitled to the benefits of the service under the same regulations as govern the admission of seamen on documented vessels. No charge shall be made for their care and treatment. THE ENGINEER CORPS, UNITED STATES ARMY. 404. Seamen employed on vessels under the charge of the Engineer Corps of the United States Army shall be admitted to the benefits of the service without charge at stations of the first, second, third, and fourth class upon the written request of the commanding officer of said vessels. 60 THE LIGHTHOUSE SERVICE. 405. Officers and crews of the several vessels belonging to the Lighthouse Service, including lightships, may be admitted to the benefits of the Public Health Service upon the application of their respective commanding officers. No charge will be made for care and treatment. 406. Light keepers and assistant light keepers of the Lighthouse Service are entitled to medical relief without charge at hospitals and other stations of the Public Health Service under the rules and regu- lations governing the care of seamen of the merchant marine, pro- vided that such keepers and assistant keepers, who receive an original appointment after August 28, 1916, pass a physical examination in accordance with rules approved by the Secretary of Commerce and the Secretary of the Treasury. THE COAST AND GEODETIC SURVEY. 407. Officers and seamen on vessels of the Coast and Geodetic Sur- vey shall be entitled to relief under the same regulations governing the treatment of seamen on documented vessels except as hereinafter provided. When immediate ' medical aid is considered absolutely essential for any member of the crew of a vessel of the Coast and Geo- detic Survey, and the services of the Public Health Service can not be procured, the commanding officer of the vessel may, for the time being, until the services of the Public Health Service can be obtained, avail himself of the most suitable local facilities, provided the charges are reasonable, and shall immediately report his action to the district supervisor, forwarding as a part of the report, the state- ment of the attending physician, certifying the necessity for imme- diate treatment and the probable duration of same. Vouchers cov- ering the expense of such service and the necessary medicines, prop- erly certified and accompanied by a full statement of the circum- stances, shall be forwarded to the district supervisor. This para- graph shall not be construed to authorize relief at the expense of the Public Health Service in foreign ports or in ports of the Philippine Islands. BUREAU OF FISHERIES. 408. Officers and crews of the several vessels belonging to the Bureau of Fisheries may be admitted to the benefits of the Public Health Service without charge, upon the application of their respec- tive commanding officers. 61 INJURED CIVIL EMPLOYEES OF THE UNITED STATES BENEFICIARIES OF THE FEDERAL EMPLOYEES' COMPENSATION ACT. 409. Civil employees of the United States, who are injured while in the performance of their duties, shall be furnished, upon applica- tion and without personal charge, needed medical and surgical treat- ment by medical officers at first, second, and third class relief sta- tions of the service, provided the applicant shall present to the medi- cal officer a " Request for treatment " on the United States Em- ployees' Compensation Commission's Form CA-16, or a letter re- citing that the bearer (giving the name) is an employee of the United States, employed at (giving the name of the office or establishment) that he was injured in the performance of duty on (giving the date and nature of the injury) and that treatment is requested for the results of said injury under section 9 of the compensation act, the forms or letter to be signed by the applicant's official superior. 410. Section 9, United States Employees' Compensation act : That immediately after an injury sustained by an employee while in the performance of his duty, whether or not disability has arisen, and for a reason- able time thereafter, the United States shall furnish to such employee reason- able medical, surgical, and hospital services and supplies unless he refuses to accept them. Such services and supplies shall be furnished by United States medical officers and hospitals, buf where this is not practicable shall be fur- nished by private physicians and hospitals designated or approved by the com- mission and paid for from the employees' compensation fund. If necessary for the securing of proper medical, surgical, and hospital treatment, the em- ployee, in the discretion of the commission, may be furnished transportation at the expense of the employees' compensation fund. 411. Beneficiaries of the compensation act will also be admitted for examination or treatment upon the request of the United States Employees' Compensation Commission. 412. In case it has been impracticable for an employee to obtain a " Request for treatment " the medical officer may furnish temporary treatment upon the statement of the injured employee giving the facts, together with the name of the Government establishment in which he is employed. In such instances, a proper ' ; Request for treatment " will be obtained within 48 hours thereafter from the employee's official superior. 413. Cases coming under the compensation act are morbid condi- tions and disabilities resulting from the nature or conditions of em- ployment at the place of employment. These include all so-called accidents which occur at places of employment during hours of em- ployment. Tuberculosis, pneumonia, typhoid fever, and malaria, .as well as lead poisoning and other recognized occupational diseases 62 may come under the provisions of the compensation act when these ailments are a result of the conditions or nature of work. 414. At United States marine and Public Health Service hospitals no charge shall be made for services or supplies furnished injured civil employees of the United States, excepting where expenditures are incurred for prosthetic or orthopedic appliances, orthpedic boots, ambulance hire, X-ray service, or similar expenses. 415. At second and third class relief stations of the service ex- penditures incurred on account of either office or hospital treatment furnished injured civil employees of the United States, shall be taken up on the Employees' Compensation Commission's Form D-19. When this is not available, Public Health Service Form 1926 or 1949 may be used and should be headed United States Employees' Com- pensation Commission. The voucher accompanied by the original " Request for treatment " of the employee will be forAvarded to the district supervisor. The rates charged shall be the contract rates for service patients at said stations. Expenditures incurred at first- class stations on account of beneficiaries of the compensation act shall be handled in a similar manner. 416. Expenditures payable by the Employees' Compensation Com- mission shall not be listed among expenditures noted on Monthly Schedule of Encumbrances, Form 1955, nor shall they be taken up on Monthly Report of Relief Furnished Foreign Seamen and Other Pay Patients, Form 1927. No charge shall be made for professional services furnished said injured civil employees by medical officers of the service, nor shall any be made for supplies in stock furnished such persons. Fees for examiners and others not on a salary basis are chargeable to the Federal Employees' Compensation Commission. 417. In order that injured employees may be furnished as complete medical and surgical service as possible, the Employees' Compensation Commission will pay the necessary car fare to those who are able to return to the dispensary for treatment. The injured employee should be definitely instructed whether and when he is to return for further treatment. 418. In cases where the injury requires such action an ambulance (one owned by a United States marine or Public Health Service hospital, or a contract hospital) should be called and the employee sent to a United States marine or Public Health Service hospital or a contract hospital at once. When neither a United States marine or Public Health Service hospital ambulance nor a contract hospital ambulance is available, the Employees' Compensation Commission will allow a reasonable charge for other ambulance or carriage service, but in all such cases the employee should be sent to a United States marine or Public Health Service hospital or contract hospital, if practicable. 63 419. When an employee of the United States has lost a leg or part of a leg as a result of an injury for which he is entitled to the bene- fits of the compensation act, the Employees' Compensation Com- mission will furnish a temporary artificial leg if, and for the time, a temporary leg is needed. The commission will furnish a perma- nent leg when a permanent leg is needed. The commission will also keep these artificial legs in repair and will replace them if worn out as a result of proper use. 420. The legs furnished will be of approved manufacture, and be- fore acceptance by the commission must, where practicable, be pro- nounced satisfactory in workmanship and fit by a competent ortho- pedic surgeon. 421. The employee should be advised accordingly, and when a leg is desired authority for its purchase should be requested from the commission. The telegraph may be used to expedite such requisi- tions. 422. When an employee of the United States has lost an arm or part of an arm as a result of an injury for which he is entitled to the benefits of the compensation act, the Employees' Compensation Commission will furnish tin artificial arm. The commission will also keep the artificial arm in repair and will replace it if worn out as a result of proper use. 423. The arms furnished will be of approved manufacture, and be- fore acceptance by the commission must, where practicable, be pro- nounced satisfactory in workmanship and fit by a competent ortho- pedic surgeon. 424. The employee should be advised accordingly, and when an arm is desired authority for its purchase should be requested from the medical director of the commission. The telegraph may be used to expedite the requisition. 425. "When an employee of the United States has lost an eye as a result of an injury for which he is entitled to the benefits of the compensation act, the Employees' Compensation Commission will furnish two properly fitting and matched artificial eyes, one to be kept for use in cnse of accidental lo^s or breakage of the other. 426. The eyes furnished will be of approved manufacture, and be- fore acceptance by the commission must, where practicable, be pro- nounced satisfactory as to fit and color by a competent ophthal- mologist. 427. The employee should be advised accordingly, and when an eye is desired authority for its purchase should be requested from the medical director of the commission. The telegraph mav bo used to expedite such requisitions. 428. Medical treatment to which injured employees am entitled in- cludes repairs to fixed false teeth or to natural teeth only hi so far 64 as such repairs are due to the injury. An estimate of the cost of the dental work should be approved in advance as reasonable by a medical officer, who should also certify on the bill that all the work Avas needed as a direct result of the injury sustained while in per- formance of duty. Bills for repairs or replacement of removable false teeth are not payable from the compensation fund. 429. Under the same conditions applying to artificial limbs and eyes, the Employees' Compensation Commission will furnish other prosthetic appliances that may be needed. 430. Orthopedic braces, orthopedic shoes, and other orthopedic ap- pliances will be furnished by the Employees' Compensation Com- mission under the same conditions and in the same way as are pros- thetic appliances. In most instances the matter of time will make it advisable for the attending medical officer to secure immediately the orthopedic appliance indicated in a given case. When this is done the bill therefor should be forwarded to the commission for payment, with a notation thereon that the article was necessary be- cause of the injury, that it Avas satisfactory, and that the price was reasonable. 431. Treatment furnished beneficiaries of the compensation act of the United States shall be reported in the usual manner to the dis- trict supervisor on Forms 1971-E, Outpatients Report Card, and 1971-F, Inpatients Report Card. On such reports the class of pa- tients shall be designated or shown, and authority for said treat- ment shall be cited as " employees' compensation act." 432. Treatment furnished said patients shall be taken up in the Medical Officer's Monthly Report of Relief, Form 1922. 433. The following forms will be used by medical officers, in addi- tion to Forms 1971-E and 1971-F, and for recording and reporting to the medical director of the Compensation Commission injuries to civil employees of the Government, beneficiaries of the compensation act under treatment : Medical Records of Injury and Treatment (Form CA-19). The form shall be filled out in all cases where an injured civil em- ployee applies for treatment. The name of the officer or physician making the examination and diagnosis should be recorded. When an operation is performed, the name of the operator and his official status and recognized specialty, if any, should be shown. X-ray examination should be made in all cases of fractures, suspected fractures, so-called " sprains," whenever bone or joint injury is suspected or possible from the symptoms and in any case where it would aid in the diagnosis. When X-ray examination is made, the fact should, be noted and findings shown. Photographic prints should be 65 made from the X-ray plates taken in the case and forwarded to the medical director, Employees' Compensation Commission. In all injuries, in so far as possible, the exact location and extent should be recorded, together with a statement of the extent of the disability arising therefrom. In fractures, the size and condition of the fragments, both before and after reduction, should be given, together with a statement whether X-ray examination was made and whether X-ray plates were preserved. Unless there is absolutely no indication therefor, X-ray plates showing the antero-posterior and lateral views of the fragments should be kept. X-ray plates and photographic prints should also be made when the patient is discharged so that there will be a record of the condition at that time. In lacerations, the location, con- formation, extent or length, and depth should be recorded. If the medical officer feels confident that an employee is not en- titled to the benefits of the compensation act, his reasons for so thinking shall be noted under " Remarks." Supplementary case records giving a more detailed clinical history of the case should be kept in all instances of serious injury. (See paragraph on " Supplementary case reports.") Medical Report of Injury to United States Employee (Form CA-20, United States Employees' Compensation Commission.) This report shall be forwarded to the medical director of the commission as soon as a case comes under treatment. Discharge Report of Injury Case (Form CA-21, United States Employees' Compensation Commission, when an injured em- ployee is transferred or discharged from treatment or the case is otherwise terminated). This report shall be forwarded to the medical director of the commission. 434. The foregoing reports serve their purpose only when for- warded promptly to the United States Employees' Compensation Commission. If the forwarding of a report is delayed for any cause, it* should be accompanied by a letter of transmittal explaining the cause of the delay. 435. Supplementary case reports in the form of a letter should be made of the following cases to the medical director, United States Employees' Compensation Commission : 1. All compensation cases treated in hospitals. 2. All cases of serious injury. 3. All cases -in which there will be a disability for work for one month or more. 4. All cases sent to the medical officer for examination under the provisions of section 21 of the compensation act. 185279 20 5 66 436. These supplementary reports should be made when the case has been under observation for a sufficient time to determine satis- factorily the nature and extent of the injury. The reports should include: 1. Date when case was admitted for examination or treatment. If admitted to hospital, this should be noted. 2. The patient's complaint, including his account of the injury. 3. The names (and specialists, if any) of the physicians or officers examining the case. 4. The condition found on examination. 5. Diagnosis of the injuries sustained. (>. Xature and extent of disability. 7. Whether disabled for his usual employment. 8. Prognosis. 0. Comments, recommendations, or suggestions regarding the case. 437. For specimen copies of reports, furnishing the information necessary for the proper handling of the cases by the Employees' Compensation Commission, see appendix. 438. Whenever a photograph of an injured part not considered necessary in connection with medical care and treatment would nev- ertheless be of value in the determination of compensation, and facilities are available, a photograph should be made and a print thereof furnished to the medical director of the commission, the expense to be charged to the Employees' Compensation Commission. 439. Whenever the services of an attending specialist are secured in connection with the examination or treatment of a beneficiary of the compensation act, a brief statement by the attending specialist of his findings at examination and his recommendations as to treatment should be given in the report of the case when forwarded by the medical officer or designated physician in charge thereof. The name and recognized specialty of the attending specialist should be indicated and the statement should include : 1. Diagnosis of the disability and its relationship to the alleged injury. 2. Prognosis. 3. Recommendation as to treatment. 4. Statement as to whether patient is disabled for usual occupation. 5. Comment or remarks. 440. When it is in the interest of economy and efficiency and to the welfare of injured civil employees of the United States, the Employ- ees' Compensation Commission will order the transfer of such patients from one station to another. The necessary expenses involved in such transfer will be chargeable to the commission. No injured em- ployee should be so transferred without the authorization of the 67 commission. (Authority may be obtained by telegraphing the medi- cal director, United States Employees' Compensation Commission.) 441. All injured employees will be treated either as dispensary or office patients or as hospital patients, and no injured employee will be furnished treatment in his home unless such arrangement is ap- proved by the medical director of the commission or unless, in the opinion of the medical officer in charge of the case, treatment at home is the only course practicable in the circumstances and the reasons for home treatment are reported to the commission. 