Health, sickness, etc. Entries to be ment records. brown which to the normal sense seem darker than the red, while the green-blind will select the shades of green or brown which seem lighter. (n) Enter in last column, in every case of rejection, the disability unfitting the applicant for service, and in other cases any abnormal condition, former grave illness, or serious injury not inconsistent with present bodily vigor. In reexamination of minors and continuous-service men, here enter statement of health since previous examination, and affix signature of the medical officer making the reexamination. 1131. (1) The examination having been concluded, and the canmade on enlist- didate found qualified for the service, the medical examiner shall enter his descriptive list upon the blank enlistment records furnished by the Bureau of Navigation or the Commandant of the Marine Corps, and, having signed it, shall transmit the record to the commanding officer of the ship, station, rendezvous, or post. When defects ment. (2) Upon the transfer at any time of an enlisted person, the medical officer shall make the necessary entries upon the enlistment records. 1132. In cases where physical disqualifications are waived by are waived by the Navy Department, the medical examiner shall fully describe the Navy Depart- same on Form X and other records of enlistment, and at once report the fact to the Bureau of Medicine and Surgery. (Art. 831.) Reexamination 1133. Recruits enlisted at a rendezvous on shore shall be reexof recruits trans- amined as soon as they arrive on board a receiving ship, and any ferred from a defects that may be discovered reported at once to the commanding rendezvous. Recruits to be vaccinated. Officers ad tals. officer. 1134. Recruits shall be immediately vaccinated, and in cases of failure the operation shall be repeated until the medical officer is convinced that the person is protected. Results of vaccination shall be reported on the quarterly report of sick. SECTION 2.-HOSPITALS. 1135. (1) When officers are admitted into a naval hospital they mitted to hospi- are entitled to remain under treatment and to have all the advantages of such hospital until cured, unless in the case of chronic disorders which, after a sufficient period, shall appear to the medical officer in charge to be not susceptible of cure. Of such cases he shall make a report to the commandant of the station and request a medical survey thereon. If a survey recommends a continuance of treatment the officer or officers surveyed may remain until a subsequent survey shall recommend a discharge. Sick and disa attendance. (2) When a medical survey, duly approved, shall recommend an officer's discharge from hospital, it shall be at the option of such officer, if disabled or decrepit, to be transferred to the Naval Home. (3) A copy of all the papers in such cases shall be forwarded by the commandant to the Secretary of the Navy. 1136. Sick, wounded, or disabled officers are entitled to the bled officers enti- benefits of naval medical and surgical attendance, either within or tled to medical without a naval hospital, so long as they remain sick, wounded, or disabled. The fact that an officer has been treated within a naval hospital for four months, or for a longer period, shall not be considered as a bar to his readmission to the same, or to any other hospital. Responsibility cers in charge. 1137. The medical officer in charge of a naval hospital is responsible for the care and treatment of the sick, and for the discipline, of medical officleanliness, and economy of the institution, which it is his duty to keep always in an efficient condition; and to this end he shall exact from subordinates, employees, and patients a proper obedience to his orders and to the laws and regulations of the Navy. Medical officers and all persons employed in the hospital shall perform such duties as may be assigned to them by the medical officer in charge. 1138. Except in cases of emergency, which shall be immediately reported to the Bureau of Medicine and Surgery, no changes shall be made in buildbe made in the hospital buildings, furniture, and grounds, such as ings or grounds. destroying or removing trees, or disturbing the soil around them; and no bills for purchases and repairs shall be contracted without the permission of the Bureau. No changes to 1139. The medical officer in charge shall inspect all medicines, Inspection of provisions, and medical supplies that may be received, or shall medicines, supcause them to be inspected by a junior medical officer, who shall plies, etc. report to him their condition. A record of the inspection shall be entered on the daily journal. Examination 1140. He shall direct the medical officers in charge of wards to present their case papers to him once each week for examination, of case papers. and will assure himself that they are accurately and carefully kept. Medical officer 1141. (1) He shall detail a medical officer who, in addition to such other professional duties as may be assigned him, shall perform of the day. the duty of "officer of the day" for twenty-four hours, commencing at 10 a. m. (2) The officer of the day, upon going on duty at 10 a. m., shall make a tour of inspection through the wards, kitchens, mess, and other rooms occupied by patients and employees. A similar inspection shall be made during the afternoon, at a different hour daily; and another at night, after the patients are in bed. (3) A list of patients and