CIRCULAR ON THE CARE AND 
'"'"DISPOSITION OF PERSONS 
FOUND UNCONSCIOUS ON 
THE STREETS OR ELSE- 
WHERE. 
PREPARED BY A SPECIAL COMMIT- 
TEE OF THE MEDICAL SOCIETY 
OF THE COUNTY OF 
KINGS, N. Y. 
Reprinted from 
The Brooklyn Medical Journal, 
June, 1895. Brooklyn, June io, 1895. 
Dear Sir : 
By direction of the Medical Society of the County 
of Kings the accompanying report is sent to you. Will 
you be kind enough to reprint so much of it as your 
space will permit, and also call attention, editorially, to 
the important matter of which it treats? 
Respectfully, 
J. H. Raymond, M. D., 
J. C. Shaw, M. D., 
L. D. Mason, M. D., 
Committee. CARF OF PERSONS FOUND UNCONSCIOUS ON THE 
STREETS. 
Rooms of the Medical Society of the County of Kings, 
Brooklyn, N. Y.. June 1, 1895. 
At a meeting of the Medical Society of the County of Kings, 
held February 20, 1894, a Committee of Three was appointed, "to 
report to the Society what means have been provided in the city 
of Brooklyn for the immediate care of persons found unconscious 
on the streets." The Committee made a preliminary and a final 
report, the latter at the December meeting of the Society, at which 
meeting it was authorized to issue a circular, in which should be 
embodied its recommendations, and to send the same to the 
medical journals, to the managers of the different hospitals of the 
city, and to such other organizations as it might deem wise. 
In accordance with these instructions, the Committee has pre- 
pared the following circular, which it recommends to the consid- 
eration of the members of all medical societies, as being largely 
instrumental in shaping public opinion ; to Health Boards, as 
being the power appointing in many instances ambulance sur- 
geons ; to managers of hospitals, as having in some measure the 
same appointing power, and especially as being the authorities 
receiving and caring for accident cases ; and to the police authori- 
ties, who are principally instrumental in summoning aid for those 
who are injured or taken ill in the streets. 
RECOMMENDATIONS. 
i. Whenever a person is found in an unconscious or semi- 
conscious state on the street, or elsewhere, away from his own 
home, the police, when notified of such case, shall immediately 
summon medical aid ; sending for the ambulance surgeon, or for 
the police surgeon ; or in towns, where there are no such officials, 
then for the nearest physician, who should be compensated for 
his services by the authorities. 
2. The police shall not decide as to the disposition of such a 
case, but must await the decision of the ambulance surgeon, 
police surgeon, or of the physician called, and must act in ac- 
cordance with such decision. 
3. A police officer who acts in opposition to such decision 
should be by the ambulance surgeon, police surgeon, or the 
physician, reported to the Police Commissioner, who should sub- 2 
CARE OF PERSONS FOUND UNCONSCIOUS ON THE STREETS. 
ject such officer to discipline, rules governing such cases having 
previously been made and promulgated. 
4. Ambulance surgeons should give prompt and immediate 
aid to patients found in the condition hitherto described, and re- 
move them to the nearest hospital, or to their homes when ascer- 
tainable, according as their judgment dictates is the best course to 
pursue in the interest of the patients. The existence of an alco- 
holic complication in the case should in nowise adversely influ- 
ence the surgeon or physician called as to the disposition of the 
case, as such a complication often renders skillful medical treat- 
ment the more imperative. 
5. Ambulance surgeons, and other medical men, brought in 
contact with cases in which alcoholism is a frequent complication, 
should be reminded that this condition often renders an immediate 
diagnosis impossible in the most serious and oftentimes fatal 
forms of cerebral disease and injury, as well as in other diseased 
conditions. 
6. The examination of ambulance surgeons should include the 
differential diagnosis of alcoholic coma from other forms of coma, 
and the various diseases or injuries that may produce a condition 
simulating alcoholic intoxication. 
7. Hospital authorities receiving financial aid from the city 
should not refuse admittance to patients suffering from supposed 
alcoholism, for in so doing they are liable to be contributory to 
the death of such patients. They should know, that if the con- 
dition be one of uncomplicated alcoholism, this fact will in a short 
time be revealed, and other disposition maybe subsequently made 
of the case ; while, if the patient is so affected as to need imme- 
diate and skillful treatment, his rejection by the hospital authorities 
may conduce to a fatal result. If they refuse to receive such 
cases, because complicated with alcoholism, they should be held 
legally responsible for the results. And, further, if such refusal is 
persistent after their attention has been called to the matter, the 
city authorities should strike the name of such hospital from its 
list of beneficiaries. 
8. The municipal authorities should also consider the question 
of the establishment of a special emergency hospital, or hospitals, 
conveniently located with reference to the various districts of the 
city; or a system, similar to that of the Bureau d'Admission in 
Paris, connected with which there is a special hospital for all cases 
of alcoholism, or cases complicated with alcoholism, that may 
occur in the streets of that city. Or, the authorities might consider CARE OF PERSONS FOUND UNCONSCIOUS ON THE STREETS. 
3 
the establishment of a special department in connection with the 
hospitals of the city, similar to the "Alcoholic Wards" of Bellevue 
Hospital, New York, where more than 4,000 alcoholics are an- 
nually treated. Such a plan would relieve the general hospitals 
of the burden of such cases, or compel them to make special pro- 
vision for their care. Should the existing methods prove inade- 
quate, the Committee recommends some such plan as is here out- 
lined. 
It is the hope of the Committee, now that the attention of all 
concerned has been specifically called to the matter, that they will 
co-operate in such a manner, by adopting rules and otherwise, so 
that methods will prevail in Brooklyn and other cities in the manage- 
ment of cases of the nature described, such as exist in most European 
cities. If this is done, then persons who are rendered unconscious 
from any cause on the streets or elsewhere, will receive prompt 
medical and humane treatment, and will escape the danger of being 
thrust in a cell as "drunks," and there left to sleep off the 
supposed debauch, which in no inconsiderable number of cases 
has proved to be "a sleep that knows no waking." 
The recommendations of this circular are in keeping with the 
spirit of the resolutions already adopted by the Medical Society of 
the County of Kings, and with the practice pursued in the prin- 
cipal cities of Europe. No attempt has been made to treat the 
subject exhaustively, or to give in detail rules and regulations, 
which can only be done by the respective authorities of a munici- 
pality. It is hoped, that wherever a similar defect exists, similar 
remedies will be applied. We invite the aid of medical societies 
and the medical and secular press in procuring the desired re- 
formation. 
J. H. Raymond, M. D., Chairman. 
John C. Shaw, M.D. 
Lewis D. Mason, M. D., Secretary. 
Committee : 
171 Joralemon Street.