442. When there is in the general locality of the relief station a Government establishment with any considerable number of em- ployees arrangements should be made with the officer in charge of the establishment whereby there will be adequate ambulance service, if needed on account of injury cases entitled to benefits of the com- pensation act. If the station has no ambulance, any other arrange- ment practicable can be made and bills on account of necessary ex- penditures incurred by said arrangement forwarded to the commis- sion in the usual way. 443. Injured employees frequently present themselves for exami- nation and treatment, and no anatomical lesion resulting from an injury is found. The diagnosis recorded in such cases is frequently ' " no disability present " or " traumatic neurosis," or perhaps " case of malingering." 444. In a proportion of these cases the diagnosis is the resXilt of the limitations of diagnosis and not due to the fact that an actual injury does not exist. In many instances the Employees' Compensa- tion Commission finds that on further and more detailed examination a definite lesion is found. These cases of what amounts to negative diagnosis are among those giving the commission the greatest amount of trouble. The injured employee insists he is injured and the com- mission is unwilling to deny his claim until it has exhausted the pow- ers of diagnosis. It is, therefore, necessary in cases of this kind that the negative diagnosis be supported by a very complete examination, the results of which are made a matter of careful record. It is in cases of this kind that the services of attending specialists are most needed. Back injuries are among those causing much trouble in this way. The surgeon of lesser experience finds no disabling condition. The experienced orthopedic surgeon looks for the injured sacro iliac joint or fractured vertebra in these injuries and frequently finds them. This makes necessary the services of an expert roentgenologisfc and expert reading of the plates. 445. In caring for beneficiaries of the compensation act chief con- sideration is to be given to the repairing of the damage due to the injury and to the restoration of function, in so far as possible, to the injured part in the best interest of the injured employee. Where the injury is of such a nature that it can be treated best by a specialist, the services of an attending specialist will be secured to take charge of the case. 446. Where available, eye injuries will be treated by ophthalmolo- gists, bone and joint injuries by trained orthopedic surgeons or by surgeons having ample experience. 447. In the treatment of injured employees limbs or parts of limbs will not be amputated unless it appears to be in the interest of the employee. Whenever an amputation is necessary, a careful and com- plete record will be made of all the circumstances requiring the am- putation. In addition to the written record of the nature and extent of injury and the necessity for amputation, a photograph of the in- jured member, and where indicated an X-ray examination, should be made, and copies of the record and of the photograph, including a print from the X-ray negative, should be sent to the medical director of the commission for filing Avith the record of the case. 448. In all cases of fractured bones adequate X-ray examination will be made and X-ray plates preserved for record. During the .course of treatment of the fracture if other X-ray examinations are indicated they should be made. When union shall have taken place and convalescence been established, and before the case is discharged from treatment, further X-ray plates showing both the antero- posterior and lateral views of the fragments will be made. Photo- graphic prints from all plates showing the injury should be for- warded to the medical director of the commission for filing with the other records in the case. Film negatives may be forwarded instead of prints. Each photograph should have noted thereon the patient's full name and the date when taken. 449. X-ray examinations should be made in injuries where fracture is suspected or thought possible and the negatives kept as a part of the record of the case. 450. In sprains, or injuries believed to be sprains, unless examina- tion shows that there is absolutely no reason to suspect a fracture, X-ray examination should be made and negative kept as a part of the record. 451. When plastic operations are to be performed, arrangements will be made by the medical officer in charge to have photographs taken showing the condition before operation. Photographs should also be made subsequent to the operation and before the patient is discharged from treatment. Unmounted copies of these photographs taken both before and after operation should be forwarded to the medical director of the commission as a part of the recoro! and for filing with the other papers in the case. These photographs should 69 have written on the back the full name of the patient and the date when taken. 452. Where expense is incurred on account of these photographs, bills will be sent to the Employees' Compensation Commission for payment, preferably at the time the photographs are forwarded. 453. In mutilating or disfiguring injuries the medical officer in charge will have an unmounted photograph made showing the nature of the mutilation or disfigurement and will send it to the medical director of the commission as a part of the record and for filing with the other papers in the case. These photographs should have written on the back the full name of the patient and the date when taken. 454. Where expense is incurred on account of these photographs, bills will be sent to the Employees' Compensation Commission for payment, preferably at the time the photographs are forwarded. 455. In a large proportion of hernia cases there is considerable doubt as to whether the case is one entitled to treatment under the compensation act. Therefore, unless the relationship of the hernia to the injury is clear, or unless immediate treatment is necessary because of strangulation or incarceration or for other reason, operation should not be performed until a full report of the case has been sub- mitted to the Employees' Compensation Commission and it has authorized operation. 456. Pending decision on the case, the patient should be discharged from hospital, if practicable. The initial report to the commission should show: (1) The nature and location of the hernia. (2) Tissues involved and the extent or size of the hernia. (3) The cause of the hernia, particularly whether brought on or materially aggravated by injury as alleged by the claimant. (4) Whether the hernia is one for which operation should be per- formed. (5) Whether patient's general health, including condition of his lieart, lungs, and kidneys, is such that it is advisable to perform operation. (6) Whether the medical officer recommends operation. 457. For nature of the evidence required in hernia cases to entitle the patient to treatment under the compensation act, see appendix. 458. In those cases requiring the services of a specialist for pur- poses of diagnosis or treatment, the jnedical officer in charge will obtain such services. 459. Whenever an employee applies for treatment with a request for treatment on Form C. A. 16, or a letter of request from his official superior, the employee should be furnished such treatment as may be required ; but if there is reason to believe that he is not entitled to 70 treatment or that his disability is not due to the alleged injury, the medical officer should take up the matter with the employee's official superior. If agreement is reached by both that the employee is not entitled to relief, he should be discharged from treatment, unless satisfactory arrangements can be made to continue treatment with- out further charge against the Employees' Compensation Commis- sion. Written records should be kept and immediate report made of all such cases to the medical director of the commission.' 460. If an injured employee admitted to a United States marine or Public Health Service hospital for treatment on account of injury refuses to comply with any hospital rule or requirement and his offense is of sufficient gravity to justify his dismissal from the hos- pital, the medical officer in charge of the hospital will telegraph the medical director of the commission 24 hours in advance of the con- templated dismissal in sufficient detail to acquaint the commission with the circumstances surrounding the proposed discharge of the patient and to enable it to take necessary action. 461. Whenever, in any case, an injured employee admitted to hos- pital is found to have or develops a disease or disability which is not related to the injury and which is liable to prolong his stay in hos- pital, the commission should be notified immediately. 462. Whenever an injured employee becomes physically fit to do light work or some form of work other than his usual Avork without detriment to himself and without interfering w r ith his recovery from the injury, the medical officer in charge of the case should record the fact in the clinical history and should notify the patient, the em- ployer, and the commission. 463. Insane injured employees entitled to the benefits of the com- pensation act will be transferred either to a United States marine or Public Health Service hospital for the insane. Requests for such transfer should in each case be made to the medical director of the commission by the medical officer in charge. PATIENTS OF THE BUREAU OF WAR RISK INSURANCE. 464. The term " patients of the Bureau of War Risk Insurance " as used in Public Act 326 of the Sixty-fifth Congress shall be held to mean, subject to the limitations contained in paragraphs 465 and 466 : (a) Any discharged sick and disabled soldier, sailor, marine, Army or Navy nurse (male or female) applying for compensation for personal injury suffered or disease contracted in the line of duty and not the result of his own willful misconduct, and until such time as claim for compensation has been disallowed. The above authori- zation is intended to cover emergency cases in which the health of the patient would be seriously injured by delay. Great care should, 71 however, be exercised in the utilization of this authorization, the patient's discharge and other papers being carefully examined to prevent, in so far as possible, persons falling within the limitations of paragraphs 465 and 466 from receiving treatment. (5) Any person who, after induction by a local draft board, but before being accepted and enrolled for active service became dis- abled as the result of disease contracted or injury suffered in the line of duty and not the result of his own willful misconduct in- volving moral turpitude or as a result of the aggravation in the lino of duty and not because of his own willful misconduct involving moral turpitude of an existing disease or injury. (c) Any such person in whose favor an award of compensation has been made, or to whom a certificate of injury has been issued by the Bureau of War Eisk Insurance. (d) Any such compensable person who has waived his rights to compensation. Patients falling in classes (a), (6), (e),and (d) will be treated only for conditions definitely connected with their military service or for intercurrent conditions having an untoward effect upon the cure or amelioration of conditions definitely connected with their military service. (e) Discharged members of the military or naval forces of those Governments which have been associated in war with the United States since April 6, 1917, subject to such regulations as the Director of the Bureau of War Risk Insurance may prescribe. 465. Discharged sick and disabled soldiers, sailors, marines, Army or Navy nurses (male or female) are rendered ineligible as patients of the Bureau of War Risk Insurance by any of the following : (a) Discharge prior to April 6, 1917. (b) Discharge or dismissal from the military or naval forces as enemy alien, conscientious objector, or deserter, or as guilty of mutiny, treason, spying, or any offense involving moral turpitude or willful and persistent misconduct. *(c) Dismissal or dishonorable or bad conduct discharge from the service. (d) Refusal to submit to, or obstruction of physical examination. 466. Persons contracting a venereal disease while in the military service, unless it can be shown to have been wholly accidental and not clue to a voluntary act, are not entitled to care and treatment by the Public Health Service. If venereal disease was contracted prior to enlistment, but the person was nevertheless accepted as sound for active service, he is entitled to care and treatment by the Public Health Service. If, however, such disability was noted at the time of his enlistment and he was subsequently accepted for service, sub- ject to such disability, he is entitled to treatment only for an aggrava- tion of the disability noted incurred while in the military service. 72 467. Claimants applying for compensation will- be required, when able, to fill out an application blank, Bureau of War Risk Insurance Form No. 526, which will be forwarded by the examiner to the chief medical adviser, Bureau of War Risk Insurance. The examination will then be made upon the prescribed form, and after its completion, if the claimant is in need of relief, the kind of treatment required, either outpatient or hospital, will be furnished by the medical officer in charge of the station to which the claimant is referred for treat- ment. 468. If the applicant requires only outpatient relief and there is no service station nearby where he can receive such relief, a designated examiner is authorized to furnish him treatment, giving him a pre- scription if necessary, to a local druggist for such medicine as is re- quired. Vouchers for prescriptions shall be rendered at the end of each month on Form 1949 and shall bear patient's name and prescrip- tion number. Copies of prescription, with price of each marked there- on, shall accompany such vouchers. 469. Examinations shall be complete, and examiners are authorized to hold any claimant under observation for such temporary period as is necessary to arrive at a definite conclusion. It should be remem- bered, that a claimant can not be held against his will. He should, however, be informed that if he refuses to submit himself for, or in any way obstruct any examination, his right to claim compen- sation shall be suspended until such refusal or obstruction ceases. 470. The examiner shall, in every case, inform the claimant in de- tail as to the procedure likely to become necessary if the patient is ad- mitted to a hospital. The examiner shall convey the impression to the patient that he is interested in his welfare, but shall carefully refrain from implanting in the patient's mind the idea that the patient's en- trance into a hospital is solicited. The final decision of entering the hospital is a prerogative that must be exercised in all cases by the patient himself, without any coercion upon the part of the examiner. Examiners are not authorized to make promises of transfers to in- stitutions and localities desired by patients. 471. Claimants who have suffered some injury or illness in service, not due to their own misconduct, which may at a future date cause disability or death, will be given an original examination at their own request for the purpose of establishing claim to a certificate of injury after presentation of an honorable discharge, or a copy thereof, dated on or after April 6, 1917. 472. Examiners shall not discuss with any patient the extent of the disease or injury from which such patient is suffering, and shall not make any statement which the patient could use for the purpose of showing a difference of opinion between the Bureau of War Risk In- surance and the examiner. 73 473. No patients shall be sent for treatment to hospitals outside of the district where they reside, except when the approval of the Sur- geon General of the Public Health Service or of the Chief Medical Adviser of the Bureau of War Risk Insurance has been- previously obtained. Mental and neuropsychiatric cases are excepted from this rule. 474. A written report of every examination of a claimant of the Bureau of War Risk Insurance shall be prepared in duplicate on Form 1934B Report of Physical Examination. Great care should be taken in order that this report shall be accurately and legibly prepared. Immediately on conclusion of the examination the original shall be mailed direct to the district supervisor, and the duplicate shall be filed at the office of the examiner. An exception to the foregoing rule is made in neuropsychiatric examinations. Owing to the complex nature of the information needed for the proper disposition of these cases, reports of such examinations will be made to the district supervisor on a special form. The above re- ports are required in addition to Form 1971-E, Outpatient Report Card. 475. Every report of a physical examination should be sufficiently comprehensive and contain sufficient data to enable the Bureau of War-Risk Insurance to form an adequate judgment of the claimant's condition. 476. It is essential that the official Nomenclature of Diseases and Conditions, 1916 be referred to in making diagnoses in order that the proper name and number of the disease or condition may be given in each instance. 477. A dental officer will be assigned to each district to act under the direction of the district supervisor for the conduct of all service dental operations in the district, including the maintenance of records, the inspection of dental clinics, and the nomination of dental examiners to the district supervisor. 478. One or more dental officers will be assigned to each of the hospitals of the service, where the demand for dental treatment is great enough to warrant such action. 479. One or more dental officers will be assigned to each out-patient office when the demand for dental treatment is great enough to war- rant such action. 480. In large cities where no service hospital or district super- visor's office is located, a dental officer will be assigned to some insti- tution with which the service has a contract, if the demand for dental treatment in that station is great enough to warrant such action. 74 481. To care for beneficiaries in rural communities or in cities where no dental officer is assigned,, civilian dentists may be appointed as dental examiners to do dental work on a iee basis. This organiza- tion will be built up under the direction of the Surgeon General by the supervising dental surgeon in each district, and a dentist will be appointed to act as dental examiner in each county. Civilian dentists appointed as dental examiners must be made to understand that aty patients of the Bureau of War Risk Insurance referred to them must be treated as private patients, and their wishes must be respected in the matter of appointment hours. 482. No dental examiners will be appointed other than n a fee basis, and whenever it is deemed best for the good of the service to discontinue the services of a dental examiner, the district supervisor should make such recommendation to the Surgeon General for neces- sary action* 483. Dental blank forms with spaces for diagnosis of oral condi- tions, detailed statement of dental treatment indicated, fees to be charged according to the fee table authorized by the Secretary of the Treasury, detailed statement of dental treatment rendered, a brief history of the patient, etc., will be furnished by the Surgeon General and sent to each dental examiner by the district supervisor. 