employees who have received passes shall be furnished the officer of the day as early as practicable every morning, and all patients and others will be required to report their return to him. 1142. The officer of the day shall keep a journal, which he shall sign at the end of his term of duty at 10 a. m., in which he shall make a brief record of the following points, that are to be noted at the time of occurrence: The condition of the wards, kitchens, mess, smoking, and other rooms at each inspection; the condition of the meals served as to quality and quantity: the names and diseases of patients admitted, and the places from which they are received; the names, number of days subsisted, and disposition made of patients discharged, and whether the necessary papers in each case are correct and complete; the names and condition of patients and employes who have returned, or who have overstayed their leave; the confinement and discharge of offenders, and cause of punishment; the appointment and discharge of employees; the reporting and detachment of officers, or their going upon and returning from leave; the record of inspection of all articles; the object and findings of all boards of survey; and all other matters occurring during his term of duty which it may be desirable to record. 1143. Medical officers in charge of wards shall be held responsible for their order and neatness, and for the good condition of all within them. They shall exercise a personal supervision over the Daily journal. Medical officers in charge of wards. Patients should comfort and welfare of the sick, visiting them at least twice daily, and oftener in severe cases; and they shall assure themselves that their directions as to medicines, dressing, regimen, etc., are accurately and promptly carried out. 1144. Patients should be accompanied, upon admission, with be accompanied hospital tickets (Form G), but they may be admitted without this with hospital tickets. paper in cases of emergency, when the medical officer shall report the fact to the commandant of the station with a statement of the emergency, and cause the necessary hospital ticket to be supplied. 1145. Convalescent patients may be detailed for light service, but shall in no case be retained in the hospital for that purpose after they are fit for duty. Convalescents to be discharged when fit for duty. Attendants. Diet tables. Special diet list. Forms to be observed upon receipt of a patient. Patients left in 1146. No patient in hospital shall be entitled to any service except that of the regular hospital attendants; nor shall any one, except medical officers on duty, patients, and employees of the hospital, be subsisted or lodged without permission of the Bureau of Medicine and Surgery. 1147. For patients, diet tables prepared by the Bureau of Medicine and Surgery will be followed when practicable; but the allowance to attendants' messes may be varied at the discretion of the medical officer in charge, provided the value of the ration be not exceeded. 1148. For each ward shall be kept a special diet list (Form P), which shall be revised and corrected every morning by the medical officer in charge of the ward. 1149. When a patient is admitted, the following forms shall be observed: (a) When the hospital ticket is found correct, indorse and file it, with accompanying papers relating to the case. If defective, return it to the medical officer who signed it, through the usual channels, if he is at hand; otherwise, through the Bureau. (b) Enter the name, etc. (1), in the general alphabetical register of patients (Form E), which is the permanent hospital record, for future reference; and (2), in the abstract of patients (Form F). (c) Open case paper (Form H). (d) If the patient is an enlisted person from the receiving or other ship, or from neighboring marine barracks, send ration notice, through the commandant, to the commanding officer of the ship or barracks. 1150. When patients are left in hospital after the sailing of the hospital after ship from which they were sent, the medical officer in charge shall sailing of ship. report to the commandant of the station as soon as they are in a position to justify their removal, making a particular statement of the facts and circumstances connected with each case. Discharges for disability. 1151. (1) No person in hospital shall be discharged from the service for physical disability, except upon the recommendation of a board of medical survey. (2) In reports of survey the name of the ship from which the person was received shall always be noted. Records of 1152. A copy of the report of survey, and of any other paper cases of persons relating to the patient, shall be appended to the case paper, which surveyed. shall be signed at its conclusion, or on detachment of the officer, by the medical officer in charge of the patient's ward. Case papers shall be verified by the signature of the medical officer in charge of the hospital. 1153. (1) When a patient is discharged from the hospital, the Discharge of fact shall be entered upon the register of patients and also upon the patients from case paper. The latter is then to be filed, with the hospital ticket hospital. attached. (2) A ration notice shall be forwarded, as directed, upon the entry of a patient. (Art. 1149.) Weekly report 1154. On every Monday, a report of sick (Form I) for the preceding week shall be made in triplicate; one copy of which shall be of sick. sent to the commandant of the station, one to the Bureau of Medicine and Surgery, and the other retained for the files of the hospital as a basis for the report of the following week. 1155. All regulations for a hospital shall be submitted to the Secretary of the Navy. SECTION 3.