C43 lju MiVtriSiTY OP !LU*iDi3 MDS^y AUG 22 1919 f University of Cincinnati Series IV 1918 Voe. I, M 1 Rules and Regulations Governing the Medical Work, Teaching, and Nursing / in THE MUNICIPAL HOSPITALS OF CINCINNATI r The Cincinnati General Hospital The Cincinnati Tuberculosis Sanatorium Adopted by the Board of Trustees of the University of Cincinnati, March 5, 1918, in accordance with the power vested in said Board by The Charter for the City of Cincinnati. Digitized by the Internet Archive in 2018 with funding from University of Illinois Urbana-Champaign Alternates https://archive.org/details/rulesregulationsOOuniv INDEX alphabetical PAGE Anesthetist .25 Anesthetics, Administration of.25 Attending Physicians and Surgeons.18 Assistant Attending Physicians and Surgeons.18 Appointments and Promotions.18 Attending Staff.19 Authority of Nursing Faculty.11 Authority of Attending and House Staffs, Nursing Department.12 Authority, Division of.12 Assistants, Nursing Department.12 Attendants, Nursing Department, Male and Orderlies.13 Attending Physicians, Surgeons, and Assistants in Laboratories.29 Bacteriologic Laboratory.26 Cincinnati General, designed for. 8 Clerks, Clinical.25 Consulting Physicians and Surgeons.19 Custodian, Library .15 Cincinnati Tuberculosis Sanatorium.27 Directing Medical Staff.17 Director, Assistant .17 Director, School of Nursing and Health.11 Director of Nurses, Assistant.12 Dietitians .13 Dietitian, Tuberculosis Sanatorium .30 Emeritus Members of Staff .20 General Rules, Medical Department .18 Internes and Resident Staff .21 Internes, Examination of .21 Internes, Rules and Regulations governing.21 Internes, Tuberculosis Sanatorium .29 Laboratories, Rules governing .26 Laboratories, Bacteriologic.26 Laboratories, Pathologic, Director of .25 Library, Medical .14 Library Committee .14 Librarian and Assistant Librarians .14, 15 Medical Record .16 Medical Department .16 Medical Library .14 4 RULES AND REGULATIONS PAG8 Minors, Admission to Hospital . 8 Maids, Ward.13 Medical Director . 17,28 Medical Director, Resident .28 Medical Director, Assistant .28 Medical Residents, Volunteer .29 Nursing Department .11 Nurses, Head . ...13 Nurses, on General Duty .13 Nurses, Supervisor of, Tuberculosis Sanatorium.29 Officers, Executive, Tuberculosis Sanatorium.28 Pathologic, Director of.25 Patrons of Library, Suggestions and Rules for .15 Privileges of Library .15 Porters .13 Patients, Discharge of.. . .8, 27 Pharmacist .14 Pharmacist, Tuberculosis Sanatorium .29 Patients, Tuberculosis Sanatorium, Discharge of .27 Physicians, Tuberculosis Sanatorium, Resident, Assistant.29 Physicians and Surgeons, Attending .29 Physicians and Surgeons, Assistant Attending .18 Physicians and Surgeons, Volunteer.18 Resident Staff .20 Resident Staff and Internes .21 Rules and Regulations . 8,21 Superintendent. 9 School of Nursing and Health .11 Superintendent, Tuberculosis Sanatorium .28 School of Nursing and Health, Tuberculosis Sanatorium.28 Supervisor, Night and Assistant Night .12 Supervisor at Contagious Group .12 Supervisor at Tuberculosis Sanatorium .12 Supervisors and Assistant Supervisors, Buildings.13 Visits, Regulations regarding. 9 Visitors, Regulations regarding, Tuberculosis Sanatorium .28 Workers, Nursing Department .13 INDEX ACCORDING TO DEPARTMENTS Hospitals, City of Cincinnati: page Cincinnati General, designed for . 8 Tuberculosis Sanatorium, established for .27 Cincinnati General Hospital: Anesthetist .25 Anesthetics, Administration of .25 Clerks, Clinical.25 Medical Record Clerk.16 Internes: Examination of.21 Internes and Resident Staff .21 Rules and Regulations governing.21 Laboratories: Rules governing .26 Bacteriologic.26 Pathologic, Director of.25 Medical Department: Medical Department of the Hospitals.16 Directing Medical Staff.17 Superintendent and Director of the Hospitals .17 Assistant Director.17 Attending Physicians and Surgeons.18 Assistant Attending Physicians and Surgeons .IS Appointments and Promotions.18 Volunteer Physicians and Surgeons .18 General Rules .IS Attending Staff .19 Consulting Physicians and Surgeons.20 Emeritus Members of Staff .20 Receiving Physicians .20 Resident Staff .20 Resident Staff and Internes .21 Medical Library: Rules governing .14 Library Committee .14 Librarian .14 Assistant Librarians.15 Custodian .15 Patrons, Suggestions and Rules for .15 Privileges .15 6 RULES AND REGULATIONS Minors: pagb Admission to Hospitals . 8 Nursing Department: School of Nursing and Health .11 Director of.11 Authority of Faculty .11 Authority of Attending and House Staffs .12 Authority, Division of. A 2 Assistant Director of Nurses.12 Supervisor, Night.12 Assistant Supervisor, Night .12 Supervisor at Contagious Group .12 Supervisor at Tuberculosis Sanatorium .12 Dietitians .13 Supervisors and Assistant Supervisors, Buildings.13 Nurses, Head .13 Nurses on General Duty .13 Attendants, Male and Orderlies.13 Maids, Ward.13 Porters .13 Workers.13 Patients: Discharge of . 8 Pharmacist .14 Rules and Regulations.S, 21 Superintendent. 9 Visits: Regulations regarding. 9 Tuberculosis Sanatorium: Attending Physicians, Surgeons, and Assistants in Laboratories ... 29 Dietitian .30 Internes . 29 Medical Director.28 Medical Director, Resident .28 Medical Director, Assistant .28 Medical Residents, Volunteer .29 Nurses, Supervisor of .29 Officers, Executive of . 28 Patients, Discharge of.27 Pharmacist .29 Physicians, Resident, Assistant .29 School of Nursing and Health .28 Superintendent.28 Visitors, Regulations regarding .28 EXTRACT FROM THE CHARTER FOR THE CITY OF CINCINNATI “Paragraph V. HOSPITALS— “1. The administrative and executive work of the municipal hospitals shall be controlled and directed by the Director of Public Safety, except as hereinafter stated. “2. The medical work, teaching and nursing in the hospitals shall be controlled and directed by the Board of Directors of the University of Cincinnati in the manner hereinafter stated. “3. The Superintendent of the Hospitals shall be appointed by the Director of Public Safety with the approval of the Directing Medical Staff, and shall not be under Civil Service rules', he shall have authority with the approval of the Director of Public Safety to appoint and remove all non-medical employes, subject at all times to such Civil Service rules as may apply. He shall be responsible to the Director of Public Safety for the efficient and economi¬ cal management of the hospitals', and shall be a member of the Directing Medical Staff, and Secretary of the same. “4. The Directing Medical Staff of the Hospitals shall consist of the Superintendent, the Dean of the Medical Faculty of the University^ and the Directors of the service of the several Professional Departments. “5. The Board of Directors of the University shall appoint to the Director¬ ship of each Department of the Municipal Hospitals a professor from the corresponding department of the University. "6. The appointment of all subordinate members of the Medical Staff shall be made by the Directing Medical Staff, with the approval of the Board of Directors of the University. “7. The Directing Medical Staff shall determine the manner in which the medical work and teaching in the hospitals shall be organized a?id con¬ ducted, provided, however, that medical instruction shall be open to the students of any medical college in Cincinnati which is recognized by the State Medical Board of Ohio, or by any licensing authority which shall thereafter be provided by the State of Ohio. "8. There shall be a School of Nursing and Health under the Depart¬ ment of Medicine of the University of Cincinnati and a Director thereof. The Director and Faculty of the School of Nursing and Health shall be appointed by the Board of Directors of the University of Cincinnati. 8 RULES AND REGULATIONS “9. The Director of the School of Nursing and Health shall be the Director of the Nursing Department of the Municipal Hospitals, and the other members of the faculty of said school shall be appointed to such supervisory positions in the Nursing Department of the Hospitals as the Board of Directors of the University shall designate .” ' " r ' ’^**‘‘ a ***_ . CINCINNATI GENERAL HOSPITAL The Cincinnati General Hospital is designed: 1. For the treatment of all medical and surgical dis¬ eases that may be cured or improved, including contagious diseases. 2. For the teaching of the practice of medicine in all of its varied branches. 3. For investigation and research in the various branches of the science of medicine. 