484. When a patient applies for dental treatment to the district supervisor he will be referred to the dental examiner nearest to his home. The dental examiner will make a thorough examination of oral conditions and record said examination on the dental blank. If the cost of dental treatment needed does not exceed $10, the dental examiner will render the treatment and forward the finished blank to the district supervisor's office, where four copies shall be made, one for the files of the district supervisor's office and three to be for- warded with the original to the Surgeon General for necessary action. One copy will be forwarded to the Chief Medical Adviser of the Bu- reau of War Risk Insurance. 485. If the cost of dental treatment exceeds $10, the blank with recorded examination, indicated treatment, and cost thereof shall be forwarded to the district supervisor. All estimates not exceeding $100 will be authorized by the district supervisor, after same have been passed on by the supervising dental surgeon. Due care will be observed in determining the serviqe origin or aggravation of the condition to be treated, and when doubt exists the case will be re- ferred to the Chief Medical Adviser of the Bureau of War Risk In- surance for decision. All estimates exceeding $100 will be sent to the Surgeon General for authority to render treatment. 486. When authority has been granted either by the district super- visor or by the Surgeon General, the letter of authority from either 75 ! office should be forwarded immediately with the original blank to the dental examiner, requesting immediate treatment of the patient. 487. Upon completion of the treatment the blank will be made out in due form and forwarded to the district supervisor by the dental examiner, where four copies shall be made, one for the files of the district supervisor's office and three to be forwarded with the original to the Surgeon General for necessary action. One copy will be for- Avarded to the Chief Medical Adviser of the Bureau of War Bisk Insurance. 488. All persons concerned will assure themselves before treatment is given that the patient to be treated has made claim for compen- sation or a certificate of injury, or has received an award of com- pensation or a certificate of injury. In all correspondence with the Bureau of War Risk Insurance relative to its claimants the " C " number of the patient should be stated. 489. Dental patients of the Bureau of War Risk Insurance should be classed as follows, as to conditions entitling them to receive treatment : Class 1. Those patients who have lost teeth or portions of either maxilla or mandible through gunshot wounds or other injuries re- ceived in line of duty, shall have restorations and such other dental treatment as may be necessary to put the mouth in the best condition possible. Class 2. Those patients whose physical disability is directly due to pathological oral conditions shall have whatever dental treatment js necessary to place the mouth in a healthy condition and insure a good masticating surface. Class 3. Those patients the relief of whose disability is retarded by pathological oral condition shall have whatever dental treatment is necessary to place the mouth in a healthy condition and insure a good masticating surface. Class 4. All patients who are shown to have lost teeth while in the service other than mentioned in class 1, shall have the same replaced with vulcanite dentures or bridge work. Class 5. All patients of the Bureau of War Risk Insurance whose teeth are shown to have decayed while in the service, shall receive such treatment as is necessary. 490. No precious metals shall be used for purely cosmetic reasons in rendering dental treatment to any of the above five classes. 491. When the dental examiner is caring for the patients referred to him, he is requested to give each patient a short talk on the value of the teeth and the necessity for the care of same. Pamphlets of instruction for distribution among dental patients will be furnished in sufficient quantities by the Surgeon General to each dental ex- aminer. 76 492. Prophylactic treatment will be allowed only to such patients of the Bureau of War Risk Insurance as have a disease of the tissues of the mouth, contracted while in the service, or patients who are under treatment for a physical ailment, whose recovery might be retarded by an unhealthy oral condition. 493. No teeth shall be extracted without using either infiltrative, conductive, or general anesthesia. 494. No extraction shall be made of teeth that have become diseased since the patient's discharge from the service, unless the jnedical officer believes that the diseased tooth is related to a systemic condi- tion which he is treating. 495. All alloy fillings shall be polished and have a perfect contact and occlusion, and shall be carved to the original contour of the tooth. 496. Gold fillings (cast or malleted) : No gold fillings will be placed in other than the 12 anterior teeth, and tJhen only when cavity extends to incisal edge. 497. All cavities shall be lined with Caulk's cavity lining or equal before placing synthetic porcelain fillings. 498. No gold shell crowns shall be placed other than for an abut- ment for a bridge. 499. Removal of pulp and filling canals : No teeth shall be devital- ized for the purpose of placing crowns, bridge work, or attachments for removal work. 500. No cement or gutta-percha fillings shall be placed, except for the sealing in of treatments. 501. No fixed bridge work shall be done except to replace lost incisors. 502. No gold shall be used for inlays under 22 carats. No gold shall be used for crowns under 22 carats, 30 gauge. No solder shall be used under 18 carats. All cast clasps shall be of Ney Oro-E cast clasp metal or equal. 503. The teeth to be used on all vulcanite dentures shall be of an "A" grade of procelain and alloy pins. 504. In case there is a loss of all posterior teeth in either upper or lower jaw, vulcanite dentures should be placed with cast-gold clasps or other efficient attachments. 505. No dentures shall be placed with attachment or clasp over any tooth that has not been proven healthy. If there is any suspicion that the teeth involved in restoration are not healthy, radiographs should be taken of same. 506. In cases being treated, where the medical officer suspects a relationship between oral conditions and the general health of patient, all teeth should be carefully examined, and any suspected should be 77 radiographed. Where it is found necessary to extract, the relation- ship of local infections to the general health and the necessity for extraction and currettement of sockets should be carefully explained to the patient, that he may understand that the loss of diseased teeth is for his own good. 507. In cases where there has been a loss of a great number of teeth or portions of either maxilla or mandible, or where any extraor- dinary condition exists that is not included in the fee table, the exam- iner shall furnish a complete description of the condition found and a detailed description of the mechanical work contemplated and an estimated cost of same, to the district supervisor for action. 508. All correspondence from field officers with the Chief Medical Adviser, Bureau of War Eisk Insurance, shall be addressed to " The Chief Medical Adviser, Bureau of War Risk Insurance, Washington, D. C." Letter should be briefed as follows : From: (Writer). To : Chief Medical Adviser. Subject : 509. Correspondence with the Public Health Service, with the Bureau of War Risk Insurance, or with others interested in the treat- ment of beneficiaries of the Bureau of War Risk Inusrance, must furnish the following information in connection with any individual claimant: (a) Full name; (b) present emergency address ; (c) rank and organization; (d) date of discharge; (e) claim number, if as- signed. 510. Separate and individual letters or reports shall be submitted in connection Avith claimants of the Bureau of War Risk Insurance, and no letter or report shall refer to more than one claimant. 511. Duplicates or carbon copies of all correspondence relating to War Risk cases shall be kept at all stations where claimants are cared for, and a special file maintained for this purpose. PATIENTS FOR SPECIAL STUDY AND INVESTIGATION. 512. There may be admitted into United States Public Health Service and marine hospitals for study persons with infectious or other diseases affecting the public health, not to exceed 10 cases in any one hospital at one time. The Surgeon General shall in each instance designate the hospitals to be used for this purpose and the diseases to be studied. 78 ARTICLE XI. OFFICERS AND ENLISTED MEN OF THE UNITED STATES ARMY AND NAVY, FOREIGN SEAMEN, BENEFICIARIES OF THE FED- ERAL BOARD FOR VOCATIONAL EDUCATION. UNITED STATES ARMY AND NAVY. 513. Officers and enlisted men of the United States Army and Xavy, and civilian officers and crews of naval auxiliary vessels, may be admitted for care and treatment as patients of the service only upon the written request of their respective commanding officers. Every sueji admission shall be immediately reported to the district supervisor by the officer .in charge of the station on Form 1971-E or 1971-F accompanied by a copy of the request upon which such officer or man was admitted. They will be furnished treatment at stations of the first, second, and third class only. The rate of charge to be made for the care and treatment of the said officers and men will be fixed by the department at the beginning of each fiscal year, and will be announced to officers and others in a circular letter to be issued by the Surgeon General. FOREIGN SEAMEN. 514. The accommodations provided for the care and treatment of the patients of the Public Health Service are also available to foreign seamen at relief stations of the first, second, and third class upon the application of the consular officer of the nation under whose flag they are sailing or upon the application of the masters of the vessels upon which said seamen serve, provided satisfactory writ- ten security is given for the payment of the expenses of such care and treatment, at rates fixed annually by the department. When treatment is furnished a foreign seaman the usual reports will be sent to the district supervisor on Form 1971-E or Form 1971-F. 515. A bill in duplicate must be rendered by the officer of the serv- . ice in charge for the care of each foreign seaman or other patient admitted (not entitled to treatment free), said bill to be rendered upon the termination of treatment in each case. One copy of this bill shall be delivered to the collector of customs, who shall at once collect the amount; the other copy shall be forwarded by the officer rendering the bill to the Surgeon General, but this shall not apply to patients admitted for care and treatment in accordance with para- graph 513, both copies of bill covering such transaction to be for- warded to the Surgeon General. 516. Customs officers acting as agents of the Public Health Service shall collect all bills when rendered by the proper officer of the Public Health Service in accordance with paragraph 515, notifying the com- 79 manding officer of the vessel against which the bill is rendered of the amount of the bill, and when paid will give a receipt therefor, and will render monthly accounts for all moneys collected on ac- count of the care and treatment of such patients, said accounts to be accompanied by abstracts giving the name and nationality of the patients, date of admission, and date of discharge, period of treatment, and amount collected in each case. 517. The rate of charge to be made for the care and treatment of foreign seamen at all Public Health Service and marine hospitals will be fixed by the department at the beginning of each fiscal year and will be announced to officers and others in a circular letter to be issiied by the Surgeon General. At hospitals under contract with the Public Health Service, the contract rate will be charged. BENEFICIARIES OF THE FEDERAL BOARD FOR VOCATIONAL EDUCATION. 518. The district organization of the Federal Board for Vocational Education corresponds geographically to that of the Public Health Service and the Bureau of War Kisk Insurance. 519. Correspondence between the district medical officers of the Federal Board for Vocational Education and the district supervisors of the Public Health Service should be direct. All questions relating to matters previously covered by instructions from the Surgeon Gen- eral and the Federal Board for Vocational Education should be settled Between the district medical officers and district supervisors without reference to the Federal Board or to the Surgeon General. 520. When requested by the district medical officer of the Federal Board for Vocational Education, the district supervisor shall cause an examination to be made of any actual or prospective beneficiary of the Federal Board for Vocational Education, and shall place him, if necessary, in a hospital for observation or special examination. 521. Upon receipt of a request from the Federal Board for Voca- tional Education for copies of reports of physical examinations made for'the Bureau of War Kisk Insurance or for the Federal Board for Vocational Education, district supervisors shall furnish such copies as may be requested. 522. Reports of physical examinations for the use of the Federal Board must contain the following information: (a) Whether there is ;t reasonable presumption that the applicant has a disability due or traceable to his military service, and whether it is permanent or temporary. (b) Whether he has a vocational handicap resulting from the disability. (c) That his physical and mental condition renders training feasible. 80 523. If reports do not contain sufficient data, the district medical officer will be required to obtain it, and on his request the district supervisor will render a new or supplementary report, supplying the missing data if possible. 524. When the district medical officer desires an examination of an applicant who lives at a distance from the district office, he will send a letter to the applicant directing him to go to the nearest available Public Health Service examiner. This letter will be sent to the dis- ' trict supervisor, who will indorse the same and mail it to the appli- cant. 525. The district supervisor will keep the district medical officer informed of the names and addresses of all persons in his district engaged in the examination of claimants of the Bureau of War Risk Insurance. 526. When the examination of a claimant is desired by both the Bureau of War Risk Insurance and the Federal Board for Vocational Education, the expenses incident to such examination, including transportation to the place of examination, will be charged to the Bureau of War Risk Insurance. 527. If an examination is made for the purposes of the Federal Board only, all expenses, including transportation, will be paid by the Federal Board for Vocational Education. 528. District medical officers will issue transportation requests to beneficiaries of the Federal Board for Vocational Education. In cases of emergency, however, such requests may be issued by the dis- trict supervisors. The district vocational officer will supply the dis- trict supervisor with a book of blank transportation requests for this purpose. 529. Clerical work connected with fees for examination and trans- portation requests must be reduced to the minimum. All bills in- curred for this purpose shall be sent direct to the district medical officer. 530. The Federal Board for Vocational Education will not pay bills incurred for X-ray examination of the chest in cases of tuber- culosis, except when specially authorized by the district vocational officer. 531. Disabled men discharged from the military or naval forces who have entered upon and are undergoing a course for vocational training are entitled to treatment at all United States Public Health Service and marine hospitals, contract hospitals, and relief stations of the service. Treatment in each instance is to be furnished, so far as facilities are available, upon the request of the district officers of the Federal Board for Vocational Education, who are authorized to use for this purpose the Admission Card (Form 1971-D). This 81 card will be given to the patient, who will be directed* to present it to the designated hospital or relief station. In using these cards the Federal Board officer will strike out the words " for examination only," will insert under " Class " the letters, " F. B. V. E.," and will sign over his official title. 532. The following distinction must be made between war-risk beneficiaries and beneficiaries of the Federal Board for Vocational Education: Discharged men from the military forces, who have entered upon and are undergoing a course for vocational training, are entitled to treatment as beneficiaries of the Bureau of War Risk Insurance for any injury or disease contracted in the military service prior to discharge, or for which they have previously received treat- ment while in the military service, or if the present disability can reasonably be connected with a former injury or disease incurred in the military service prior to discharge. Bills for treatment of these men shall be rendered to the Bureau of Public Health Service, even though they were received or treatment was given at the request of the Federal Board for Vocational Education. If beneficiaries of the Bureau of War Risk Insurance, however, are in need of treatment for any injury or disease which is in no way connected with their military service they may receive such treatment at all relief stations of the Public Health Service at the expense of the Federal Board for Voca- tional Education, and separate vouchers headed " Federal Board for Vocational Education " shall be rendered for the care of such patients for payment by the Federal Board for Vocational Education as here- inafter provided. Transportation to and from a hospital when nec- essary for such cases will be furnished by the Federal Board for Voca- tional Education. 533. At stations of the first class a per diem charge, as announced by the Surgeon General, shall be made for each in-patient bene- ficiary of the Federal Board for Vocational Education and repay- ment accounts on Form 1928 shall be prepared in duplicate, the copy to be forwarded direct to the Surgeon General and the original sent to the district supervisor for submittal to the district medical officer of the board for examination and certification. Fol- lowing the approval of the district medical officer, vouchers will be prepared by the district vocational officer for transfer settlement from the " Vocational rehabilitation appropriation " to that for " Care of seamen, etc.," or " Pay of Personnel and Maintenance of Hospitals, P. H. S." These vouchers, together with the original Form 1928, will be forwarded by the district vocational officer to the Surgeon General, attention relief section. Charges covered by repayment accounts, Form 1928, should be taken up on the Monthly 185279 20 6 Eeport ef Belief Furnished Foreign Seamen and Other Pay Patients, Form 1927. 534. A charge of $1 per treatment shall be made for each out- patient beneficiary of the Federal Board for Vocational Educa- tion. Eepayment accounts covering such treatment should be ren- dered on Form 1929 as provided for in-patients in paragraph 533 and taken up on the Monthly Eeport of Belief Furnished Foreign Seamen and Other Pay Patients, Form 1927. 