-GENERAL INSTRUCTIONS. Regulations to be submitted to Secretary. Medical jour 1156. (1) The senior medical officer of every ship, station, or place of duty, except at hospitals where case papers are used, shall nal. keep, or cause to be kept by a medical officer subordinate to him, a medical journal, which must be a complete and succinct history of the medical affairs coming within his province. In this, and in all other records, especial regard must be paid to neatness, accuracy, and uniformity. (2) While it is impossible to give directions so minute as to cover Instructions every detail, and much must be left to an intelligent discretion, the for keeping jourprincipal points in keeping this journal are the following: (a) Patient's name in full, also his grade or rate; both from the muster roll. nal. (e) Enlisted at on the day of 19-. (f) Disease; with explanatory remarks, if necessary. (g) Time and place of occurrence, or dates between which there was exposure to morbific cause. (h) Whether considered to be in line of duty or not in line of duty; state all facts that can be elicited, distinguishing between the testimony of the patient himself and that of any other witness, and in express terms accepting or rejecting that of the patient and giving reasons for so doing. (i) Medical officers will observe conciseness in clinical reporting. Common symptoms of ephemeral diseases need not be noted; the simple nosological title will suffice in such cases, as "diarrhoea acuta," "constipatio," "catarrhus," with statement of origin. (j) The medical journal must be indexed daily. (k) Any evidence that could have any bearing on a claim for pension must be fully noted. (3) The journal will be indexed in the following manner: Instructions (a) Henry Ashton first appears at page 1, where the description for indexing. of him is complete; he reappears at page 34, where reference is made to page 1; again at page 67, and new reference. (See page 1.) Order names. of Change of diagnosis. A patient readmitted. Temperature, pulse, etc. In case death. of Mention of general duties. Record of each day. One-day patients. Responsibility (b) When the first line allotted to any name is filled, take up that name again on the next blank line below-e. g., Ashton (Henry), 190, 234. (c) The journal may thus be traced for a full history of each case: A in the margin means admitted. RA in the margin means readmitted. D in the margin means discharged to duty. Dsd in margin means deserted. DD in margin means died. H in margin means invalided to hospital. HI in margin means invalided to Government Hospital for Insane. L in margin means invalided on leave. (4) On each successive day the names of the patients shall be recorded in the order of admission, with mention of the changes in the condition and treatment until the final disposition of the case. (5) Should a change of diagnosis become necessary, the case must be closed by the discharge of the patient, and reopened by his admission with the new diagnosis, except in cases of intercurrent affections depending upon the original cause of disease, when the record may be continued. This rule applies alike to case papers and journals. (6) Original admissions for any one disease shall be considered as admission, and indicated in the margin of the medical journal by the letter A. A subsequent entry on the journal for the continuance of the same disease shall be designated a readmission, and indicated in the margin of the medical journal by the letters R A. Forms F, F2 and K shall correspond with the journal as to admissions and readmissions. (7) Records of the temperature, pulse, respiration, and excreta of important cases shall be kept (form Q) and appended to the journal or case papers. (8) In case of death, post-mortem examinations should be made, when practicable, and the results fully recorded in the journal or on case paper. (9) After the completion of the daily record connected with the sick, mention shall be made of all matters relating to the duties of the medical officer, such as sanitary inspections, recommendations made to the captain, and vaccinations. (10) The record of each day shall include all admissions, discharges, deaths, and other occurrences up to midnight of that day. (11) When a case is admitted and discharged on the same day it shall count as one sick day, provided the discharge be to duty or on account of death, but when the discharge is a transfer to hospital, or in any way involves admission on another journal, it shall not be counted. (12) The senior medical officer of the ship or station is responsible for accuracy of for the accuracy of the journal and case paper, which must always journal. be written by a medical officer. Signatures to entries. Sickness of a (13) Whenever a medical journal is kept, the medical officer who holds sick call shall make the entries in the journal over his own signature. The journal shall be inspected daily by the senior medical officer, who shall attach his signature to indicate the correctness of the record, and shall make any additional entries he may deem proper. (14) When a patient is treated whose sickness is of so trivial a trivial character. character that a relief from duty is not necessary, his name shall be |