4. For the instruction of young women (in the School of Nursing and Health) in the principles and practice of the science of nursing. ■4 Admission of Minors. —When patients under legal age are admitted, whose conditions require, or are likely to require, any operative procedure, the Superintendent and Medical Director and the Admitting Physician shall endeavor to obtain a written permission (upon a special blank form) from the patients’ nearest responsible relatives, or guardians, at the time of admission, for such operative procedure, unless in the opinion of the surgeon in charge immediate operation is considered imperative. All children under twelve years of age admitted to the Cincinnati General Hospital shall be assigned to the Pediatric Service; the exception to this rule shall be emergency surgical cases. Discharge of Patients. —Neither the Resident Staff nor Internes shall discharge patients, but after obtaining the written consent of the Attending Physicians or Surgeons they shall recommend patients for dis¬ charge to the Superintendent of the Hospital as “cured,” “improved,” or “not improved,” respectively. This rule shall also apply to all patients mentally competent who, upon their own initiative, request to be discharged. Rules and Regulations. —All children under the age of fourteen years; all unmarried mothers; and patients who have received all the benefit that can be offered from treatment in the hospital, but who are still unable to earn a livelihood, shall, after the Attending Physician or Surgeon has recommended their discharge, be referred to the Department of vSocial Service for follow-up work. Monthly reports shall be filed by the Attending Staff with the Super¬ intendent, of all patients on their services who have been in the hospital sixty days or more, with reasons for their longer staj r , if such be necessary. CINCINNATI MUNICIPAL HOSPITALS 9 The Superintendent may discharge any patient for improper conduct or other violation of the rules. When the patient demands his or her discharge against the advice of the Attending Physician, the Superintendent may grant such discharge, provided the patient (or nearest responsible relative or friend, if one can be found) sign a written acknowledgment that such discharge is against advice, and granted under protest. This shall not apply to those held by order of the Court, Board of Health, or for other institutions. Regulations Regarding Visits.— Visitors to Patients in Public Wards.—Visits from immediate rela¬ tives or friends of a patient will be allowed daily from 1:30 p.m. to 2:30 p.m. Those who cannot visit during the day may do so between 7:00 p.m. and 8:00 p.m. on Tuesdays and Thursdays. All visitors must obtain permission to enter the wards at the office in the Administration Building. No visitor shall be permitted to visit any patient at other than regular visiting hours, except by special permission of the Superintendent. Visitors are not to remain more than twenty minutes on any day, except by special permission of the Superintendent, and are not to converse with any patient who is not a relative or friend. Not more than two persons will be allowed to visit a patient at the same time, unless the patient’s condition is marked “Dangerous." No visitor shall give tobacco, drink, or food of any kind to a patient. All articles sent or brought by visitors for patients must be plainly marked and left at the office, and will be subject to inspection by the hospital authorities. The Superintendent may, at his discretion, exclude visitors from any ward or patient. Superintendent. —The Superintendent of the Cincinnati General Hospital and of the Cincinnati Tuberculosis Sanatorium shall have charge of the general administration of the Cincinnati General Hospital and of the Cincinnati Tuberculosis Sanatorium, and shall be a voting member of the Directing Medical Staff and Secretary of same. He shall have control of all admissions to the hospital, and of the final discharges. As the resident medical representative of the Board of Directors of the University of Cincinnati, it shall be his duty to see that each patient receives prompt medical and surgical service from the men assigned to such duties. If any member of the staff fails to render such service, he shall call the physician’s attention to such neglect, and if repeated, then the Superintendent shall report the facts to the Directing Medical Staff for action. The director of each of the medical and surgical services in the hos¬ pitals shall be responsible to the Superintendent for the keeping of complete and accurate histories of all patients. 10 RULES AND REGULATIONS The Superintendent shall cause to be kept proper and complete records of all patients, showing name, address, age, residence, employment, nativity, date and terms of admission, date of discharge or death, result of treatment, etc. He shall cause to be tabulated at the end of each week a report showing the daily visits of each member of the Attending Staff, giving the time of arrival and departure. If anj r physician is irregular in his attendance, the Superintendent shall call his attention to his dereliction, and if persisted in, then the Superintendent shall notify the Directing Medical Staff. To facilitate the working efficiency of his office, as his duties are numerous and scattered, he shall be in his office daily, with the exception of Sundays and holidays, from 8:30 a.m. to 9:30 a.m., which shall be known as his "official office hour.” He shall keep accurate records of the proceedings of the Directing Medical Staff. He shall cause relatives or nearest friend of any patient reported to the Attending Physician as dangerously ill to be notified at once. He shall endeavor in every way possible to establish the identity of all unknown persons brought to the hospital. On the decease of a patient, he shall cause immediate notice to be sent to the nearest relative or friend, and shall cause the body to be kept safely until the expiration of the legal time limit. Every endeavor shall be made to locate relatives or friends before the body of any deceased patient shall be pronounced unclaimed. In disposing of unclaimed bodies he shall be governed by the laws as set forth in the General Code of Ohio. Section 9984. Superintendent of City Hospitals, directors or superintendents of city or county infirmaries, directors or superintendents of workhouses, directors or superintendents of asylums for the insane, or charitable institutions founded and supported in whole or in part at public expense, the directors or warden of the penitentiary, township trustees, sheriffs, or coroners, in possession of bodies not claimed or identified, or which must be buried at the expense of the county or township, before burial shall hold such bodies not less than thirty-six hours and notify the professor of anatomy in a college which by its charter is empowered to teach ana¬ tomy, or the president of a county medical society, of the fact that such bodies are being so held. Before or after burial such superintendent, director, or other officer, on the written application of the professor of anatomy, or the president of a county medical society, shall deliver to such professor or president, for the purpose of medical or surgical study or dissection, the body of a person who died in either of such institution, from any disease not infectious, if it has not been requested for interment by any person at his own expense. CINCINNATI MUNICIPAL HOSPITALS 11 History. R. S. No. 3763; 93 v. 84; 78 v. 25, No. 1, Sec. G. C. No. 9985. Section 9985. If the body of a deceased person so delivered be subsequently claimed, in writing, by a relative or other person for private interment, at his own expense, it shall be given up to such claimant. (R. S. Sec. 3763.) History. R. S. No. 3763; 93 v. 84; 78 v. 33; 67 v. 25, No. 1. The next of kin of a decedent have the right to determine the place and manner of burial. Smiley v. Bartlett, 6 O. C. C., 234; 3 O. C. D., 432. He shall send to every member of the Attending and Resident Staffs and Internes a copy of the printed Hospital Rules and Regulations. It is important that every member of the Attending and Resident Staff and every Interne shall thoroughly familiarize himself with said Rules and Regulations. Nursing Department. —The Director and Faculty of the School of Nursing and Health shall be nominated to the Board of Directors of the University of Cincinnati by the Directing Medical Staff of the Cincinnati General Hospital. The Director of the