ONTARIO 
OFFICIAL 
REGULATIONS 
HOSPITALS OFFICIAL 
REGULATIONS 
FOR THE 
Government of Public and Private 
Hospitals, Refuges, Orphanages 
and Infants' Homes 
IN ACCORDANCE WITH CHAPTER 300, SECTION 3. 
AND CHAPTER 301. SECTION 3. REVISED 
STATUTES OF ONTARIO. 1914 
PRINTED BY ORDER OF 
THE LEGISLATIVE ASSEMBLY OF ONTARIO 
AND 
APPROVED BY THE LIEUTENANT-GOVERNOR- 
IN-COUNCIL 
TORONTO: 
Printed and Published by A. T. 'WILGRESS. Printer to the 
King's Most Excellent Majesty 
19 2 0 INDEX 
Section. 
Accident to a patient or inmate, notification of ... . 18 
Accounts, notices of, to Municipal Clerk 33 
Account Books required 2 (4) 
Admission, requirements at time of 14, 29, 68 
Appliances for extinguishing fire required 7 (10) 
Approval of Inspector required for plans and altera- 
tions • 6 (1) 
Beds and Cots, standard and size required 13, 43 
Boards of Management, duties and powers of 1 
Boilers, official inspection of required 6 (16) 
Books and Records required to be kept 2 
Care of Inmates, regulations for . . . 14, 62 
Children, special regulations for the care of 49,67-73 
Children not allowed in Refuges for adults 57 
Construction, general plan of, suggestions for 6, 50 
Conveniences, sanitary, number required and eare of 15 
Coroner, to be notified of deaths 19 
Cottage system of construction, advantages of 50-53 
County Houses of Refuge, Additional Regulations for 54-63 
Dietary, regulations as to 38,49, 74 
Disinfection 14' 
Drugs and medicines, regulations regarding 28, 44 
Employees, duties of and regulations for 23, 47 
Father of infant, responsibilities of ■ ■ 64 
Feeble-minded, care of (see also Mentally Defective) 
17, 22, 59, 73 
Feeding bottle, care of . 37,49 (6) 
Field worker, duties of 67, 73 
Fire, prevention of and precautions against 6. 7 
Flies, not to be tolerated in any Institution 10 
Floor space required for each patient and inmate. . 6 (4) 
Food, provision, preparation and care of 6, 38,49 
Friends of inmates to be allowed to visit them .... 17 
Furnishings to be adequate and comfortable 40, 61 
Garbage, disposal of 9, 10 (2) (3) 
Grants, Provincial, regulations as to and records 
required for 34 
Grounds, regulations as to 21, 51 
Heating of buildings, regulations for 16 
Hospital: 
Accommodation, standard of 25 
As a health centre 27 
Definition of 25, 41 
Duties of staff and employees in 27 
Maternity, additional regulations for 46-53 
Organization of 27 
Private, additional regulations for 41-45 
Public, additional regulations for 25-39 
3 4 
Section. 