535. At places where the service has a contract, the per diem charge for in-patient beneficiaries of the Federal Board for Vocational Edu- cation shall be the contract rate. 536. Original bills from contract hospitals shall be examined by the representative of the Public Health Service and if he finds that the bills were incurred according to regulations, that the charges are reasonable, and that services rendered were satisfactory, he shall stamp the bill Approved: , 192 . , Surgeon, U. S. P. H. S. 537. All such bills should then be forwarded through the district su- pervisor to the district medical officer for direct payment by the Fed- eral Board. The bills must be accompanied by the original or a true copy of the request for treatment in each case. Only one request is necessary, regardless of the length of time a patient remains under treatment. Bills should be rendered promptly at the end of each month. Such bills should include not only charges for hospital care and treatment but miscellaneous service under contract, such as ambulance and X-ray service, use of operating room, etc. Ex- penditures covered by such bills should not be taken up on the Monthly Eeport of Belief Furnished Foreign Seamen and Other Pay Patients, Form 1927, and Monthly Schedule of Encumbrances, Form 1955. 538. Expenditures incurred by stations of the first class for articles of service under contract, such as X-ray or ambulance service, will be handleel in the same manner as specified in the foregoing para- graph. 539. Differences of opinion between the Federal Board and the Public Health Service, involving the character of the patient's con- dition with respect to the expense of medical care in any particular case, shall be determined whenever possible by conference between the district vocational officer or the district medical officer of the Federal Board for Vocational Education and the district supervisor of the Public Health Service. 83 540. Before the discharge of a patient from a hospital the medical officer in charge will notify the district vocational officer a sufficient time in advance of the contemplated discharge to provide for proper disposition of the patient. 541. Upon receipt of a survey from a representative of the Federal Board for Vocational Education, indicating the educational fitness ef a patient to receive such training as he may desire, the medical officer in charge will cause an examination to be made of the patient to de- termine his physical and mental condition. After the findings of the examination have been recorded in the clinical record, the survey will be returned by indorsement to the representative of the Federal Board for Vocational Education, with a recommendation as to the general character and daily hours of work to be undertaken by the patient. If a patient able to undertake training is ambulant and otherwise fitted to assume the status " On pass " for a limited period, Form 1946-L shall be completed and indorsed "To the Federal Board for Vocational Education " and sent to the medical officer with the survey. 542. Form 1946-L shall be completed as above directed and for- warded to the training officer on the first of each month thereafter, and no patient of a Public Health Service hospital may be given vocational training under the Federal Board for Vocational Educa- tion, unless this form, properly completed and signed by the medical officer, for the current month, is on file with the training officer hav- ing supervision of the training. 543. The training officer of the Federal Board for Vocational Edu- cation, to whom the patient is assigned for training, will enter the specific kinds of work in which the patient is engaged and the num- ber of hours employed daily, on Form 1973-D and Form 1946-L. Form 1973-D will be returned to the medical officer at the close of work on each Saturday and Form 1973- will be returned to the medical officer on the last day of each month, as directed by instruc- tions for the use of these forms. 544. Patients in Public Health Service hospitals taking vocational training under the Federal Board for Vocational Education remain under the jurisdiction of the Public Health Service, and while actually attending classes have the status of patients "On pass.'' 545. Each patient in a hospital of the service, who is receiving voca- tional training under the Federal Board for Vocational Education, will be observed carefully each day, and if the physical or mental condition is in any way impaired by, or during the period of, such training, the training will be discontinued immediately, and the training officer notified as to the cause and probable duration of the 84 absence of the patient. The training will not be resumed until, in the opinion of the medical officer, the physical and mental condition of the patient is such as to justify continuance. ARTICLE XII. OUTPATIENT RELIEF. 546. Sick and disabled patients of the Public Health Service whose diseases or injuries are of such a nature that they can properly be relieved by medicines, dressings, or advice, without admission to hospital, shall be treated as outpatients and furnished medicines, dressings, surgical appliances, or advice, as the case may require. 547. Seamen will not be furnished relief at their own home except by special authority from the Surgeon General, and then only an allowance for medical attendance and medicines will be made at rates fixed by the Treasury Department. REGISTER OF OUT-PATIENTS. 548. At all places where examinations and out-patient treatment are conducted, one copy of Form 1971-E, Out-patient Report, Record, and Transfer Card, shall be executed at the time of the examination, so far as available data will permit, whether the applicant or patient is received by transfer or applies for original examination. The word " Report " will be inserted in the blank space in the heading. The card shall be immediately forwarded to the district supervisor. Original report cards shall be filled out for all patients in addition to Form 1934-B Report of Physical Examination required for bene- ficiaries of the Bureau of War Risk Insurance. ' 549. Upon completion of treatment, transfer at a later time, or other final disposition, another report card shall be executed, the record of treatment completed on the reverse side, including date of first treatment or examination and date of all subsequent treatments, the word " Report " inserted in the heading, and the completed card immediately forwarded to the district supervisor. 550. When a patient receiving out-patient treatment fails to re- appear within 30 days from date of last treatment, a completed re- port card shall be executed and forwarded to the district supervisor. Should the patient apply for treatment at a later time, a new register number will be assigned, and reports will be prepared as for original examination. 551. In every case of transfer from a place of examination or out- patient treatment to another out-patient office or to a hospital, a 85 transfer card, which shall be a copy of the completed report card, shall be executed and the word " Transfer " inserted in the blank ; space in the heading of the card. The destination -will be stated under " Disposition," and the transfer card shall be mailed to the 1 receiving officer at the out-patient office or hospital to which the appli- cant or patient is directed. The applicant or patient will be furnished I with an Admission Card, Form 1971-D, which he will be directed to present to the admitting officer. If the services of an attendant are i required, the transfer card will not be mailed, but will be given in- stead to the attendant for presentation to the admitting officer, and in such cases the admission card will not be required. 5J>2. Designated examiners of the Bureau of War Risk Insurance, in addition to using Form 1971-E as a report and transfer card, may, if they so desire, keep a record of applicants and patients as herein- after described. 553. All officers conducting examinations in out-patient offices shall execute a second card at the time of examination, which shall be pre- served as a permanent record at the place of examination or treat- ment, the word " Record " will be inserted in the heading of the card, and the treatment recorded from time to time on the reverse side. Record cards shall be kept in two files: (1) The current file will consist of the cards of incomplete cases, arranged in alphabeti- cal order according to the surnames of the patients; (2) the perma- nent file will consist of cards of completed cases, arranged in the serial order of their register numbers. Register numbers will be con- secutive and continuous. Upon transfer or completion of treatment, the completed record card shall be placed in the permanent file. If the applicant or patient is examined only, or is transferred or other- wise finally disposed of at the time of original examination, record cards shall be placed in the permanent file as soon as examination is completed. 554. A card index to the record shall be kept on Form 1971-G, Index to Register of Patients. One index card shall be kept for each individual applicant or out-patient for whom a record card is on file. Index cards will be filed in alphabetical order according to the sur- name of the applicant or out-patient. When a record card is to be started and its number to be assigned, the index shall be searched for previous record of the applicant or patient. If an index card is found, the new number will be entered thereon, and the register num- ber of the last previous examination or treatment w r ill be noted on the new record card. , 555. When an applicant presents himself for examination or out- patient treatment and states that lie has previously received exami- nation or treatment at another place, a copy of his former record card 86 may be requested by mail from the officer who furnished the treat- ment. Treatment, however, will be furnished upon presentation by the applicant of evidence establishing his right to the same, pending the arrival of the record card. 556. The evidence of each out-patient's right to relief will be re- corded by all persons conducting examination or treatment under "authority" in Form 1971-E, Eegister of Out-patients, and all papers authorizing treatment will be filed. FOURTH-CLASS STATIONS. 557. Whenever an application for relief is presented at a station of the fourth class, the proper customs officer at the port is authorised and directed to cause out-patient relief (medicines, etc.) to be fur- nished in accordance with paragraph 546, or to request authority from the district supervisor to furnish transportation to a relief station of the first class. 558. One dollar wijl be allowed physicians (not officers of the Pub- lic Health Service) for the medical examination of each seaman who is referred by a customs officer for such examination, whether ac- companied by a prescription or not, unless otherwise previously directed by the department (by the terms of special agreements or contracts). When more than two treatments are furnished the same seaman in one month, an explanatory statement signed by the cus- toms officer in charge of the port will be attached to the phj'sician's bill for the services. Treatment in cases of emergency only is contemplated. 559. No separate compensation or allowance will be made for the medical examination made by physicians in cases where the appli- cants examined are placed under hospital treatment or its equiv- alent at the relief station where the examination is made except when treated in hospital by another physician. 560. Unreasonable charges for relief furnished in emergency cases will not be allowed by the department. 561. Foreign seamen or employees of the various Government serv- ices are not entitled to treatment by physicians (not officers of the Public Health Service) at stations of the fourth class. IN-PATIENT RELIEF. 562. A sick or disabled patient of the Public Health Service shall be admitted to hospital only in cases where the gravity of the dis- ease or injury from which he suffers is such as to require hospital treatment in the opinion of a medical officer or other authorized medical representative of the service. This is not to be construed to 87 exclude patients admitted for examination and observation only. In case of doubt as to the gravity of the disease or injury the patient should be temporarily admitted. 563. Medical officers and other authorized representatives of the Public Health Service who provide for the admission of patients to contract hospitals are required to procure the discharge of such patients promptly upon the termination of the necessary hospital treatment. 564. Officers shall not be required to attend sick or disabled seamen on board vessels or to visit them in harbor except at the discretion of the officer to whom the application is made. 565. Form 1971-D, Admission Card, will be given to each patient for presentation to the admitting officer at the hospital by all per- sons authorizing hospital treatment of patients of the service. REGISTER OF IX-PATIEXTS. 566. At stations of the first class and contract hospitals a copy of Form 1971-F, In-patient Report, Record, and Transfer Card shall be executed immediately upon the admission of a patient to a hos- pital. The word " report " will be inserted in the heading, all data available at the time recorded, and the card immediately forwarded to the district supervisors. 567. Upon completion of the case by transfer, discharge, or death, a completed report card shall be executed, the word " report " in- serted in the blank space provided in the heading, and the card immediately forwarded to the district supervisor. 568. In every case of transfer of a patient from one hospital to another a transfer card, which shall be a copy of the completed report card, shall be executed and the word "transfer" will be in- serted in the blank space in the heading of the card. The destination will be stated under " disposition " and the transfer card shall be mailed to the receiving officer at the hospital to which the patient is directed. The patient will be furnished with Form 1971-D, Hospital Admission Card, which lie will be directed to present to the admit- ting officer. If the services of an attendant are required, the transfer card will not be mailed but will be given instead to the attendant for presentation to the admitting officer, and in such cases the hospital admission card will not be required. 569. A second card shall be prepared at the time of admission of a patient at stations of the first class and contract hospitals, which shall be preserved at the hospital as a permanent record. The word ' ; record " will be inserted in the heading of the card. Record cards shall be kept in two files: (1) The current file will consist of cards of uncompleted cases arranged in alphabetical order according to the surnames of the patients; (2) the permanent file will consist of cards of completed cases arranged in the serial order of their register numbers. Upon transfer or completion of treatment the completed record card shall be placed in the permanent file. 570. A card index to the record shall be kept on Form 1971-G, Index to Register of Patients. One card index shall be kept for each individual inpatient for whom a record card is on file. The index cards will be filed in alphabetical order according to the surnames of the patients. A separate index, a separate register, and a separate series of register numbers shall be kept for inpatients and outpatients at all hospitals where both classes of patients are treated. When a record card is to be started and its number to be assigned, the index will be searched for previous record of the patient. If an index card is found, the new number will be entered thereon and the register number of the last previous treatment will be noted on the new record card. 571. When an applicant presents himself for hospital treatment and states that he has previously received such treatment at another place, a copy of his former record card may be requested by mail from the officer who furnished the treatment. Treatment, however, will be furnished upon presentation by the applicant of evidence establishing his right to the same pending arrival of the record card. 572. When a patient of the Public Health Service makes applica- tion for admission to a contract hospital after the office is closed for the day, the person in charge of the contract hospital may admit the patient, should the case be urgent, and on the following day report the action taken and present the evidence of the patient's right to treatment to the authorized representative of the Public Health Service. 573. Whenever a patient applies at a fourth-class station for hos- pital relief and in the opinion of the customs officer it is a case re- quiring immediate attention, and the papers presented by the appli- cant show him to be entitled to relief, a competent physician, in the absence of an acting assistant surgeon, shall be called to decide whether hospital relief is necessary, and if so advised, and the patient is not in a condition to be transferred to a Public Health Service or marine hospital, the customs officer shall make suitable arrange- ments for the care and treatment of the patient, and report imme- diately by letter to the district supervisor, giving rates charged there- for. In all such cases the customs officer will require the hospital to forward to the district supervisor Form 1971-F, In-patient Eeport Card, upon admission and discharge, as required by regulations. 574. Whenever a patient of the Public Health Service applies to an acting assistant surgeon or to a designated examiner of the Bureau 89 of War Risk Insurance for hospital relief and upon examination is found to require hospital treatment, if the applicant is not in a condition to be transferred to a Public Health Service or marine hos- pital, the officer or examiner shall make suitable arrangements for the hospital care and treatment of the patient at the prescribed rates, and shall immediately report the admission by letter to the district super- visor, giving the rate charged. In all such cases the person authoriz- ing such treatment shall require the hospital to submit to the district supervisor Form 1971-F, In.-pat.ient Report Card, upon admission and discharge, as required by regulations. DENTAL TREATMENT. 575. Patients of the Public Health Service entitled to relief shall be furnished with such dental treatment as may be necessary by com- missioned dental officers of the service. Xo precious metals shall be used for purely cosmetic reasons. ARTICLE XIII. PUBLIC PROPERTY. GENERAL PROVISIONS. 576. Accountability and responsibility devolve upon any person to whom public property is intrusted and who is required to make re- turns therefor. Responsibility without accountability devolves upon one to whom such property is intrusted, but who is not required to make returns therefor. An accountable officer is relieved from re- sponsibility for property for which he holds a proper memorandum receipt. A responsible officer is not relieved from responsibility for public property for which he has given memorandum receipt until he lias returned the property to the accountable officer or has secured memorandum receipt from a successor, or until he has otherwise been relieved by the operation oj regulations or orders. 