School of Nursing and Health. —The nursing of all patients in the Cincinnati General Hospital and the Tuber¬ culosis Sanatorium shall be under the charge of the Director of the School of Nursing and Health, subject to the approval of the Superintendent and Medical Director, and of the Directing Medical Staff. She shall have supervision of the teaching in the School of Nursing and Health, subject to the approval of the Dean of the College of Medicine. She shall have supervision of all other employes in the Nursing Depart¬ ment. She shall recommend to the Superintendent all appointments affecting the Nursing Department. On the request of the Superintendent she shall suspend or dismiss any graduate or pupil nurse who has committed an act detrimental to the welfare of a patient or the discipline of the hospital. She shall send to the Dean of the College of Medicine for his approval a detailed report in all cases of dismissal of pupil nurses from the School of Nursing and Health, stating fully the reasons for such action. It shall be her duty to direct her assistants, supervisors, and head nurses in the principles and practices of nursing and ward management, and to see that the w r ork of all nurses and employes in her department is properly performed. In order that members of the Medical Staff and others may know when they can interview her, she shall be in her office daily from 9:00 a.m. to 10:00 a.m., Sundays and holidays excepted. Authority of Faculty of School of Nursing and Health. —Senior and Junior student nurses, not in charge, shall receive directions for medical 12 RULES AND REGULATIONS care and treatment of patients from the head nurse or Senior in charge of the ward, who shall be responsible for the execution of all orders given by the physicians. All nurses, whether head nurses, graduates, or undergradu¬ ates, shall, in all procedures, be under the direction and supervision of the Faculty of the School of Nursing and Health, whose duty it shall be to maintain the highest possible nursing standards. Authority of Attending and House Staffs. —The nurse in charge of each ward shall receive and attend to the execution of all orders con¬ cerning the medical care of patients from the Attending or Resident Staff, or from Internes, who are assigned by either of the former to the care of any patient. Orders given directly by the Attending Staff to the nurse in charge, when the Resident is not present, shall be carried out, and shall be communicated to the Resident on his next visit to the ward. Nurses shall accompany the Attending Staff and Resident Staff on rounds, and shall render such assistance and give such information as may be required. Nurses shall carry out only such medical orders as are signed. Division of Authority. —The head nurse or nurses in charge of wards, whether graduate or undergraduate, shall be under the direction of the Attending and Resident Staff in matters relating to the medical care of patients, and under the supervision of the Faculty of the School of Nursing and Health in matters relating to government and discipline. Assistant Director of Nurses. —The Assistant Director of Nurses shall assist the Director of Nurses in the performance of her duties, and during her absence shall discharge the duties of the Director. Night Supervisor. —The Night Supervisor shall have direction of the nursing at night, and shall act for the Director of Nurses, and for the Superintendent of the Hospital. She shall perform such other duties as the Superintendent of the Hospital and the Director of Nurses may desig¬ nate. Assistant Night Supervisor. —The Assistant Night Supervisor shall perform such duties as the Director of Nurses or the Night Supervisor may require, and shall act as Night Supervisor in her absence. Supervisor of Nurses at Contagious Group of the Cincinnati General Hospital. —The Supervisor of Nurses at the Contagious Group shall, under the direction of the Superintendent of the Hospital and the Director of Nurses, have immediate supervision of the administration of the Contagious Department. In all matters pertaining to the medical care of the patients she shall be under the Director of the Contagious Department, and the Director of the School of Nursing and Health. Supervisor of Nurses at the Tuberculosis Sanatorium. —The Supervisor of Nurses at the Tuberculosis Sanatorium shall, under the direction of the Director of the School of Nursing and Health, and the Resident Medical Director, have immediate supervision of all nursing in the Tuberculosis Sanatorium. CINCINNATI MUNICIPAL HOSPITALS 13 Dietitians. —The Dietitians shall, under the direction of the Super¬ intendent of the Hospital, and of the Director of Nurses, have charge of the ordering, preparing, and serving of all diets for patients, subject to the order of the Medical Staff. The}’ shall perform such other teaching and supervising duties as the Director of Nurses or her assistants may designate. Supervisors and Assistant Supervisors. —The Supervisors shall, under the direction of the Director of Nurses and her assistants, have supervision of the buildings of their respective departments. They shall see that all orders and instructions regarding the care of wards and rooms are carried out, and shall see that there is no waste or improper use of any article of hospital property. They shall attend, under the direction of the Director of Nurses and her assistants, to all business transacted between the executive officers of the hospital and the pavilions under their charge, and shall see that directions given for nursing care of patients are carefully executed. They shall perform such other duties as the Director of Nurses and her assistants may designate. Head Nurses. —Head nurses, whether graduate or undergraduate, shall, under the supervision of the Director of Nurses and her assistants, have charge and care of wards assigned them, and of the nursing of patients therein. They shall be responsible for the obedience and deportment of the nurses under them, and also for that of the attendants, orderlies, and w’ard maids. They shall attend to the carrying out of all special rules made for the government of patients. They shall see that the wards are kept clean and in good order. They shall perform such other duties as the Director of Nurses and her assistants may designate. Nurses on General Duty. —Graduate or student nurses on general duty shall be assigned to wards for either day or night duty, and shall carefully carry out the instructions of the head nurse for the nursing of patients, and for the care of the ward and all utensils therein. They shall perform all nursing procedures according to the standards set by the Director and Faculty of the School of Nursing and Health. They shall be subject to all special rules w’hich may be made for the government of the wards. Male Attendants and Orderlies. —Male attendants and orderlies shall perform such duties in the wards as may be assigned to them by the Director of Nurses, under the supervision of the head nurse. Ward Maids. —Ward maids in all wards shall perform such duties as may be assigned to them by the Director of Nurses and her assistants, under the supervision of the head nurse. Porters. —Porters shall perform such work as the supervisors or head nurses of their respective buildings may assign to them. Other Workers. —Cooks, chambermaids, waitresses, housemen, and all other workers assigned to the nurses’ residences of the hospitals shall perform such work as the supervisors of their respective buildings may assign to them in the various positions which they have been selected to fill. 14 RULES AND REGULATIONS Pharmacist. —The Pharmacist shall have a registered pharmacist’s certificate from the Ohio State Board of Pharmacy. He shall consult with the Superintendent concerning his time off duty. He shall be an Instructor in the School of Nursing and Health of the College of Medicine. He shall have one or more assistants competent to put up prescrip¬ tions, and perform all duties devolving upon the Pharmacist. They shall have charge of the drug department in the absence of the Pharmacist, and shall reside in the hospital. The Pharmacist shall have charge of all the medicines, wines, liquors, and miscellaneous supplies. He shall inspect all of these, when received, and shall verify quantity and quality purchased. He shall then dispense them only on orders properly signed by the Attending or Resident Staff, Internes, or Superintendent. He shall report without delay to the