577. The officer in permanent or temporary charge of a station is responsible for the security of all public property of the station, whether in use or in store, and although the materiel officer or other subordinate officer be accountable, the officer in charge is nevertheless responsible and pecuniarily liable with him for the strict observance of the regulations in regard to its preservation, use, and issue. He will take care that all storehouses are properly safeguarded, that 'only reliable agents are emploj'ed, and only trustworthy men are detailed for duty in them or in connection with property. 578. In preparing requisitions, invoices, and receipts for property, all entries will be made in alphabetical order under two classifica- 90 tions: First, all drugs and chemicals; second, all other supplies and equipment. To facilitate the handling of these papers, one line of writing only shall be placed in each interlinear space. 579. Property belonging to the United States shall not be disposed of at private sale. When authority has been obtained from the Secretary of the Treasury to dispose of such property, it may be sold at public sale, after due notice by advertisement either by publica- tion in newspapers authorized by the Secretary of the Treasury or by posting written or printed notices in places frequented by the public. 580. The exchange of medicines or supplies with druggists or mer- chants is prohibited. 581. In type A and B hospitals the materiel officer shall be account- able for all service property at the station, and shall be responsible therefor w y hile the property may be in his possession, thereby reliev- ing the medical officer in charge of direct accountability and re- sponsibility for the property in the hospital. The medical officer in charge, however, in his capacity as senior officer in charge of the sta- tion, shall have supervision of the activities of the materiel officer and shall be responsible with him for he proper observance of regu- lations in regard to property. 582. In type C hospitals the pharmacist or administrative assist- ant assigned as chief clerk shall have charge of all service property at the station and shall assume the other duties of the materiel officer. 583. At second and third class stations the medical officer in charge shall have custody of all property belonging to the service and will account for the same to the Surgeon General. 584. At stations where no officer of the Public Health Service is on duty, the proper customs officer shall have custody of all property belonging to the service and will account for the same to the Surgeon General. ARTICLE XIV. RESPONSIBILITY FOB PROPERTY IN HOSPITALS. 585. The service property required to equip the wards and various departments of hospitals will be issued by the materiel officer on requisition approved by the medical officer in charge to officers in immediate charge of the wards and departments where said prop- erty is to be used. Such requisition shall be submitted weekly to the materiel officer on Form 1902-H, Nonexpendable Slip, and Form 1902-E, Expendable Slip, on a day to be designated by the medical' officer in charge. All officers will be responsible for the service prop- erty issued to wards or departments under their immediate charge. 91 586. At the end of the month the materiel officer will combine the original copies of memorandum receipts for nonexpendable property issued, obtain the signature of the responsible officer in each case upon Form 1902-1, Consolidated Memorandum Receipt For Nonex- pendable Property, and return the old receipts to the officer concerned. 587. Upon receipt of the consolidated memorandum receipt from the materiel officer, officers will be required to check the property enumerated thereon in order that shortages can be traced, and that proper disposition can be made of unserviceable and excess prop- erty. All shortage or excess must be reported to the materiel officer at once. Property which is not needed for immediate use must be returned to the material officer. 588. In addition to the monthly check of property by responsible officers a check will be made in the event of the transfer of a responsi- ble officer from a ward or department. No officer will be relieved from his responsibility for property in a ward or department until a re- ceipt from his successor has been obtained by the materiel officer. 589. When an officer is assigned as ward surgeon or in immediate charge of a department he will obtain from his predecessor an ac- curate list of all nonexpendable property in use in the ward or de- partment, and at once make a personal check of the same. If no shortage is discovered, both officers will report to the materiel officer where a transfer of responsibility will be made. The officer receiv- ing the property will sign the new consolidated receipt and the old receipts will be returned to his predecessor. All shortage discovered will be recorded and the officer receiving the property will sign only for the property actually present. A copy of all memorandum receipts to the materiel officer will be on file at all times in wards or departments concerned. 590. Officers in charge of wards or departments must exercise constant vigilance to prevent the unauthorized transfer of property for which they are responsible to other wards or departments. 591. When it is necessary to make such transfers the materiel officer must first be notified, except in cases of extreme emergency. In such event the action taken will be reported to the materiel officer at tho earliest possible moment. 592. Nurses and other employees of the hospital will be responsible to the officer who has signed a memorandum receipt for the property, for the care and proper use of all such property in their immediate possession. 593. Officers will exercise constant supervision over their subordi- nates in order to prevent the use of service property for improper purposes. This applies especially to the misuse of blankets, towels, and sheets for polishing, dusting, scrubbing, or window washing. 92 ARTICLE XV. LOSS OB DESTRUCTION OF PROPERTY. 594. Causes of damages to and loss or destruction of service prop- erty may be classed as follows : (a) Unavoidable causes^ being those over which the person re- sponsible for the property has no control, occurring in the ordinary course of service, or as incident to unusual emergency. (5) Avoidable causes being those due to carelessness, willfulness, or neglect. 595. In case of loss or destruction of nonexpendable articles, the officer accountable for the property shall investigate the loss or de- struction thereof at once, and report the same to the medical officer in charge, accompanied by the affidavit in duplicate of the responsible officer or employee. If the evidence is considered satisfactory by the medical officer in charge, the responsible officer will be so in- formed, and both copies of the affidavit will be forwarded to the Purveying Depot, attention Property Return Section, for the ap- proval of the Surgeon General. If approved by the Surgeon Gen- eral, the accountable officer will be authorized to drop the property from his return. If the evidence is not satisfactory, the Surgeon General will appoint, or authorize the medical officer in charge to appoint, a board of survey, consisting of not less than two commis- sioned officers, to investigate the loss or destruction of the property, the report of said board to include recommendations as to restitution in such amount as may seem to be just or practical, or both. ARTICLE XVI. UNSERVICEABLE PROPERTY. 596. The medical officer in charge of each hospital station shall set aside a suitable room for the reception and storing of property turned over to the accountable officer as worn out or unfit for use. This room shall be provided with shelving and compartments for the orderly arrangement of such property. 597. Form 1902-G Exchange Slip will be used by responsible offi- cers for the purpose of exchanging property which has become un- serviceable through the ordinary course of service. The responsible officer will present such property, accompanied by the exchange slip, to the accountable officer. Articles will be listed on this form in accordance with the instructions on the reverse side, and if in the opinion of the accountable officer the property has been rendered unserviceable without fault or neglect upon the part of the respon- sible officer, new articles will be given in exchange; othenvise the 93 property will be presented to the medical officer in charge for his in- spection and decision. 598. Articles of property inspected by officers, under instructions from the Surgeon General, will be reported upon fully as to their con- dition, with recommendations for -their disposal. Such articles as can be repaired or utilized by the service will not be recommended to be sold or destroyed. 599. Care of such property and the preservation of same pending the action of an inspector is required. Articles which may be re- paired or which are not entirely worn out must be suitably protected from the effects of atmosphere, vermin, or other deteriorating agen- cies after deposit in such room. 600. Accountable officers shall forward to the Surgeon General, attention Inspection Division, on the 1st day of January and 1st day of July of each year an inventory of all articles of property for which they are accountable, which have been broken, worn out, or otherwise rendered unfit for further use, and all such articles will be retained for inspection. The last report shall include all articles pre- viously reported, which have not been condemned. 601. Articles of hospital bedding and clothing will be made up into parcels of 10, properly labeled, and broken crockery and glassware restored by piece, as far as possible, and arranged for inspection and count. To facilitate the work of condemnation, all articles are to be so placed in the room that they shall follow in order the sequence of the list as presented to the inspector. 602. All articles when condemned by the inspector shall be sepa- rated into two lots for destruction and disposal, viz, articles that can be destroyed by burning, and articles that are indestructible by this means. The former class shall be immediately burned on the premises in the presence of the inspector, and the latter class shall be immediately carried off to a public dumping place and there deposited. 03. The inspector is authorized to except from the above provi- sion a reasonable quantity of articles (sheets, pillowcases, towels, etc. ) for use in cleaning work and to permit the retention of portions of articles that may be useful in the preservation of others of a simi- lar character or suitable for repair work about the station. 604. The officer accountable for unserviceable property about to be condemned will accompany the inspector during such examination and give him all necessary information as to its use and present condition, with the cause thereof. 605. Public property in use shall not be reported as unserviceable, nor condemned by the inspector, merely because worn or shabby in appearance, if the same be still serviceable. 94 606. Xo other persons than those designated in paragraph 602, ex- cept the Surgeon General and the Secretary of the Treasury, shall order the final disposition of condemned property, unless in case of live stock, which may be immediately killed to prevent contagion or suffering. 607. Articles of property inspected by officers, under instructions from the Surgeon General, will be 1 reported upon fully as to their condition, with recommendations for their disposal. Such articles as can be repaired or utilized by the service will not be recommended to be sold or destroyed. 608. Reports of the inspection of unserviceable property shall be given the proper voucher number as required by paragraph 617 and forwarded in duplicate to the Purveying Depot, attention Property Return Section, for the approval of the Surgeon General. 609. Unserviceable property which has once been condemned shall not again be submitted for inspection. 610. Public property which has been condemned and is offered for sale by authority of the department shall not be purchased by the officer who was responsible therefor at the time of condemnation, nor by any officer or attendant who bore any part in such condemna- tions. 811. Receipts accruing from the proceeds of sale of condemned and surplus property belonging to the Public Health Service shall be deposited as " Miscellaneous receipts." ARTICLE XVII. ACCOUNTABILITY FOR PROPERTY. 612. All officers accountable for public property will take up on their property returns and account for all property of the service, expendable and nonexpendable, which comes into their possession. If it is property with which they have not been formerly charged, as property found at station, they will report, if possible, to whose account it should be credited. Expendable property will be dropped from the property return on Form 9203-C as directed under " Prop- erty returns." 613. Xo property will be accounted for as on hand at the end of the accounting period unless the same is then in fact on hand. 614. Xo property will be dropped from the property return with- out authority from the Surgeon General except such articles as are declared to be expendable by the Surgeon General. Lists of such articles will be issued by the Surgeon General from time to time. 615. All books, such as lists of merchant vessels, city directories, nomenclature of diseases, and other publications, the dates of which 95 render them useless after the year for which they are intended, may be dropped from the return. PROPERTY RETURNS. 616. All accountable officers will render a property return semi- annually, on December 31 and June 30, of all property received, issued, and remaining on hand during the period. The original return shall be forwarded promptly to the Purveying Depot, attention Property Return Section, and the duplicate return filed at the station, together with the retained vouchers pertaining thereto. 617. All invoices, receipts, lists of property received by purchase, lists of property expended, lists of property found at station and taken up on the property return, approved inventory, and inspection reports will be considered as vouchers to the property return. All vouchers will be numbered serially, beginning with number 1 for the first voucher of the period. As vouchers are received or prepared and forwarded they shall be immediately entered on the property return and the balance cast. At the end of the accounting period it will be necessary only to total the columns and number the slips in order to close the return. To open the new property return, slips for all property remaining on hand shall be written and the balance remaining oil hand from the old return carried forward to the "on hand last return " column of corresponding new slips. The vouchers to the new return will be numbered serially, beginning again with number 1. 618. The number given a voucher at the station of its origin bears no relation to the number to be given it at the station receiving same ; for instance, the purveying depot's invoice for a shipment may bear the number 912, Avhile the corresponding receipt may be the fourth voucher to the property return of the receiving station, and would, therefore, be numbered 4. 6J9. At the end of each month the accountable officer shall list in alphabetical order on Form 9203-C, first, all alcoholics and narcotics; second, all other drugs and chemicals; third, all other expendable property issued from the storeroom during the month. This voucher shall be prepared and signed in duplicate, the voucher number and date entered, and the original copy forwarded promptly to the Pur- veying Depot, attention Property Return Section. The duplicate copy shall be filed with the retained property vouchers after the proper credits have been made on the property return. 620. At the end of the semiannual accounting period all expendable property issued during the period shall be listed alphabetically on Form 9203-C and the same disposition made of this voucher as di- rected in the preceding paragraph. This voucher shall be the last 96 voucher of the series of the semiannual return, and after the credits claimed thereon have been entered on the property return the quan- tities shown in the " Balance " column shall agree with the stock on hand in the storeroom. 621. Before the property return is closed an actual count of stock in the storeroom shall be made, and the quantities on hand in the storeroom plus the quantities shown on memorandum receipt as in use at the station shall agree with the total shown on the property return as remaining on hand. TRANSFER OF PROPERTY BETWEEN ACCOUNTABLE OFFICERS. 622. In ordinary transfer of supplies and equipment between ac- countable officers, the transferring officer should list all articles transferred on Form 9203-A or 9203-B, in quintuplicate, enter his voucher number on all copies, sign the first two as invoices, imme- diately forward the first copy to the Purveying Depot, attention Property Return Section, the second, third, and fourth copies direct to the receiving officer, the fifth copy to be retained until the arrival of the receipt from the receiving officer, then destroyed, and the re- ceipt posted on his property return and filed. The receiving officer shall, upon receipt of the supplies, promptly check same with the in- voice, enter the date and his voucher number on the invoice and two receipts, sign the receipts and forward one to the Purveying Depot, attention Property Return Section, and the other direct to the trans- ferring officer. The invoice shall be posted on his property return and filed. A packer's list, if necessary, will be furnished by the transferring officer immediately upon shipment of supplies. 623. Great care shall be exercised before receipting for cases of instruments, microscopes, and other property of similar character not enumerated on the property papers in detail, to ascertain that the full contents of such cases are present and in good order. In- complete cases shall be receipted for as such and a list of the miss- ing articles shall accompany the receipt, in order that the proper officer may be held accountable for the deficiency. Receipts with- out remarks for cases of instruments and similar property will be considered as evidence that they are complete, and the receiving officer will be held accountable in accordance therewith. 624. The transferring officer shall enter on his invoices, and the receiving officer on his receipts, the condition of all articles not serviceable. The maker's serial number of all microscopes, type- writers, safes, motor vehicles, and similar property shall be entered on all invoices and receipts. 625. In cases in which complete transfer of medical property oc- curs the receiving officer, instead of giving separate receipts, shall 97 receipt for the property transferred on the final return, both origi- nal and duplicate (Form 1903-D), of his predecessor. The trans- ferring officer shall forward the original return promptly to the Pur- veying Depot, Attention Property Eeturn Section. The duplicate return will be filed with the retained records of the hospital. 626. Whenever property is taken over by a representative of the service from any department of the Government or any other sources, inventories shall be made in quadruplicate fully describing the prop- erty and condition of same. Three copies of this inventory shall be dated, signed, and forwarded promptly to the Purveying Depot, at- tention Property Return Section. ARTICLE XVIII. REQUISITIONS FOB PROPERTY. 