Superintendent the unauthorized use of any wines, liquors, or medicine. He shall compound promptly all prescriptions required for use of the patients. He shall manufacture all medicines that can be conveniently manu¬ factured in the hospital; keep an account of all medical and surgical supplies; charge each ward with the value of each commodity sent to it; and see that all containers are promptly returned from the wards, reporting to the Superintendent any neglect. At the end of each month he shall make out a report of the quantity of each article used; the value of the medicine and supplies used in each ward; and annually or oftener he shall make a complete inventory of all medicine, liquors, supplies, and property belonging to his department, together with the value thereof. He shall make requisition on the Superintendent for all drugs and supplies in the operation of his department. Rules for the Government of the Hospital Medical Library— Library Committee. —The Cincinnati General Hospital Medical Library shall be governed by a Library Committee consisting of the Superintendent of Hospitals, the Chairman and the Librarian of the Directing Medical Staff, and a Trustee of the Medical College Library. This committee shall outline the general policy of the library, recom¬ mend for appointment the Librarian and assistants to the Safety Director, authorize expenditures, and recommend titles for purchase. All orders for books and periodicals shall be approved by the Librarian of the Directing Medical Staff before purchase. He shall also o.k. all bills for the same. All requisitions for books and library supplies shall be approved and signed by the Superintendent of Hospitals before purchase. Librarian. —The Librarian shall have charge of the library and reading room, plan and supervise the work of the assistants and custodians, be responsible for the care of books and other library property, classify CINCINNATI MUNICIPAL HOSPITALS 15 and arrange all books and publications, and catalogue same, according to such plans as shall be approved by the Library Committee, keep an itemized account of all money received from fines and other sources, and report the amount to the Library Committee, and shall perform such other duties as the Superintendent may direct. Assistant Librarians. —The Assistant Librarians shall perform such duties as may be assigned by the Librarian and be responsible to the Library ian and Library Committee. Any dealings with the Library Committee shall be carried on through the Librarian. Library Custodian. —The Library Custodian shall perform such duties as may be assigned him by the Librarian. He shall take books and other library material to and from other buildings as needed, carry books and periodicals to the reading room and return the same to the shelves at the request of the Librarian, and assist in the reference work as needed. Any spare time which he may have outside his duties as custodian may be spent in tabulating, abstracting, etc., for physicians. Suggestions and Rules for Patrons—Days and Hours for Opening. —From the first of October to the first of June the library is open on all week days, legal holidays excepted, from 8:00 a.m. to 9:00 p.m. During the months of June, July, August, and September, it is open from 8:00 a.m. to 5:30 p.m., Sundays and legal holidays excepted. Privileges.— 1. The Cincinnati General Hospital Medical Library is open to the entire medical profession of Cincinnati and vicinity; also to those interested in the allied sciences. 2. The library is for reference and not for circulation, except that members of the Attending and Resident Staffs may, by special permission of the Librarian, take out such material as may be needed for a limited time. This privilege does not include current numbers of periodicals. Applications for special permission must be signed on blanks for this pur¬ pose, which are in the possession of the Librarian. 3. Renewals may be made by telephone, but no material may be renewed if any other member of the staff desires the same. 4. If a book, pamphlet, or periodical be lost by a patron, he shall either replace it or pay the value thereof. 5. Any physician may, through the library, borrow from the Surgeon General’s Library, or from the Library of Congress, material which is not in the hospital library, provided he pays the expressage to and from the libraries above named. He shall be responsible for all such material while in his possession. 6. The shelves in the reading and reference room are open to all readers, so that material in this room may be freely examined. Here are kept all current journals, bound journals frequently consulted, medical 16 RULES AND REGULATIONS indices, and other works of reference. Readers are requested to leave books and periodicals on the tables instead of returning them to the shelves or magazine racks after consultation. Permission to use the lower stack rooms must be obtained from the Librarian or assistant in charge. 7. The Librarian will be glad to receive suggestions in regard to material which it may be desirable to add to the library. Request blanks are furnished for this purpose, and all such suggestions are presented to the Library Committee. It is obvious that it will be impossible to buy all material asked for, but requests will be met as far as possible with due regard to the quality of work, the needs of the library, and the limits of the book fund. The Librarian and assistant are ready at all times to supply all available aid and information to those seeking material on any subject. Medical Record Clerk. —The Medical Record Clerk shall have charge of the filings of all medical records pertaining to patients that have been discharged. He shall see that a record of every patient treated in the hospital is sent to the Superintendent’s office and properly classified and filed. He shall tabulate such statistics from the patients’ records as the directors of the various services and the Superintendent shall direct. He shall prepare an annual report of all cases treated in the hospital. He shall answer all subpoenas to court which call for presentation of the medical record of any patient. Patients’ records must never be re¬ moved from the hospital by any person (staff officers not excepted) except upon an order from Court. Only members of the Medical Staff shall be permitted to examine patients’ records, except on a written order from the Superintendent. He shall perform such other duties as the Superintendent shall direct. Medical Department of the Hospitals. —All the medical work in the hospitals shall be grouped under the following heads, and known as "Departments,” while the out-patient department shall be known as the "Dispensary of the College of Medicine of the University of Cincinnati.” 1 . 2 . 3. 4. 5. 6 . 7. 8 . 9. 10 . 11 . Medical Surgical (First, Second) Obstetric Pediatric Neurological Orthopedic Gynecological (First, Second) Dermatological Genito-Urinary Ophthalmological Otological CINCINNATI MUNICIPAL HOSPITALS 17 12. Laryngological 13. Pathological 14. Bacteriological 15. X-ray 16. Dental (General Hospital and Tuberculosis Sanatorium) 17. Contagious 18. Tuberculosis All the physicians and surgeons connected with, but not residing in, the hospital shall be known as the “Attending Staff.” There shall be one Director at the head of each service (except in 9 urgery and gynecology, where there shall be two) until funds are available to pay full-time professors; then there shall be only one at the head of each department. The Director of each service shall be on duty the entire year. He shall have absolute control of the whole service, including the distribution and assignment of patients to his medical associates in his service. He shall at all times be responsible for the working efficiency of his service, and for the professional treatment of all patients assigned to his service. The Directing Medical Staff. —The directors of the departments enumerated above, the Superintendent of the hospitals, and the Dean of the Faculty of the College of Medicine of the University of Cincinnati, shall constitute the Directing Medical Staff. Nominations for directors shall be forwarded by the Dean of the College of Medicine to the President of the University for transmission to the Board of Directors of the Uni¬ versity of Cincinnati. Said directors shall each year after their appoint¬ ment by the Board of Directors of the University of Cincinnati convene and elect a chairman and vice-chairman. The Superintendent of the General Hospital and Tuberculosis Sanatorium shall be the Secretary and voting member of the Directing Medical Staff. In order to facilitate the co-relation of the work between the various departments and Nursing Department of the hospitals, the Director of the School of Nursing and Health shall meet with the Directing Medical Staff (except when the Chairman shall announce an executive session). She shall have the privilege to present and discuss any question relating to the Nursing Department, but shall not vote. The Directing Medical Staff shall meet the second Friday of every month, but for the months of July, August, and September the Chairman of the Directing Medical Staff may, at his discretion, appoint a committee, including the Superintendent, who shall supervise the routine medical work during the three summer months named. Assistant Director. —There may be an Assistant Director in each service who shall be on duty the entire year. In the absence of the Director for a period of more than three days, the Assistant Director shall take charge of the service during his absence, during which time he shall be 18 RULES AND REGULATIONS clothed with the same power as the Director. If there be no Assistant Director, then one of the Attending Physicians or Surgeons shall be selected to act during the absence of the Director. Salaried assistants in the College of Medicine of the University may be on continuous service in the hospital, irrespective of their rank in the hospital. Attending Physicians and Surgeons. —The next in rank below the Assistant Directors shall be known as Attending Physician and Surgeon, who may have a rotating service of four (4) months each. Any member of the Attending or Resident Staff who receives a salary, whether from the hospital or University, shall not be connected with any other hospital. Exception to this shall be the X-ray Department until such time as a full-time paid Director can be secured. Members of the Attending Staff who serve without compensation shall not be affiliated with more than one other hospital. Assistant Attending Physicians and Surgeons. —Next in rank to the Attending Physicians and Surgeons, the appointees shall be known as Assistant Attending Physicians and Surgeons, and in each service they shall be graded as first, second, third, etc., assistants. Appointments and Promotions. —In filling positions on the staff made vacant by death, resignation, or other causes, or to fill new positions, time of service shall be considered, but shall give no one a claim to advance¬ ment. Ability and efficiency shall be given chief consideration. Volunteer Physicians and Surgeons. —At the discretion of the Director of any one of the medical or surgical services, and subject to the approval of the Directing Medical Staff, there may be appointed by the Board of Directors of the University of Cincinnati Volunteer Physicians and Surgeons on any service; but they shall agree to serve not less than four (4) months; they shall serve without compensation, and shall not reside in the hospital. General Rules. —The number of Attending Physicians and Sur¬ geons, and Assistant Attending Physicians and Surgeons, shall be deter¬ mined for each service by the Director of the Service, the Chairman of the Directing Medical Staff, and the Dean of the College of Medicine of the University of Cincinnati. When a position below Director is to be filled on the Attending Staff of the Cincinnati General Hospital or of the Tuberculosis Sanatorium, then the Director on whose service the appointment is to be made shall, at the next regular meeting of the Directing Medical Staff, nominate one or more candidates for such position, indicating his preference by placing the preferential candidate first on the list, and so on. The Chairman of the Directing Medical Staff shall refer the name or names to a committee of three, one of whom shall be the Dean of the College of Medicine. Said committee shall report its findings at the next meeting of the Directing CINCINNATI MUNICIPAL HOSPITALS 19 Medical Staff, and the Directing Medical Staff shall select by majority ballot a candidate or candidates from such list and present said name or names in writing to the Board of Directors of the University of Cincinnati for its approval. All appointments to the Medical Staff of the Cincinnati General Hospital and the Tuberculosis Sanatorium shall be for one year. The Board of Directors of the University of Cincinnati shall at their regular monthly meeting in December of each year appoint a Director for each department. The only exception to this rule shall be where for special reasons a suitable man cannot be found at that date. If such a condition arises, then they may upon the recommendation of the Dean of the Medical College make a temporary appointment with the title, “Director pro tem.” The President of the University shall within one week notify in writing each Director of his appointment. The Directing Medical Staff shall, through the Dean of the College of Medicine, within fifteen days from the date of their appointment in December, present to the Directors of the University of Cincinnati for their approval, the names of candidates for all positions to be filled below that of Director. The Director of a service in the hospital shall be a Professor of the corresponding department in the College of Medicine of the University of Cincinnati. Attending Staff.— 1. The Attending Staff when on duty shall pay daily visits to their services, and such additional visits as perfect attention to their patients may demand. 2. They shall respond to all emergency calls sent them as promptly as possible. The hospital will pay, where necessary, for their transporta¬ tion to and from the hospital between the hours of 12:00 midnight and 6:00 a.m. 3. Members of the Attending Staff shall sign all orders for ward medical and surgical supplies. All requisitions for new therapeutic agents, diagnostic and other instruments shall be signed by the Director of the service. 4. Within forty-eight hours after the admission of a patient the Attending Physician or Surgeon in charge of the case shall write or dictate the results of his personal examination of the patient, also his tentative diagnosis, and the Attending Physician's name, with date of examination, shall he appended to this report. 5. Every member of the Attending Staff, including the Contagious Department and Out-patient Dispensary, shall announce to the telephone operators when he enters and leaves the hospital. Consulting Physicians and Surgeons. —Nominations for the posi¬ tions of Consulting Physicians and Surgeons shall be made in writing by 20 RULES AND REGULATIONS the Dean of the Medical College to the President of the University of Cincinnati, who shall transmit same to the Board of Directors of the Uni¬ versity of Cincinnati for approval. Consulting Physicians and Surgeons shall respond to calls for con¬ sultation from the Attending Staff. They shall have the privilege of visiting at any time the services they represent. Emeritus Members of the Staff. —A member of the staff may, upon retiring at the age limit or before, (provided he has served at least ten [10] years) be given the title of Emeritus. This title shall only be conferred when the candidate has rendered special and distinguished service to the hospital and Medical College, and then only upon the joint recommendation of the Faculty of the Medical Department, and the Direct¬ ing Medical Staff of the hospital, to the Board of Directors of the Uni¬ versity of Cincinnati. Receiving Physicians.— 1. The Receiving Physicians shall reside in the institution, and shall devote their entire time to their duties at the hospital. 2. The Chief Receiving Physician shall have charge of the Admitting Department, and shall direct the work of his assistants. 3. In his absence one of his assistants shall assume charge of the department. 4. The Receiving Physician, or his assistants, shall examine all applicants for admission to the hospital, and if hospital treatment is required, he shall designate the ward and service to which they are to be sent, accord¬ ing to the schedule of distribution of cases as prepared bj- the Directing Medical Staff. 5. If, after examination, he finds that an applicant is not in need of hospital attention he shall: (a) Attend to his immediate needs, if surgical dressing or medical attention be required; make note of same with diagnosis; and file same. ( b ) Refer him to the proper agency, clinic, or District Health Officer, etc., for further treatment. 