627. Requisitions for medical, surgical, and other supplies shall bo forwarded semiannually, in duplicate, to the medical purveyor, United States Public Health Service, Washington, D. C. In order to expedite the filling of semiannual requisitions, they shall be for- warded from the various stations as follows : From stations in district Continued. No. 8 November 1 and May 1. No. 9 October 15 and April 15. No. 10__July 15 and January 15. No. 11 August 15 and February 15. No. 12 August 15 and February 15. No. 13__October 15 and April 15. No. 14__November 15 and May 15. From stations in district No. 1 July 1 and January 1. No. 2 August 1 and February 1. No. 3 December 15 and June 15. No. 4 September 1 and March 1. No. 5 October 1 and April 1. No. 6___December 1 and June 1. No. 7___ September 15 and March 15. 628. The standard as to articles and quantities allowed to stations shall be the Official Supply Table of the United States Public Health Service. No remark shall be made opposite the name of any article that a special kind or a special make or pattern is wanted, as the semiannual requisition is intended to include only such articles as are kept on hand in the purveying depot for issue, and not such as have to be specially purchased; the latter when wanted should be asked for on special requisition. Only such quantities should be asked for as will probably be needed during the six months' period, computed on the basis of original packages. Fractional parts of a bottle or package should not be asked for. The quantities asked for, plus the quantities on hand, should not exceed those specified in the supply table as the allowance for the station. 629. When, as a result of the prevalence of an epidemic or for any other reason, necessary supplies are likely to be exhausted before the next semiannual requisition is to be made, they shall be called for on 185279 20 7 98 a special requisition, with a full explanation of the emergency and its cause. ITT extreme cases telegraphic application shall be made direct to the medical purveyor for the supplies needed to meet the emer- gency, which shall be followed by a letter of explanation. Officers in charge will be held accountable for any suffering which may result from their failure to requisition for supplies when it is evident the same will be needed. The frequent rendition of special requisitions would usually argue a want of reasonable foresight in asking for supplies, or a want of proper economy in the use of hospital property and would be a reproach to medical administration. If due care in the use of hospital property is exercised, and the regulations herein made for the timely preparation of semiannual requisitions are ob- served, it will seldom be necessary to resort to the special or tele- graphic requisition. 630. The local prevalence or rarity of certain diseases, as well as the quantity or number of each article on hand, will be considered in the preparation and approval of semiannual requisitions. The> smaller stations will not need all of the articles included in the supply table. The officer preparing the requisition is not expected to ask for an article merely because it is listed/ He shall call for only what there is reason to think he will need. 631. Officers in charge and materiel officers shall, so far as practi- cable, anticipate the needs of the service at their respective stations by making requisition for such articles of hospital equipment, bed- ding, clothing, and medical supplies, or other property, as may be necessary to anticipate the probable needs of the station for a period of six months. 632. Requisitions for articles of hospital equipment must not be made in anticipation of needs beyond a period of six months with a view to accumulate a surplus stock in excess of probable loss by break- age or wear. STATIONERY AND BLANK FORMS. 633. Requisitions for stationery will be made quarterly, on Janu- ary 1, April 1, July 1, and October 1. All instructions on the requisi- tion blank must be carefully observed and requisitions must be sub- mitted in duplicate on the proper form. When stationery articles not listed on the requisition blank are needed, stationery articles listed under class 1 of the General Schedule of Supplies can be in- serted, giving the item number and all necessary details. Requisi- tions for blanks and blank books will be made quarterly, on January 1, April 1, July 1, and October 1. All instructions on the requisition blank must be carefully observed and requisitions must be submitted in duplicate on the proper form. 99 634. Officers will give personal attention to requisitions for sta- tionery and blanks, to see that excessive amounts are not asked for and that only enough supplies to last until the time for making the next requisitions are requested. The invoices for stationery and blanks received must be promptly signed and immediately forwarded to the Surgeon General. Requisitions and all correspondence regard- ing stationery and blanks must be addressed to the Surgeon General. When supplies are required to be replenished at any time between the dales for making regular requisitions, supplementary requisitions may be forwarded, listing only the articles and quantities required up to the time of the next quarterly requisitions, stating the reason which necessitates the request. A small reserve stock should be kept on hand at all times, so that if there should be delays in obtaining sup-- plies asked for on requisitions, the work at the station will not be inconvenienced. On the other hand, there should not be a large ac- cumulation of blank forms, etc., as when changes are made in any forms the old stock becomes obsolete and there results a waste of sup- plies. The samples of letterheads and envelopes, or other matter, requiring special printing, must be carefully prepared and submitted in duplicate with the requisitions, showing exact copy of printing de- sired. Whenever it is desired to institute a new form, the matter should be submitted to the bureau, giving all reasons and data regard- ing the form and the object sought to be accomplished. Under the law all printing^ must be furnished through the Government Printing Office in Washington, D. C. ARTICLE XIX. SPECIAL REQUISITIONS AND PURCHASES. 635. When supplies or articles not listed in the supply table are required, special requisition should be prepared and forwarded in duplicate to the medical purveyor, United States Public Health Serv- ice, Washington, D. C., with explanation of the necessity for the reqifest. To avoid delay in filling these requisitions a full descrip- tion of the articles, as to dimensions, type, pattern, quality, or num- ber shall be given, together with a statement of their cost or approxi- mate cost, as ascertained from dealers' catalogues or other reliable sources of information, in appropriate columns, properly totaled. 636. Special requisitions for furniture, rugs, etc., required for the quarters of officers, nurses, dietitians, aides, and other employees, shall show separately the quantities required for each class of quar- ters, the style, color, and finish of furniture it is intended to match, if any, and the rooms it is intended for: Recreation, office, library, living, dining, and bed rooms. In asking for rugs the floor dimen- sions of the room as well as the size of the rug shall be given. 100 637. Special requisitions should be made for articles which are not on contract and can be purchased advantageously at the station. If the need of the articles is urgent, proposals taken by poster and cir- cular letter advertisement should be forwarded with a special requi- sition for approval by the Surgeon General or the Secretary of the Treasury. The law requires that proposals be solicited from at least two responsible dealers. When only one proposal is forwarded, the failure to secure competitive proposals should be explained. 638. The several columns in special requisitions should be filled out in respect to each item listed. The estimated price shall be given in each case when practicable to obtain it from dealers. In case of new or unusual supplies and equipment involving considerable expense the explanatory letter should describe in detail the supplies or equipment desired, and submit adequate reasons for their purchase. 639. The subject of repairs to property of the service shall form the basis of separate communications to the Surgeon General, and in all cases must be accompanied with estimates of the probable cost of same. 640. All shipments shall be made on Government bill of lading and instructions on same should be closely followed. The freight charges shall not be prepaid and are not to be paid by the consignee, who should sign the bill of lading in proper form and deliver it to the last carrier. 641. When authorized purchases of property are made at a station, two copies of Form 9202-B, invoice of property received by purchase, shall be prepared at the time of preparing the public voucher ; said invoice shall show the name and address of the contractor, the ar- ticles purchased, quantity, unit, unit price, and total amount as shown by the public voucher. The date, voucher number, and signature of the accountable officer shall be entered thereon, and the original copy forwarded promptly to the Purveying Depot, attention Property return section. The duplicate copy shall be filed with the retained Property Vouchers after the proper debits have been entered on the property return. This invoice shall always be forwarded under sepa- rate cover as it is a property voucher and of no interest to the section that audits the public voucher. EMERGENCY PURCHASES. 642. When the necessity to purchase supplies or equipment or make minor repairs at the station is urgent, the medical officer in charge shall advertise by poster and circular letter for proposals to furnish the supplies, equipment, or repairs needed, and forward all proposals received to the Surgeon General by letter of transmittal (Form 1907), stating his recommendation as to which shall be approved and the reasons therefor. 101 643. For such absolutely necessary purchases and repairs as require immediate attention bills involving small amounts may be incurred without special authority; but it must be clearly shown by a state- ment of the facts in the case that the expenditure was immediately necessary, that the necessity therefor could not have been foreseen with ordinary care, that injury to the public interests or damage to public property would have resulted from the delay necessary to procure authority for the expenditure. The facts must be stated in full on the face of the voucher, without reference to any statement that may be made in the letter of transmittal. 644. Three methods shall be used in purchasing on the authority contained in the preceding paragraph. (a) When the necessity for an article or service is not so urgent as to prevent the purchase thereof on competitive proposal received by poster and circular-letter advertisement, this course should be fol- lowed and the lowest and most advantageous proposal received should be accepted, the article or service ordered from the successful bidder, and all proposals received forwarded by letter (Form 1907) to the Surgeon General, together with the voucher for said expenditure. If one of the higher proposals received is accepted, the reasons for such action shall be clearly set forth on the face of the voucher. (b) When the necessity for an article or service is so urgent as to preclude advertising by means of poster and circular letter, but never- theless there is time available for direct personal solicitation of com- petitive bids, competition shall be solicited by means of the telephone, personal visit, or otherwise. In such case, the lowest or most advan- tageous verbal bid should be accepted and the order placed. The voucher covering said expenditure shall show the manner of purchase and the fact that informal bids were solicited, after the letter " C," under the heading " Form of agreement," on the reverse of the voucher blank (Form 1949). If other than the lowest proposal is accepted, the reasons for such action shall be clearly set forth on the face of the voucher. '() The injury was accompanied or immediately followed by pain and discomfort. 118 (c) There was a material aggravation of the condition of the hernia existing prior to the alleged injury. 4. In all cases of liernia which the commission shall find remedi- able by operation, the claimant shall be awarded such operation as a proper and necessary part of medical, surgical, and hospital treat- ment. If he refuses either to accept or to secure operative treatment, he shall be denied further compensation and treatment, unless there are particular circumstances warranting the waiving of this rule. INDEX. A. Abbreviations. (See Appendix.) Paragraph. Absences, without leave, of patients 112 Accountability for property. (See Property.) Acts, persons concerned to familiarize themselves with 24, 25 Additional duties, officers and employees 21 Administrative assistant, responsibility of 20, 582 Admissions : Clinical records Comfort of incoming patients 96 Communicable diseases 85 Consultation in doubtful cases 78, 86 Employees compensation commission 409, 41141.3 Money and valuables 84 Officer of the day, to relieve admitting officer 77 Duties and reports- 80, 81 Emergency cases 79, 84 Patients to be assigned to proper wards 82 Psychiatric patients Drug addicts 269 Eligibility to be established 268 Examination within 24 hours after admission 281 Relatives to be informed 270 To be sent immediately to the proper ward 85 Transfers 271. Records 88-91 Of previous admission 111 Responsibility of admitting officer 87 War Risk Insurance . 464, 467, 468 Admitting officer, duties of. (See Hospital organization and administra- tion.) Advance payments, restricted by law " : 714 Advertising for subsistence. (See Subsistence, proposals and contracts.) Aides in physiotherapy 258-265 Alcohol and narcotics. (See also Prescriptions.) Form 1903-B to be used 139 Head nurse to keep account of 228 To keep under R>ck and key 227 Prescription files 137 Property returns of 619 Record of dispensary receipts and expenditures 139 Regulations to be observed 13G Serial numbers 138 Signatures on prescriptions to be in ink 136 (119) 120 Paragraph. Alien paupers not eligible for treatment 268 Ambulance service 104, 105, 334 Amusement and employment of patients 295 Annual Reports. (See Reports.) Apparatus, prosthetic and orthopedic: Appliances not covered by accepted proposal 656 Artificial limbs and eyes 429 Officers to serve best interests of patient and Government 657 Orthopedic appliances 430 Proposals to furnish 655 Receipts to be obtained 657 Appendix. (See Pages 113-118.) Appliances, prosthetic and orthopedic 429,430 Arms, artificial 422-424, 429 Army personnel, officers and men eligible 513 Assistants, dental 245 Autopsies 197, 205, 206 B, Bathing of patients 230, 304 Beneficiaries, list of 360 Army 360, 513 Bureau of -Fisheries 408 Coast Guard. (See Coast Guard.) Coast and Geodetic Survey 407 Compensation Commission. (See Employees Compensation Com- mission.) Engineer Corps, United States Army 404 Federal Board for Vocational Education. (See Federal Board for Vocational Education.) Foreign seamen 514-517 Lighthouse Service 405, 406 Merchant Marine. (See Seamen.) Mississippi River Commission 403 Naval auxiliary 513 Navy 513 Public Health Service, field 402 Seamen. (See Seamen.) Special cases, not to exceed 10, etc 512 War-risk insurance. (See War-risk insurance.) Between-meal requirements 149 Bonds and sureties: Administrative assistants to furnish 20 Contracts for subsistence secured by 658 Formal contracts to be prepared with 681 Not required when quarterly proposals are solicited 674 Breach of discipline, chief nurse to report 213 Buildings, public. (See Custodians.) Bureau of Fisheries 408 Burials 318-320 121 c. Paragraph. C-type hospitals, charge of property in 582 Cases : Doubtful 459-461 Malingerers 443, 444 Special, not to exceed 10, etc 512 Certificate of fuel inspection 1 713 Change of diagnosis, instructions relative to 185 Charts, dental 246 Chauffeurs, instructions to 132 Checking of property. (See Property.) Chief clerk, duties of 7,8,10,106,107 Chief dietitian, status and duties. (See Hospital organization and administration.) Chief nurse. (See Nursing Service.) Chief of service. (See Officers.) Civilian employees not entitled, except 561 Clandestine correspondence to be reported 285 Clerk, drug 134 Clinical director. (See Officers.) Clinical records. (See Records.) Clothing of patients. (See Patients.) Coast and Geodetic Survey 407 Coast Guard: Admission to hospital only in grave cases ^ 395 Authority for use of station conveyances 401 Commissioned officers, relief same as in Army 390 On leave, or sick leave, entitled 391 Retired, entitled 391 Discharge on termination of treatment 396 Emergency treatment, at stations of first class 398 Bills for 399 Report of 393 Under regulations governing fourth-class stations 393 Vouchers 393 Home treatment of officers 400 Hospital treatment afforded when required ; 395 Noncommissioned officers and men, relief on certificate 392 Out-patient treatment 397 Relief 60 days after discharge 394 Comfort of incoming patients 96 Communicable diseases. (See Diseases.) Compensation Commission. (See Employees Compensation Commission.) Complaints, nurses. (See Nursing Service.) Conduct of personnel in isolation wards 169 Conjoint direction of District supervisors 42 Consular officer, valuables to be delivered to 317 Contracts for subsistence. (See Subsistence, proposals and contracts.) Contract hospitals, authorized rate in ,_ 39 Convalescent patients, light duty 200, 462 Cooperation with District supervisors : 34, 35 122 Paragraph. Corrections In regulations, authorized 26 Correspon deuce : Federal Board for Vocational Education 519 Third and fourth class stations- 36,37 War risk insurance , 508-511 Cross infection, prevention of - 171 Cultures - 170 Custodians : Advance payments for services , 714 Authority necessary to change fences, etc 710 Certificate of inspection of fuel 713 Diagrams of buildings '. 705 Economy in use of gas, light, and water 712 Fire control 715-720 Furniture, list of, in quarters ; 708 " Instructions to Custodians of Public Buildings " 703 Leases, application for renewal of 711 Medical officer in charge, ex officio 702 Official to serve during absence 704 Repairs to property : 639 Reports of necessary repairs 709 Rooms to be used for official purposes 707 Trespass and destruction of property, prevention of 706 Custody of valuables. (See Valuables.) Customs officer . 321-324 Custody of property 584 D. Death certificates 198 Deceased patients. (See Patients.) Dental assistants . 245 Officers, duties. (See Officers.) Records. (See Records.) Service. (See also War risk insurance.) Charts - 246 Commissioned dental officers 575 Duties of assistant to chief 245 Personnel, described 243 Records, to be complete 247 Disposition of ^ : 248 Responsibility of dental officers 244 Surgical treatment _ ' 428 Destruction of property. (See Property.) Diagnosis, change of, instructions relative to 185 Negative , 443,444 Diagrams of buildings 705 Dietetic Service. (See Hospital organization and administration.) Diets. (See Hospital organization and administration.) Diphtheria, isolation of_ 170, 171 Discharges. (See Patients.) Discipline of patients 309-313 123 Diseases, communicable: Pai-agraph. Cross infection, prevention of 171 Cultures 17 Discharges and transfers 93 Disinfection of kitchen equipment , 150 Clothing, patients, personnel and wards 168 Examination of employees 151 Incoming patients . 