6. He shall see that the clerks make complete record of the informa¬ tion required, on stationary supplied, for the purpose of identification of applicants or their property. 7. When valuables are taken from the person of any applicant for admission, he shall see that a correct entry of their description is made and attested by one or more witnesses before it is placed in the deposit vault. Resident Staff. —The Resident Staff shall consist of those physicians resident in the hospital, assigned to the various services, who shall have completed at least one year as internes in this or any other first-class hos¬ pital. CINCINNATI MUNICIPAL HOSPITALS 21 The senior resident on a service shall be designated Resident Phy¬ sician, Resident Surgeon, etc. Those next in line shall be designated First, Second, Third, etc.. Assistant Resident Physician or Surgeon. The duties of the Resident Staff shall be as follows: The Resident Physician (Surgeon, etc.), under the direction of the Director, shall supervise the professional work of the Assistant Residents and Internes assigned to duty in his department. He shall be responsible, under the direction of the Director, for the professional care and treatment of all patients in his department. Upon the signed order of the Director he, or, in his absence, an Assist¬ ant Resident, shall prepare the formal written recommendations to the Superintendent for the discharge of patients in his department. Nominations for all positions on the Resident Staff shall be made similarly to those for the Attending Staff. There shall be a paid Resident Physician in the Contagious Depart¬ ment who shall devote all his time to said department. His duties shall be the same as those defined for the Resident Physicians in other services. A complete physical examination must be made and recorded by a member of the Resident Staff or by an Interne within two hours after admission of a patient to the wards. A complete history must be recorded in writing within twenty-four hours from the time of admission of a patient to the wards: frequent notes upon the progress of the case are likewise to be recorded. Immediately after each operation there shall be entered a description of the operation, giving the findings and diagnosis as dictated by the operating surgeon. Resident Staff and Internes. —The number of Internes shall be determined by the Directing Medical Staff and the Superintendent of the hospital. The term of service for Internes shall be fixed by the Directing Medical Staff and the Superintendent of the hospital. Internes shall be entitled to a vacation for a period not to exceed two weeks each year, subject to the convenience of the hospital, and by written permission of the Superintendent. They shall not take vacations either in the first or the last months of their service in the hospital. Examination of Internes. —The Directing Medical Staff shall from time to time conduct competitive examinations for the positions of Internes in the city hospitals. The examination for Internes shall be open to graduates from the two medical schools at present in Cincinnati, and to graduates from Class "A” schools located elsewhere. Rules and Regulations.— 1. Internes shall reside in the hospital. They shall not engage in any other business than that of the hospital, nor receive any fee for any 22 RULES AND REGULATIONS service rendered in the hospital, except for signatures of legal papers and court summons. 2. No diploma or certificate of time served in the hospital shall be granted to any Interne who shall resign or be removed, and no Interne or Resident Surgeon or Resident Physician shall receive a diploma or certifi¬ cate of service, unless recommended by the Directors of the divisions on which he has served. 3. The Internes and Resident Staff are responsible to the Super¬ intendent and Attending Staff for the proper performance of their pro¬ fessional duties, but in all matters of personal conduct and administration or general duties, including the prompt and proper attention to all of the patients on their respective services, and the keeping and filing of complete and accurate histories of their patients, they shall be directly responsible to the Superintendent. 4. They shall not leave the hospital at any time before 1:00 p.m., except by permission of their Attending Staff or the Superintendent, and upon court summons. 5. Not less than ten of their number shall remain at all times, day and night, in the hospital, in order that all calls may be promptly attended to. 6. On leaving the hospital each Interne must assign his service to some other Interne, who is at that time on a similar service or has served a term on that service. 7. Internes shall register when leaving and when returning to the hospital. They shall visit the wards frequently but regularly before 9:00 a.m., and between 5:00 p.m. and 9:00 p.m. 8. They shall carefully and faithfully attend to patients assigned to them, and be at all times subject to the control and direction of the Attend¬ ing Staff, and of the Superintendent in all matters pertaining to good order and the proper discipline of the house. 9. They shall be called to the wards on the admission of every patient coming into their service. Also, they may be called to render surgical or medical attention to all patients admitted to the Receiving Ward on their respective services during the day or night, whose condition is such as to warrant temporary or permanent hospital observation or treatment. They shall be called to the wards day and night, whenever in the judgment of the nurse in charge of the ward the condition of the patient warrants. Upon the death of any patient the Interne shall be summoned by the nurse in charge to perform the death test. 10. All orders for medicines or other treatments for patients shall be made in writing in the books provided for that purpose. Verbal orders shall be ignored. 11. In all cases of emergency they shall at once notify the Director; if he cannot be reached, then the next in charge of the service. If neither one can be found, then they shall report to the Superintendent. CINCINNATI MUNICIPAL HOSPITALS 23 12. Resident Surgeons shall not operate upon any case without the sanction of the Attending Staff Surgeon, except in cases of emergency, and then only on instructions from the Superintendent. 13. Internes shall not operate upon any patient except under the direct personal supervision of a member of the Attending Staff. Lumbar punc¬ tures, aspirations of chests and abdomens, venesections and similar pro¬ cedures to be determined by the Attending Staff, may be performed by the Internes only under the personal supervision of a member of the Attending or Resident Staff. 14. They shall make carefully written and complete histories of each patient when entering, and shall keep a daily record of all cases where indicated, carefully noting the symptoms, changes, and treatment of each. 15. They shall each make a daily health report of each patient under their charge, to the hospital office before 11:00 a.m., and in the case of death of any patient shall report immediately to the office the name of the deceased, with the cause of death. 16. They shall report to the office immediately, when any patient is deemed dangerously sick. 17. They shall report to the office any facts coming to their knowledge before or after the death of any patient, -which might indicate the necessity for a coroner’s inquest or other action by the police. 18. The} 7 shall not transfer patients from one ward to another except on the written order of their staff, and with the approval of the Superin¬ tendent. In all instances transfers must be made through the hospital office only, where the order shall be stamped with the "time stamp” at the time received. 19. They shall not discharge any patient from the house without an order of an Attending Staff officer. They shall not discharge patients for disorderly conduct or violation of the rules of the hospital, but shall report to the Superintendent, for his action, all facts in reference to such cases. They shall report to the Superintendent all patients desiring to leave the hospital against the advice of the Attending or Resident Staff. 20. The descriptive cards and clinical histories of all patients reported as ready to be discharged, must be filed in the Clerk’s office previous to their discharge. In the case of deaths these cards and histories must be sent with the body to the Pathologic Institute. 