85 Observation room for . 07 Patients not to handle food, dishes, etc., used by other patients 172 Personnel in isolation wards 169 Not to be detailed to surgical cases within 10 days 170 Venereal, segregation of 180 Eligibility for treatment '_ 466 Visitors with, denied admittance to .hospital , 101 Dishes, food containers, etc., in isolation wards 168, 172 Disinfection of kitchen equipment 150 Patients 168 Rooms 168 Dispensary, charge of 134 Dispensing, economy to be exercised in 199 Disposal of property. (See Property.) District examiner. (See District supervisors.) Relief officer. (See District supervisors.) District supervisors: Bills for examinations, statement to be placed on 45 Conjoint direction of 42 Cooperation with, by service officers 34, 35 District examiner 43 Relief officer 44 Division into districts 32 Field representatives of 41 Function of Public Health Service 42 War Risk Insurance 42 General duties 33 Hospital centers 54-58 Records 46 Report cards 47 Reports 48-52 tate supervisors 53 Third and fourth class stations under direct supervision 86,37 To keep record of available facilities . 38 Doubtful cases. (See Employees Compensation Commission.) Drug addicts, treatment of : 269 Drug clerk 1 134 Duties of dietitians. (See Hospital organization and administration.) Nurses. (See Nursing Service.) Officers . (See Officers.) E. Economy in use of gas, light, and water 712 Efficiency reports, nurses 218,226 Personnel 161 124 Emergency purchases. (Ree Special requisitions anil purchases.) Paragraph. Treatment 84 Employees, responsibilities and duties: Additional duties '. 21 Ambulance drivers 104, 105 Assistants to head nurse in wards 209,223 Bathing of patients 304 Carriers of diseases 151 Chauffeurs 132 Chief dietitian, authority over 153 Complaints of 353 Confidential duties 283 Dereliction of duty 9, 293 Discipline of, in hospital mess 150 Economy in use of lights and water 712 Exercise of patients 290, 291 Fires, vigilance with regard to i__ 74,303 Flag ceremonies 1 Forced feeding not permitted, except 294 Fuel supplies 713 Hospital postoffice 126, 127 Illness of, in hospital 194 Information clerk 91 Instruction of, by chief nurse 1 212 : Isolation wards '_ 168, 170 Kitchen and dining room, examination of 151 Laundry 140, 144 Medical officer in charge responsible for 62 Mess 145 Observation room 97 Patients not permitted to work on wards without presence of 297 Not to be left alone in wards ' 292 Permission to leave reservation 11 Place of duty of ward employees 298, 299 Property, responsible for misuse of 592,593 Restraint 296 Roster of 66 Station office not to be left without 10 Storekeeper 148 Supplies, checking of 147 Testimonials of character 12 To be informed of dangerous patients 281 To notify admitting officer 96 To notify officer of the day : 79 To remain with patients during meals 301 To retain charge of patients 295 Weapons, patients not to possess . 289 Employees Compensation Commission. (See also Appendix.) Act, section 9 410 Admission 409,411-413 Appliances, prosthetic and orthopedic 429,430 Arms, artificial 422-424, 429 Convalescents, light work for 462 125 Employees Compensation Commission Continued. Paragraph. Dental surgical treatment 428 Doubtful cases 459-461 Expenditures for 414-418 Eyes, artificial 425-427 Hernia (see also Appendix) 455-458 Home treatment 1 441 Insane, transfers of , 463 Limbs, artificial 419-424, 429 Negative diagnosis 443-445 Orthopedic appliances 430 Photographs to be made 438, 448, 452-454 Records 462 Reports (see also Appendix) 431-437,456 Specialists, services of 439, 446, 447 Teeth 428 Transfers, of patients 440 X-ray 447-451 Empyema, isolation of 171 Enforcement of regulations. (See Regulations.) Engineer Corps 404 Erysipelas, isolation of 170, 171 Escape of insane. (See Neuro-psychiatric patients.) Estimates of subsistence. (See Subsistence.) Repairs, reported by custodian __ 709 Examinations of employees 151 Federal Board 526-530 Lighthouse Service 406 War Risk Insurance 469-472, 474, 526 Exchange of unserviceable property. (See Property.) Supplies, prohibited . _ 580 Executive officer, duties of. (See Officers.) Exercise of insane. (See Neuro-psychiatric patients.) Exigency purchases. (See Special requisitions and purchases.) Expendable property. (See Property.) Expenditures, additional, authority for : 700 Compensation Commission. (See Employees Compensation Commis- sion.) Federal Board. (See Federal Board for Vocational Education.) Eye, ear, nose and throat department 173, 178 Eyes, artificial 425-427 F. False impressions of patients to be checked 284 Federal Board for Vocational Education : Correspondence, direct 519 Discharges 540 Examinations 520-530,541 Forms to be used 542, 543 Organization, district, to correspond to Public Health Service and War Risk Insurance - 518 126 Federal Board for Vocational Education Continued. Paragraph. Training 531, 532 Charges for 533-538 Conferences 539 Observation, daily 545 Passes 544 Federal Employees. (See Employees Compensation Corn-mission.) Female patients. (See Patients.) Field personnel, Public Health Service, entitled 402 Field representatives. (See District supervisors.) Fire, regulations, apparatus, etc. : Custodian in charge of equipment 715 Head nurse to assemble patients in hall 303 Inspection of hazards 354 Instructions to employees in winter 74 Regulations 716-720 Flag, display of 1,2,19 Food supplies - 145-150 Forced feeding and medication 294 Forms, blank _ 633, 634 Formulae, sanctioned only by medical officer in charge 15 Foreign seamen 514-517, 561 Fourth-class stations 557-561 Fuel, and bills for 712, 713 Function of Public Health Service 42 War Bisk Insurance 42 Furniture, list of, in quarters 708 G. Garage, employee in charge of 131 Gasoline consumption 132 Gossip forbidden 283 Grounds, policing of _ 130 H. Hair cutting 305 Head nurses, duties. (See Nursing Service.) Hernia (see also Appendix) 455-458 Holidays, legal 16-18 Home treatment, Coast Guard 400 Employees' Compensation Commission 441 Field service 402 Seamen __ 547 Hospitals, classification of 29 Contracts with 39 Hospital centers or units 54-58 Hospital organization and administration : Administrative plans of type A, B, and C hospitals 60 Admitting officer Ambulances, supervision of 104, 105 Card index in office 88-92,96 Clinical record, preparation of 83 Comfort of incoming patients 96 127 Hospital organization and administration Continued. Admitting officer Continued. Paragraph. Communicable diseases, observation room for 97 Discharges and transfers 93, 191 Doubtful cases 86 Examination of incoming patients 82, 85 Registrar to be notified before discharge of patients 95 Responsible for care and treatment, until 87 To be notified of impending discharge 94 Valuables of patients, receipt and delivery of 84, 122 Visitors *. 88-103 Chief clerk, duties of 106, 107 Dental Service. (See also War Risk Insurance.) Charts 246 Duties of assistant to chief 245 Personnel, described 243 Records, to be complete 247 Disposition of 248 Responsibility of dental officers 244 Dietetic Service Between-meal requirements, 24-hour supplies only 149 Breach of discipline, to be reported by chief nurse 213. Checking and recording of supplies 147, 148 Chief dietitian, cooperation with nurses 215 Cooperation with Nursing Service 152-154, 156 Dietitian, responsibility and authority 146, 150, 153-155 Diets 168, 186, 236-238 Examination of kitchen and dining-room employees 151 Food supplies 145-150 Medical officer in charge to maintain constant supervision 145 Menus to be submitted to medical officer in charge 154 Ration report 152 Status of dietitians 157 Executive officer, responsibilities and duties. (See Officers.) Eye, ear, nose, and throat department in type A hospitals 178 Isolation wards Conduct of officers, nurses, and employees 169 Diets 168 Disinfection, of clothing 168 . Patients and personnel 168 Wards 168 Handling of dishes and food containers 168 Nurses and attendants not to be detailed to surgical cases within 10 days 170 Patients not to handle food, dishes, etc., used by other patients 172 Prevention of cross infection 171 Segregation of nurses and employees 168 Laboratory Service Autopsy, reports of findings 206 Chief, in type A hospitals 203 Examination of specimens ^ 204 Pathologist 205 Post-mortems, duty of officers to be present 207 X-ray 'section 208 128 Hospital organization and administration Continued. Materiel officer in type A and B hospitals Paragraph. Alcohol and narcotics 136 Charge and care of 131-133 Dispensary 134 Duties of 130 Laundry supervision 140-144 Prescriptions, to be numbered and filed 137-139 To be signed by medical officer 135 Property, charge of , 581 Medical officer in charge, responsibilities and duties (see also Officers) 61-64 Medical Service 165 Neuropsychiatric ward ; 167 Nursing Service (see also Nursing Service) 210-242 Officer of the day Disposition of bodies 76 Doubtful cases 78 Duties of 80 Emergency sick calls 79 Instructions to employees ^ 74 Inspections 71-73 Notification to relatives '. 75 Not to leave hospital, except 70 Relief of, by admitting officer 77 Reports 81 Tour of duty 69 Valuables 123 Personnel officer, type A hospitals 108 Professional services Attending specialists, to be utilized in type B and C hospitals 164 Chiefs of service 161,162 Clinical directors 161, 162 Communications, in type A hospitals 163 Type A hospitals _" 158 Type B hospitals 159 Type C hospitals 160 Reconstruction service Aides, chief 258 In physiotherapy 260 Head, in physiotherapy . 259 Pupil, in physiotherapy 261 Head, in occupational therapy 263 In occupational therapy 264 Pupil, in occupational therapy 265 Employees, special 262 Instructors, special 257 Reconstruction officer, duties 252-256 Scope of service 249-251 Registrar, in type A hospitals Absences of patients without leave 112 Clinical records 114 129 Hospital organization and administration Continued. Registrar, in type A hospitals Continued. Paragraph. Custody of valuables 109 Duties of I 09 Forwarding address 128 Information relative to disease of patients 113 Inquiries to be referred to 109 Leave of absence 124 Mail 125-127 Notification to relatives 110 ' Patients' property 116-121 Records of patients : 111 Transfer of responsibility : 124 Valuables of patients 115, 122 Surgical Service Chief of service, responsibility 173, 174 Officers not to take part in post-mortems 175 Operating room to be always open 177 Written consent to be obtained for operation 176 Tuberculosis ward 166 Type A hospitals, purpose of 59 Urology, in type A hospitals 179, 180 Segregation of venereal diseases 180 Sterilization of dishes 180 Ward employees. (See Employees.) Ward surgeons. (See also Officers.) Authority to be secured for transfer of patients 191 Autopsy, authorization for 197 Clinical records. (See also Records.) Accuracy and conciseness 184 Completion of '_ 189 Not to be removed from ward 190 Time of first examination to be noted 182 To accompany patients before boards 187 To accompany patients transferred 188 Daily reports of patients 193, 195 Deaths, notification to Officer of the Day 196 Death certificates 198 Diagnosis, change of 185 Diets 186 puties of 181 Examination of patients 182 Illness of personnel 194 Passes : 201 Patients, convalescent, light duty 200 Prescriptions, economy in 199 Service property. (See Property.) Transfers, between wards 188, 192 Valuables , 183 Hours of duty, nurses. (See Nursing Service.) 185279 20 9 I. Illness of nurses. (See Nursing Service.) Paragraph. Personnel ^ 194 Information relative to disease of patients 113 In-patient relief. (See also Relief.) Dental treatment, by commissioned officers 575 Fourth-class stations < 573 Register 569, 570 Reports 566,567 Transfers of patients 568 Insane. (See Neuro-psychiatric patients.) Inspections : By medical officer in charge 356-359 Fire hazards 354 Of goods received 651 Of relief stations Commissioned officers to inspect 335,336 Complaints 1 353 Emergency action, by telegraph 346 Examination of all station activities 340 Fire hazards, requirements 354, 355 Infraction of service regulations 341 Method of procedure 339 Personal inspection by officer 338, 349 Recommendations to medical officer in charge 342, 343 Reports 344-348 Requisitions : 351 Special orders for 337 Supplies on hand 352 Unserviceable property 1 350 " Instructions to Custodians of Public Property " 703 Instructors, special, in physiotherapy _ 257 Isolation wards - 168-172 Issue of property, by materiel officer 585 J. Junior officers not to leave station without consent K. Keys, custody of 13 L. Laboratories 203-208 Chief, l-tpe A hospitals 203 Examinations 204 Laundry - 130, 140-144, 229 Laws, persons concerned to be ftimiliar with 24, 25 Leases 686, 687, 711 Lighthouse Service 405, 406 Lights, economy in use of 712 131 Paragraph. Limbs, artificial 419, 424, 429 Liuen, disposition of . ' 229, 233 Live stock 606 Locator cards 88-92 Loss of property. (See Property.) M. Mail, method of handling 125-128 Male nurses. (See Nursing service.) Malingerers 443, 444 Marine hospitals, types of 29 Materiel officer. (See Hospital organization and administration.) Medical officer in charge. (See Officers.) Medical officers, general, duties. (See Officers.) Medical Service 165 Medical and surgical supplies: Medical officers to report defects in 653 Property return of microscopes and accessories in possession of officers 654 Supply table 652 Medicines, vouchers for. (See Vouchers.) Memorandum receipts. (See Receipts.) Meningitis 170, 171 Mental defectives, treatment of 269 Merchant marine. (See Seamen.) Messes, supervision and regulation of 145-147, 168 Mess attendants 150, 151 Mississippi River Commission . 403 Morale ,- 251 Morgue 76, 205 N. Narcotics. (See Alcohol and narcotics.) Naval auxiliary 513 Navy, personnel entitled to treatment 513 Negative diagnosis, Compensation Commission 443-445 Neuro-psychiatric officers. (See Officers.) Neuro-psychiatric patients : Admission, care to be exercised in 268 Rules governing 266 Amusement and employment 295 Bathing 1 304 Care to be exercised In dining room 301 Clandestine correspondence, reporting of 285 Clinical director, duties 280 Consent of relatives to be obtained 270 Dangerous articles, not to possess 287 Detail work, assigning of 286 Drug addicts and mental defectives 269 Employees' Compensation Commission 463 Escapes 290,293 132 Neuro-psychlatric patients Continued. Paragraph. Exercise of ____ . 290, 291 False impressions to be checked 284 Forced feeding 294 Fire 302, 303 Gossip about patients forbidden 283 Guarding and searching of 289 Hair cutting : 305 Not permitted to aid one another '. 300 Not to be left alone in ward 292, 297 Nurses Amusement for patients 295 Duties of, confidential _- 283 Escapes, to be considered negligence 293 Forced feeding, not permitted, except 294 Head nurse, duties ."___ 303 Night nurses- 307 Night supervising nurse 308 Nonparole patients to be exercised 290 To be guarded from strangers 291 Patients not allowed to be in ward without nurse 292 Patients to be properly clothed for visitors 299 Restraint 296 To remain in dining room during meals 301 To report presence of strangers 300 Obscene allusions to be suppressed J. 284 Organization of hospital to conform to 278,279 Paroles and discharges 274-277 Peripheral nerve injuries, study of . 273 Reassurances to patients 288 Restraint of 296 " Shell shock " term not to be used 272 Temporary care in observation ward 267 Transfers : 271, 332, 333 Visitors 299, 300 Ward employees, duties -. 298 Surgeons, duties , 281, 282, 286 Neuro-psychiatric wards 167 Night supervising nurse 308 Nomenclature of diseases and conditions 476 Nursing Service: Chief nurses 210-219 Complaints, to be transmitted. through chief nurse 214 Duties, general 239-242 Efficiency reports __. . 218, 226 Head nurses: Clothing of patients, to care for 183 Diets to be noted on clinical record 186 General duties 229-237 To assemble patients in hall in case of fire 303 Hours of duty - 239 Illness 216 Male nurses 209 133 Nursing Service Continued. Neii re-psychiatric. (See Neuro-psychiatric patients.) Paragraph. Night nurses 219-221, 240 Night supervisor : 219-221 Quarters 213 Resignations 214 Responsible for property in immediate possession 592 Segregation, isolation in wards 168 O. Obscene allusions to be suppressed 284 Observation room for patients 97 Obsolete books 615 Occupational therapy 250, 262-265 Officer of the day. (See Hospital organization and administration.) Officers, responsibilities and duties: Admitting officer. (See Hospital organization and administration.) Chief of laboratory service, type A hospitals*. 203 Chief of service Assistant to medical officer in charge 162 Clinical records 189, 190 Communications in type A hospitals 163 Consultant, general 164 Surgical 174 Departments under supervision of, in type A hospitals 158 Permission to enter isolation wards 169 Personnel of medical service 165 Surgical service 173 Responsibilities of 161 Transfers 192 Clinical director . Assistant to medical officer in charge 162, 280 Clinical records 296 Professional work under supervision of, in type B hospitals 159 Responsibilities of 161 Consular officer, valuables to be delivered to 317 Customs officer 321-324 Dental officers Assigned to contract hospitals 480 . Each hospital of the service 478 Each out-patient office of the service 479 District treatment under direction of district supervisor 477 Examiners on fee basis 4S1-484 Treatment by commissioned dental officers 575 Type A hospitals 243-248 District examiners. (See District supervisors.) Relief officers. (See District supervisors.) Supervisors. (See District supecvisors.) Executive officer Communications, in type A hospitals 163 Junior officers, not to leave station without consent 4 Responsibilities, in type A and B hospitals 65-67 134 Officers, responsibilities and duties Continued. General medical Paragraph. Accountable for property- 612 Acts, to be familiar with , 24 Additional duties 21 Contracts for over $100 683 Cooperation with district .supervisors 34, 35 Deceased patients not to be moved until pronounced dead 314 Dereliction of duty, employees 9 Discussion with patients prohibited 472 Inspection of bodies 315 Inspector to be accompanied by - ,_^ 604 Junior officers not to leave station without consent 4 List, alcohol and narcotics 619 Morning rounds, reports of 3 Not required to visit seamen on vessels, except 564 Patients to be informed of necessary procedure on admission to hospital i w 470 Post-mortems, officers to : be present ^ 207 Surgical staff not to take part in 175 Prohibited from visiting isolation wards when off duty ' 169 Prompt discharge from contract hospitals at -termination of treatment 563 Property not to be purchased by condemning officer ! 610 Receiving officers to be notified of patients' arrival 334 Regulations, changes in to be noted *. 27 Enforcement of ,.. ,___ 25 Rules for departure from and return to station 5 Station not to be without officer . 8 Transfer of supplies and equipment - 622 Materiel officer. (See Hospital organization and a^miinrstratioti.) Medical officer in charge Anticipation of six months' needs . 631 Bidders to submit samples ,_^- . _^ ___ 665 Custody of keys . 