21. Applications for post-mortems must be made to the Pathologist, or in his absence to the Assistant Pathologist, or, in the absence of both, to the Superintendent or Assistant Superintendents. 22. Internes shall be notified of and attend the post-mortem examina¬ tion, when such is made, of any patient dying on the service to which they are attached. This rule does not apply to the Interne on duty in the Obstetrical Service. 24 RULES AND REGULATIONS 23. Whenever a patient dies in the hospital, the physician or surgeon in charge of said patient shall certify to the cause of death. 24. Neither the Resident Staff nor Interne shall render medical attention to any employe or nurse, unless instructed to do so by the Super¬ intendent. Examination of female patients shall not be made by any member of the Resident Staff, or by an Interne, unless there be at least one nurse present during the examination. 25. They shall not report cases for medical or other journals without express permission of the Director of their service, nor shall they communi¬ cate information respecting the hospital or their patients to interviewers or reporters. 26. They shall not remove any apparatus, furniture, or instrument from any ward without furnishing the head nurse of such ward with a written and signed slip stating clearly what is to be taken, and where it is to be taken, and they shall see that such articles are piomptly returned at the earliest opportunity. 27. When instruments are removed from the operating pavilion, a full record of such removal, with signature, shall be made on the records provided for that purpose. 28. In the absence of the Receiving Physician and his assistants, one of the Resident Staff shall perform his duties in the Receiving Ward, and during such time shall be constantly present at the Receiving Office ready to render immediate service. In the meantime he shall turn over his own regular duties to one of his associates. 29. The Resident Staff and Internes shall cultivate at all times the most friendly relations with the Superintendent of the hospital, and treat him as the manager and governor of the house, with all due respect. 30. Good order and decorum must be maintained at all times, and the House Staff is expected, as officers of the house, to exhibit an example which may be profitably copied by all persons. 31. Internes are cautioned after 10:00 p.m., when in their rooms, and in passing to and from them, to refrain from loud talking, and to walk as quietly as possible in order that others may not be disturbed. 32. Smoking in the dining-room or in any other part of the hospital, except in the sleeping quarters, recreation or assembly rooms, is positively forbidden. 33. The use of liquor by the House Staff during their term of service, while on the hospital premises, is inconsistent with their duty, and is for¬ bidden. 34. Internes desiring a leave of absence from the hospital for longer than twenty-four hours, except in case of illness, shall obtain written per¬ mission from the Attending Staff officer in charge of the respective service. In case of absence over night, the Superintendent or the Assistant Super¬ intendent shall be previously notified. CINCINNATI MUNICIPAL HOSPITALS 25 35. In matters concerning the Internes, collectively or individually, a committee of three Internes shall represent the entire body. This com¬ mittee shall be chosen by the Internes, the choice to be subject to the approval of the Superintendent. 36. The Superintendent and Assistant Superintendent have entire charge of the interne supervision day and night, and in their absence the Receiving Physician or his assistants shall assume this responsibility. Anesthetist and the Administration of Anesthetics. —A full¬ time paid Anesthetist shall reside in the hospital and devote all of his or her time to the duties incident to the administration of anesthetics. The Anesthetist shall have general control and direct the giving of anesthetics, subject to the approval of the Surgical Staff and Superintendent, and shall have, in conjunction with the nurse in charge of the Operating Pavilion, supervision of the various anesthetic appliances, and see to it that they are kept in perfect working order. The Anesthetist shall instruct the Internes in the administration of anesthetics during the time they are assigned to the anesthetic service. The Anesthetist shall deliver two lectures, or more, if desired, on "Anesthetics, Their Administration and Danger,” each 3 'ear to the Senior class in the Medical Department of the University. Anesthetics shall not be administered by an Interne who has not had at least one month on the anesthetic service, except under the direct super¬ vision of the full-time Anesthetist, a qualified Assistant Anesthetist, or a member of the Attending or Resident Staff. The Anesthetist shall be on duty from 8:00 a.m. to 12:00 m., and from 1:00 p.m. to 3:00 p.m. daily, except Sundays and holidays, and at such other hours as the Superintendent may direct. The Anesthetist shall respond to emergency calls at any hour. Clinical Clerks. —Clinical Clerks are fourth-year medical students. They shall file with the Superintendent a card of assignment to the hospital service from the office of the Dean of the Medical School. They shall report for duty at the hospital at 8:00 a.m. during the period of their assign¬ ment. They shall perform the work assigned them under the immediate supervision of the Attending Staff, the Resident Staff, and the Internes. Clinical Clerks shall have absolutely no authority regarding treatment of patients, nor shall they issue any orders to nurses or others serving in the wards. Male students are forbidden to make physical examination of female patients in the absence of a nurse. The Director of the Pathologic Laboratory. —The Director of the Pathologic Institute, who shall also be the Pathologist and a member of the Attending Staff, shall have direction of all examinations of pathologic specimens and of autopsies. He shall have direct control, subject to the authority of the Superintendent and Dean of the Medical College, of the management of the Pathological Building, and either directly or through his assistants (whose duties shall be designated) of the ward laboratories, and the laboratories of the Receiving Ward and Operating Pavilion. 26 RULES AND REGULATIONS He shall specify the duties of all his assistants; namely, Resident Pathologist, Clerk and Stenographer, Technicians, Morgue Attendant, Housemaids, and any other special assistants, who from time to time shall be appointed, and such Internes as shall be assigned to laboratory duty. When necessary, he shall recommend to the Superintendent dismissal of any of his assistants who are on the hospital pay roll; to the Dean of the College of Medicine those who are on the University pay roll. In cases other than dismissal, he shall have full disciplinary powers in his depart¬ ment. He shall recommend to the Superintendent or the Dean of the College of Medicine all appointments affecting the laboratory service. He shall be responsible for the physical condition of the Pathologic Institute, and for the work accomplished in his department, and it shall be his duty to assign work and to make regulations governing the carrying out and reporting of work. He shall see that indexed records of all routine work are kept, and such files shall embrace all examinations which are made after the receipts of requests made upon "special request” blanks. He, or a designated assistant, shall perform all post-mortems between 10:00 a.m. and 12:00 m., and at such other hours as may be necessary, complete records of which shall be kept according to methods which he shall determine. He shall order, through the Superintendent, all articles or materials for hospital work in the laboratory, and shall, upon written request from the head nurse of the ward, supply materials needed in the ward laboratories. In the absence of the Director of Pathology or of the Director of Bacteriology, or in the absence of both, some one of their assistants (whom they shall designate) will become the Acting Director. The Director of the Bacteriologic Laboratory. —The Director of the Bacteriologic Laboratory, 'who is also a member of the Attending Staff, shall have direction of all bacteriologic, serologic, and parasitologic examinations. He shall specify the duties of all his assistants. When necessary, he shall recommend to the Superintendent dismissal of any of his assistants who are on the hospital payroll; to the Dean of the College of Medicine those who are on the University payroll. In cases other than dismissal, he shall have full disciplinary powers in his department. He shall recom¬ mend to the Superintendent or the Dean of the College of Medicine all appointments affecting his laboratory. Rules Governing the Laboratories.— 1. Any qualified person who desires to avail himself of the facilities of the laboratories of the Cincinnati General Hospital and the Tuberculosis Sanatorium, may be permitted to do so with the consent of the Directors of the laboratories, if it will in no way interfere with the regular hospital and college work. 2. All materials, supplies, and apparatus issued to any worker in the CINCINNATI. MUNICIPAL HOSPITALS 27 laboratories will be signed for on a memorandum by the worker to whom they are issued, and he will be held accountable for them, and, unless a part of the routine hospital work, material and breakage must be paid for. 3. All experiments done upon animals must be conducted in a manner which will entail a minimum of pain and suffering. In every experiment the animal must be placed under the influence of some effective anesthetic or drug, the action of which must continue during the whole course of the operative procedures. At the termination of a completed experiment the animal must be killed by a painless method. 4. Operative work on animals will be done only in the operating rooms set aside for that purpose, except with the express consent of the Director. There will be two laboratory assistants who will be available for such work. Special assistants may not be called upon for assistance except in very special instances. 5. The workers in the various divisions of the laboratory must confine their demands for assistance to the attaches of the division in which they are working. 6. In all printed reports which are based upon work done in the laboratories, it shall be indicated that such work has emanated “From the Laboratories of the Cincinnati General Hospital,” or “From the Laboratories of the Cincinnati Tuberculosis Sanatorium.” 7. Routine blood and urine examinations will be done in the ward laboratories by or under the direction of the house officers. 8. Specimens sent to the laboratory for special examination will be delivered, accompanied by the proper blanks, to room No. 219, Pathologic Institute, from which, after receiving a serial number, they will be delivered to the proper workers. Tuberculosis Sanatorium The Cincinnati Tuberculosis Sanatorium is established: 1. For the care and treatment of patients suffering with tuberculosis, especially those in the advanced stages of the disease. 2. For instructing medical students in the diagnosis and treatment of tuberculosis. 3. For investigation and research in tuberculosis. 4. For the instruction of nurses and attendants in the principles and practice of the science of nursing, especially with relation to tuberculosis. Discharge of Patients. —Patients shall not be discharged from the institution unless the disease is quiescent, and they are no longer a source of menace to the public health. When patients leave the hospital against the advice of the physician, or without his knowledge, the Superintendent shall endeavor w r ith the aid 28 RULES AND REGULATIONS of the Health Department and Police Department (should that patient’s disease still be active) to secure his return to the institution. The Superintendent may discipline any patient for improper conduct or other violation of the rules. Regulations Regarding Visitors.— Visitors to Patients.—Relatives or friends of patients will be allowed to visit patients daily between the hours of 1:30 p.m. and 4:30 p.m., and between the hours of 6:00 p.m. and 7:00 p.m. No visitors shall be permitted to visit any patient at other than regular hours, except by special permission of the Superintendent. Visitors are not allowed to remain more than one hour on any day, and are not to converse with any patient who is not a relative or friend, unless by special permission of the Superintendent. Not more than three persons will be allowed to visit a patient at the same time. No visitor shall give tobacco, drink, or food of any kind to any patient. All articles sent to patients must be plainly marked and left at the office, where they will be subject to inspection by the hospital authorities. The Superintendent may, in his discretion, exclude visitors from any ward or patient. Executive Officers of the Sanatorium.— 1. Superintendent 2. Assistant Superintendent and Resident Physician 3. Resident Medical Director 4. Director of the School of Nursing and Health Superintendent and Medical Director. —The Superintendent shall have charge of the general administration of the Cincinnati Tuber¬ culosis Sanatorium in addition to his duties at the Cincinnati General Hospital. Rules governing his office at the Cincinnati General Hospital shall also apply to his work at the Sanatorium. Resident Medical Director. —There shall be one Medical Director who shall be responsible for the medical treatment of all the patients. He shall supervise the work of the other medical and laboratory attendants. He shall be a member of the Directing Medical Staff of the Cincinnati General Hospital and Tuberculosis Sanatorium. Director of the School of Nursing and Health. —The Director of Nurses in the Cincinnati General Hospital shall be the executive head of the Nursing Department of the Tuberculosis Sanatorium. Assistant Medical Director. —There shall be one Assistant Medical Director, who shall be on continuous service. CINCINNATI MUNICIPAL HOSPITALS 29 Assistant Resident Physicians.— 1. The Assistant Resident Physicians shall be under the direction of, and responsible to, the Medical Director. 2. -They shall not be absent from duty without the consent of the Medical Director and Assistant Superintendent. 3. They shall visit all the wards twice daily and oftener, if necessary. They shall be subject to the orders of the Medical Director in all matters pertaining to the medical administration of the sanatorium. Attending Physicians, Surgeons, and Assistants in the Labora¬ tories. —The number of physicians, surgeons, and assistants in the labora¬ tories shall be determined by the Directing Medical Staff, subject to the approval of the Board of Directors of the University of Cincinnati. Internes. —The number of Internes assigned to the Tuberculosis Sanatorium shall be determined by the Directing Medical Staff, subject to the approval of the Superintendent. Volunteer Medical Residents. —There may be one or more Volun¬ teer Medical Residents appointed, who shall receive maintenance, but no pay. They must be graduates of a recognized medical college, and agree to serve not less than six months. At the end of their term, if their service has met with the approval of the Medical Director, they shall receive a certificate of service, signed by the Medical Director, the Superintendent, and the Dean of the Medical College. Supervisor of Nurses.— 1. The Supervisor of Nurses shall be under the direction of, and responsible to, the Director of the School of Nursing and Health of the Cincinnati General Hospital. 2. She shall frequently confer with and report to the Assistant Super¬ intendent and the Medical Director concerning the Nursing Department at the institution. Pharmacist.— 1. The Pharmacist shall be on duty in the Drug Department from 7:30 a.m. to 12:00 m., and from 1:00 p.m. to 4:30 p.m. 2. He shall compound and dispense such medicines as may be re¬ quired. 3. He shall issue supplies only upon orders duly signed, and shall keep a record of all supplies received and issued each day. 4. He shall take care of the personal property of the Drug Depart¬ ment and render strict account of the same to the Superintendent. 30 R ULES A ND REG ULA TIONS Dietitian.— 1. The Dietitian shall be under the direction of, and responsible to, the Superintendent or Assistant Superintendent, and the Director of Nurses. 2. She shall supervise the work of all her assistants in the Culinary Department. 3. She shall prepare menus for officers, employes, and patients, and shall see that these are properly cooked and served. 4. She shall prepare such special diets as may be ordered by the physicians. 5. She shall keep an accurate record of the work done by her depart¬ ment. 6. She shall consult with the Medical Director on the question of the selection and preparation of foods. 3 0112 1057385