13 Property at second and third class stations ____ 583 Departure from and return to station 6 Details officers , , . _ 68 Designation of necessary labor on holidays , 16 Duties and responsibilities 61-64 Employees to obtain permission to leave station 11 Equipment requisitions to be signed by * 585 Escapes to be reported 293 Examination of Federal Board patients . 541 Immediate supervision in type C hospitals -. . . , 160 Inspections of station __^~ ^^ ,_. 356-359 Instructions to officer of the day :___ 69 Notification of transfer . + 271 Officers to obtain consent to ieave station 4 Overseeing of patients to be paroled ._. 277 Prosthetic appliances, proposals * 655 Rejection of inferior supplies _- ,_^__ 685 135 Officers, responsibilities and duties Continued. Medical officer in charge Continued. Paragraph. Reports, by chief nurse 213-218 Of paroled patients 275 Specialist to be obtained by 453 Submission of menu by chief dietitian 154 Subsistence supplies at contract rates 682 Supervision of mess , 145 State holidays 17 Testimonials of character given by 12 Neuro-psychiatric officers 167, 280-282 Officer of the day. (See Hospital organization and administration.) Pathologist 205 Personnel officer__ 108,194 Reconstruction officer. (See Hospital organization and administra- tion.) Registrar, in type A hospitals. (See Hospital organization and administration.) Roentgenologist 208 Specialists 439, 445, 440 Compensation Commission 458 For diagnosis 458 Local physicians in type B and C hospitals 164 State supervisors. (See District supervisors.) Tuberculosis officer 16G Ward surgeon. (See also Hospital organization and administration.) Assigns patients work 286 Diet slip, to sign 237 Emergency 238 Disinfection of rooms 168 .Employees to be informed of dangerous patients 281 Exercise of nonparole patients 290 Head nurse, to assist 233 To receive orders from 224 To report valuables in possession of patients . 221. Hair cutting 305 Isolation wards 169 Permission for employees to leave ward 298 Property, responsibility for 585 Recreation for patients 282 Responsible, in emergency, for patients' effects 120 Restraint of insane 296 Verification of drug record , 228 Oil and gasoline, account of 132 Open-market purchases 671 Operating room, to be always available 177 Operation, written consent to be obtained for 176 Orders, written, from ward surgeon 224 Organization. (See Hospital organization and administration.) Orthopedic apparatus and appliances 430 Out-patient relief. (See Relief.) 136 p. Paroles and discharges. (See Neuro-psychiatric patients.) Paragraph. Passes 201 Pathologist 205 Patients : Absence of 112 Alien paupers 268 Clothing, care of 183 Disinfection of 1GS Consent, written, to be obtained for operation 176 Contract 39. Convalescent, light duty for 200 Deceased . Autopsies 197, 205, 206 Bodies, disposition of : 314 Examination of, by officer of the day 16 Inspection of 315 Burial expenditures 318 Death certificates, local 198 Disposition of effects 118 Nonbeneficiaries, disposition of 320 Notification to officer of the day 196 Official message to relatives 75, 193 Record, referred to officer in charge of clinical records 189 Report, to medical officer 162 Of ward surgeon 185 Transportation regulations 319 Valuables 316 Of seamen 317, 321-324 War-risk insurance -i 318, 319 Discharges Advance notification, to admitting officer 94 To registrar 95 At own request 312 Clinical record, completion of 189 Inspection of 93 Locator card to be destroyed _ 92 Neuro-psychiatric 276, 277 Discipline 309-313 Disinfection of 168 Drug addicts 269 Female 333 Ineligible for treatment 465 Information relative to diseases of 113 Insane. (See Neuro-psychiatric patients.) Mental defectives 269 Passes . 201 Property Disinfection 168 Form 1971-J, preparation of 117 Patients' property slips 232 Responsibility for 116 Ward surgeon to deliver 183 137 > Patients Continued. Paragraph. Public Health Service, field 402 Register of. (See Appendix.) Seamen. (See Seamen.) To include war-risk patients 40 Transportation- Authorization for 325 Officers to notify in advance, of transfer 334 Neuro-psychiatric 332, 333 Requests for 326-328 Travel expense, war-risk insurance 329 Public Health Service . 330 Persons leaving hospital contrary to advice 331 Valuables Admitting officer, to deliver to patients at departure 93 To notify registrar on departure of patients 95 Bond to be furnished 20 Collection and delivery of, at death 76 Custody of during absence of regular officer : 122-124 Discovery of, in possession of patients 231 Emergency cases, ward surgeons to be responsible 120, 183 Forwarding to relatives 316 Immediate delivery to responsible officer at time of admission__ 84 Registrar, in type A hospitals, responsible 109 To be deposited in safe 115 Venereal diseases 180, 466 War risk insurance Autopsy findings, one copy to chief medical adviser 206 Beneficiaries, classes of 464 Blank form No. 526, use of 467 Chief medical adviser to be kept informed 1 23 Dental treatment. (See War risk insurance.) Discussions between examiner and patient prohibited 472 District treatment, of 473 Examination, after presentation of discharge dated on or after April 6, 1917 471 Examinations to be complete 469 Function of Public Health Service : 42 War risk insurance 42 Hospital treatment to be in residence district, except 473 Hospital treatment not solicited 470 Limitations of term " patients of Bureau of War Risk Insur- ance " 464 Nomenclature of diseases and conditions, to be referred to 476 Out-patient relief 468 Persons not entitled 465 Record cards 46, 47 Reports, annual 52 To be comprehensive 475 Weekly and monthly 48-51 Written, of examinations 474 Statement on bills for examinations 45 To be included as Public Health Service patients 40 Venereal diseases 466 13S Paragraph. Peripheral nerve injuries, study of. (See Neuro-psychiatric patients.) Personnel officer 108 Illness of 194 Photographs 438. 447, 451-455 Physiotherapy 250, 253, 259-262 Policing of grounds 130, 132 Post-mortem examinations . . 175, 207 Post office . 125-128 Prescriptions. (See also Alcohol and narcotics.) Alcohol and drug, to be signed in ink 136 Current prices to be charged 695 ( Designated examiner to give -prescription in case of necessity 468 Economy to be exercised in filling 199 Files for 137 Inspection of prescription files 138 Signature of medical officer on Form 1921-A necessary 135 Vouchers for 468, 696 War-risk insurance 468 Private sale of property prohibited 579 Prophylactic dental treatment 492 Property : Accountability for Administrative assistant accountable in type C hospitals 582 Authority to drop from return 614 Customs officer accountable at stations where no officer is on duty. 584 Definition of 576, 577 Exchange with druggists prohibited 580 Expendable 612, 614 Materiel officer accountable in type A and B haspitals 581 Medical officer in charge accountable at third and fourth class stations 583 Obsolete 615 Officers to take up and account for on returns 612 Preparation of requisitions, invoices, and receipts- 578 Private sale prohibited _ 579 Property must be on hand to be accounted for 613 Loss or destruction of Causes 594 Board of survey 595 Patients'. (See Patients.) Requisitions- Dates for forwarding semiannual from districts 627 Emergencies 629 Officers to request only what is actually needed 630 To request six months' supply only 631, 632 Official supply table, to be standard 628 Stationery and blank forms fc 633, 634 Responsibility for Monthly exchange of memorandum receipts . 586, 587 Curses and employees responsible fr property in immediate 592 139 Property Continued. Responsibility for Continued. Paragraph. Supervision to prevent misuse 593 Transfers of responsibility 588, 589 Unauthorized transfers 590, 591 Ward surgeons responsible for property under their im- mediate charge 585 Returns Expendable 620 Instructions for making 617 Monthly and semiannual lists on Form 9203-C 619, 620 Semiannual 616 Stock, count of, in storeroom , 621 Vouchers 618 Transfers of, between accountable officers Care to be taken in ascertaining contents of wises 623 Instructions for making 622 Inventories 626 Medical property , 625 Serial numbers of microscopes, safes, etc., to .be entered on invoices 624 Unserviceable Arrangement for Inspection 601 Articles that can be repaired not to be recommended for sale ,_ 607 Care and preservation 599 Condemned, not to be purchased by condemning officer 610 Not to be resubmitted for inspection 609 Exchange Klips 597 Inventories 600 Live stock, killing of 606 Miscellaneous receipts 611 Not to be condemned if still serviceable 605 Officer to accompany inspector 604 Reports of condition and recommendation for disposal 598 Of inspection - 608 Retention of articles to be used in cleaning, etc 603 Separation into lots 602 Storage room 596 'Proposals. -(-See Subsistence, proposals, and contracts.) Prosthetic appliances ami apparatus 429, 655-657 Public buildings. (See Custodians.) R. Radiographs 506 Ration report 152 Rations 660 Receipts, memorandum 585-587 Reconstruction officer. (See Hospital organization and administration.) Reconstruction Service. (Sec Hospital organization and administration.) Records : Alcohol and Narcotic. (See Alcohol and narcotics.) 140 Records Continued. Paragraph. Clinical Autopsy findings to be recorded 206 Charts to accompany patient appearing before board 187 Compensation commission 462 Completion of, at death 189 At time of transfer ^ 188 Diets to be noted on 186 History of previous admission.-^ 111 Not to be furnished, except 114 Not to be removed from ward 190 Results of specimen examinations to be inserted 204 Time of first examination to be noted on 182 To be prepared under direction of head nurse 234 To show complete record 184 Ward surgeons responsible for preparation 181 Dental 246-248 District supervisors 46 Reconstruction 255, 256 Recreation for patients 282 Red Cross 250 Register, of in-patients. (See also Appendix) 566^-570 Registrar, in type A hospitals. (See Hospital organization and Admin- istration. ) Regulations : Corrections in, authorized 26 Enforcement of 25, 27 Infraction of 341 Officers to note changes in 27 Rules governing transportation of deceased 319 Rejection of proposals 668 Relatives to be informed of admission of patient to hospital 270 To be informed of patient's death 75, 193 Relief : Dental, by commissioned dental officers 575 Fourth-class stations ^ 557-561, 573 Authorization for 557 Civilian employees, not entitled at 561 Fees 558 Foreign seamen, not entitled at 561 Separate compensation or allowance not allowed, unless 559 Unreasonable charges at 560 In-patients Admission cards 565 Admissions, discharges, reports, transfers 566-574 Admitted for examination and observation only 562 Authorized in grave cases 562 Contract hospitals 562-565 Record card, former, transfer of '. 571 Register of 566-574 Treatment of applicant not in condition to be transferred 574 Out-patients Home treatment of seamen i _ 547 Records 553 141 Relief Continued. Out-patients Continued. Paragraph. Register 548-55(5 Reports 548-550, 552 Transfers 551 Relief Stations, classes of, defined 28-31 Inspections. (See Inspections.) Repairs 639, 643-646,709' To property 639 Reports 48-5S Annual 52 Compensation Commission. (See Employees Compensation Commis- sion. ) Custodian 705,709- Efficiency, nurses 218, 226. Personnel 161 In-patient 566,567 Monthly 51 Officers in charge of units 57 On duty at first-class stations , 3 Out-patient 548-550, 555 Patients 46-52 Ration, monthly 152 Reconstruction officer * '256 Special. (See War Risk Insurance.) Supplementary 435, 436 Unserviceable property 600, 607, 608 Ward 195 War Risk Insurance 22, 23, 474-476, 552 Weekly Progress 50- Requisitions 130, 627-638 Special 635-638. Restraint of insane. (See Neuro-psychiatric patients.) Roentgenologist 208 S. Safe, combination of 14 Sale of property. (See Property.) Scarlet fever, isolation of 170, 171 Seamen : Affirmation of applicant to be accepted _ 374 Application after 60 days' absence ; 378 Canal boat employees, not entitled 361 . Certificate of discharge, not evidence of title to relief 387 Certificate -of owner or agent accepted 367 Certificate to be furnished by master, on demand 368 Closure of navigation 371,372. Contagious diseases 383 - Disability while actually employed on documented vessel 386 Doubtful cases 376, 377 Vessels 362 Evidence to be furnished, by applicant for relief 365 Expenditures during voyage 382 142 Seamen Continued. Paragraph. False certificate of service 370 Hospital treatment not considered absence, to debar 373 Indefinite residence in hospital not intended 388 Less than sixty days service 375 Masters' certificates 306 Merchant vessels returned by consular officers . 364 Pending cases 380 Reimbursement for expense incurred during disability 384 Rejection of claim for relief 369 Second certificate of service 381 Signature required, from applicant 379 "Sixty days continuous service" 366 Street brawls, not entitled 385 Temporary care, authority for, at minor stations 389 Transfers, authority for 389 Valuables of. (See Patients, deceased.) Wrecked seamen entitled, without reference 363 Seamen, foreign 514-517 Merchant, officers not required to attend, except 564 Segregation of personnel in isolation wards '. 168 Venereal diseases 180 " Shell shock " term not to be used . 272 Shipments, on Government bill of lading- 640 Sick call 64 Specialists. (See Officers.) Special cases, for study 512 Special instructors ._,_, _. i _^ i 257 Special requisitions and purchases : Articles not on contract 637 Emergency purchases Authority to alwajs be requested 648 Bills incurred without special authority 643 Citation of paragraph on all exigency vouchers 645 Exigency, definitions of . 646, 647 Inspection of supplies 651 Medical officer in charge to advertise 642 Methods to be used in purchasing on authority of paragraph 643 644 Officer in temporary charge may order emergency purchases^ 649 Purchases to be made by junior officers only when unavoidable 650 Furniture, rugs, etc . 636 Instructions for preparation and forwarding 635 Invoices 641 Proposals, competitive, failure to secure 637 Repairs to property ,_. 639 Shipment to be made on Government bill of lading 640 Special, to be filled out in respect to each item listed 638 State Supervisors. (See District supervisors.) Stationery and blank forms 633, 634 Status of dietitians 157 Sterilization of dishes 168, 180 Food containers 168, 180 Storage room for unserviceable property 596 143 Subsistence, proposals, and contracts: Paragraph. Advertising 672 Description of 673 Approval of amounts over $100 683 Under $100 683 Bonds and sureties 681 Circular letters and posters, to he similar in language 674 Contracts, to be made for the fiscal year, or some part thereof 07!) To be signed in firm name 680 Effort to be made to have responsible dealers submit proposals 678 Officers may purchase ordinary subsistence supplies at contract rate 682 Open market purchases 671 Proposals, extension of items 667 For more than three months 669 Opening of 665 Quarterly, when practicable 658 Rejection of 668 Recommendation of medical officer to be accepted in case there is delay 670 Schedules, grouping of 663 Preparation 661 Separation 663 To be prepared for each class of articles 662 Solicitation from three dealers 677 Subsistence, annual estimates <:r>!) Supplies not to exceed contract value of 660 Sufficient time to be given dealers 675 Supplies, inferior, to be rejected 685 Inspection of 684 Samples of, to be submitted 665 Trade names, use of 664 Triplicate signature and delivery 67(J Subvouchers, preparation of 701 Sunday, observation of 18 Supplies, food 145-150 Supply tables 652-654 Sureties. (See Bonds and sureties.) Surgeons, neuro-psychiatric 28O-282 Ward : ., 181-202 Surgical Service 173-177 Supplies. (See Medical and surgical supplies). Surveys of property 595 T. Teeth, Compensation Commission patients 428 Telegrams 697 Telephone vouchers 698, 609 Testimonials of character 12 Therapy, occupational 263-265 Trade names, use of 664 Training, vocational ; 541-545 144 Transfers, of patients : Paragraph. Compensation Commission T 440 In-patients ' Authority for 191 Between wards 188 Card to be mailed to receiving officer 508 Clinical records to be completed 189 Emergency 192 Transportation 325-334 Insane. (See Neuro-psychiatric patients.) Out-patients _ 551 War-risk insurance. (See War-risk insurance.) Transfers, of property : Between accountable officers _: 622-626 Responsibility for 588, 589 Unauthorized 590, 591 Transportation of patients. (See Patients.) Transportation requests 326-328, 528 Travel expense 329-331 Trespass on property 706 Tuberculosis wards 166 U. Units, hospitalization 54-58 Unserviceable property. (See Property.) Urology 173,179 V. Valuables. (See Patients.) Vehicles, responsibility for 132 Venereal diseases 180, 465, 466 Verification of drug record 228 Visitors : Admitted through admitting office 98 Junior officers to obtain consent for 103 Obnoxious, reporting of 300 Patients to be properly clothed for 299 Persons referred to medical officer in charge 102 With communicable diseases denied admittance 101 Prohibited from visiting contagious disease wards, except 99 Undesirables - 101 Visiting days 99 Women excluded from venereal disease wards 100 Vocational training 541-545 Vouchers : Authority to be obtained for additional expenditures. 700 Authorized expenditures 688 Bills for medicines to state name and class of patients . 696 Current prices to be paid for medicines . 695 Memorandum list to accompany 692 Preparation, in accordance with instructions Of subvouchers 701 Prompt forwarding of bills necessary-, 690 145 Vouchers Continued. Paragraph. Proper blanks to be used 689 Restricted to items on approved proposals 693 Telegrams, official, to be sent " collect " 697 Not official, to be paid by sender 697 Telephone toll service 698, 699 To be considered as transcripts of records 694 Ways of paying telegraph bills 697 W. Wards : Isolation 168-172 Neuro-psychiatric 167 Tuberculosis 166 Ward employees, duties 209 Reports , 195 Surgeons. (See Officers.) War Risk Insurance. (See also Patients.) Correspondence 508-511 Dental treatment Assignment of officers 477-480 Bridge work, crowns, and fillings 495-501 Classes of patients 489 Costs, authorizations for 485 Dental examiners on fee basis 481-484 Dentures - 502-505 Extraction of teeth 493, 494 Extraordinary conditions 507 Forms, disposition of, when completed 487 To be furnished 483 Instruction in care of the teeth 491 Letter of authority 486 Precious metals not to be used 490 Prophylactic treatment 492 Radiographs 506 Right to treatment to be investigated 488 District Supervisors. (See District supervisors.) Examinations Discussions with patients prohibited 472 Hospital treatment not solicited 470 On presentation of discharge 471 To be complete 469 Written reports necessary 474 To be comprehensive 475 Patients. (See Patients.) Prescriptions 468 Reports 48-52 Special 22 Transfers 330, 470, 473 Venereal diseases ^ 465, 466 X-ray 45 Waste, disposal of . 130 185279 20 10 146 Paragraph . Water, economy In use of 71H Weekly inspections 356-35JJ Written orders, from ward surgeon 224 X. X-ray service: Compensation Commission 447-451 Laboratory chief in charge 203 Section under immediate supervision of roentgenologist 208 THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW AN INITIAL FINE OF 25 CENTS W1L RN THIS BOOK ON THE DATE DUE. THE PENALTY WILL INCREASE TO SO CENTS ON THE FOURTH DAY AND TO $1.OO ON THE SEVENTH DAY OVERDUE. Mil 1 iLCSIMiFif ISfLA-J f OCT23 1964 ^fO REC. PUBL MAR 09 92 i^ii^i: \-M-V* ONfc MONTH LOAN ir\r\ A 5P