Houses of Refuge, additional regulations for 46-53 
Illness, serious, of inmate, notification of 18 
Infants, admission, care, nursing and feeding of 
16. 34 (5), 37, 44, 49, 65, 67, 68-73 
Infirmary, required in House of Refuge 54 
Inmates, supervision, care and befriending of. . . . 59, 62, 64 
Inspector of Hospitals and Public Charities to ap- 
prove by-laws and rules . 1 
to approve plans and specifications 5 
inspector of Feeble-minded, notification to be sent to 22 
Instruction in industries and out-door occupations. . 56 
Laundry 6 (7) 
Maternity Hospital, Wards and Homes, regulations 
for ,.36,37,46-53,64-67 
Medical Advisory Board, appointment of 28 
Medical Officer of Health, supervision of. over 
Maternity Hospitals 44, 64 
Mentally Defective (see also Feeble-minded) care of 
17. 22, 59, 73 
Monthly returns required 34 (8) (13) 
Municipality, responsibility of 22, 33 
Nurses, duties of, accommodation required for. . . . 24, 26, 47 
Orphanages, regulations for 46-53,68-73 
Patients, regulations as to care of 27, 29-33, 43 
Penalty for infringement of Act . .. . 4, 41, 45 
Physician, duties of .48, 60, 68 
Private Hospital, additional regulations for 41-45 
Refuges and Public Charities, additional regulations 
for 46-63 
Refuges for Women, additional regulations for .... 64, 65 
Registration of Births and of Deaths required 3 
Religious services and duties, regulations regarding 63, 71 
Sanitation, regulations as to 8-11 
Site and location recommended for buildings 6,51,53 
Social Service Department of Hospital, duties of. . . 39 
Supplies, regulations as to 2 (5) (8), 12,49 (1) 
Superintendent, appointment and duties of ...3,12, 
18, 19, 26, 46, 47, 69 
Toilet and Bath accommodation required ...6 (12), 15, 23 
Tuberculous patients, admission, care and transfer of 35, 60 
Visitors to be admitted to Institutions at reasonable 
times 17 Regulations for the Government of Public 
and Private Hospitals, Refuges, Orphan- 
ages and Infants' Homes: 
1. The Board of Governors, Direct- 
ors, or Managers or other responsible 
authority of every Public Hospital, 
House of Refuge, Refuge, Orphanage, 
Infants' Home or other Public Charity 
shall meet not less frequently than 
once a month and shall appoint one 
or more of their number from time 
to time to visit and inspect such in- 
stitution not less frequently than once 
a week. A record of such meetings 
and inspections shall be kept in the 
institution in a book provided for the 
purpose, and a copy of all by-laws, 
rules and regulations adopted by such 
responsible authority, and of any 
changes in the same shall be sent to 
the Inspector within seven days of 
their adoption in accordance with sec- 
tion 16 of the Act relating to Hos- 
pitals and Charitable Institutions. 
Board of 
Managers. 
Meetings. 
Rules. 
2. The following books are required 
to be kept at Public Hospitals, Re- 
fuges, Houses of Refuge, Orphanages, 
Infants' Homes and other Public 
Charities: 
Books. 
Books to 
be kept. 
5 6 
(1) A daily Record, as prescribed 
by the Inspector. It is also sug- 
gested that a diary be kept of all mat- 
ters of interest and importance in the 
institution. 
(2) A general Register, in which 
shall be entered for each inmate the 
name, date of admission, age, address 
with municipality, name of relatives 
or friends or responsible authorities 
and their addresses and other par- 
ticulars and also the date of discharge 
or death. 
(3) A Physician's Book, in which 
shall be entered the visits of phy- 
sicians, with date and other particu- 
lars. 
(4) Account Books, containing all 
accounts, etc., and all financial state- 
ments required by law or regulation. 
(5) Supplies and Stores Book, con- 
taining a record of stores and supplies 
received, given out and remaining on 
hand, with dates. 
(6) Diet Book, containing a record 
of meals supplied, menus and other 
important matters. 
(7) Effects Book, in which the 
clothing and other personal effects re- 
ceived from the inmates for safe 
keeping should be entered and re- 
ceipts for the return of the same en- 
dorsed thereupon. Ft is also conveni- 
ent to have a separate book, kept in 7 
the office safe, to record all money and 
valuables belonging to patients and in- 
mates as above. 
(8) A Stock Book, containing in 
alphabetical order, an account of all 
supplies on hand at the end of each 
month, and clearly indicating the dis- 
position of all goods purchased. 
(9) In all General and Maternity 
Hospitals a chart of approved form 
must be kept for every patient until 
convalescence occurs or the case is 
otherwise terminated, and the same 
must be properly filed for reference. 
Every hospital should preserve its 
clinical records, in order that the his- 
tories of cases may be on record. 
3. In addition to the legal notifica- 
tion and registration, the Superinten- 
dent or Secretary of every Hospital 
and Public Charity must enter in a 
proper book of record, within twenty- 
four hours after the event, any and 
every birth and death that takes place 
therein, with all particulars in regard 
to the same. 
Births and 
deaths. 
4. Accuracy and exactness in all re- 
turns is required. This applies to any 
omission to enter immediately the 
name of any patient admitted. Any 
inattention to these matters is illegal 
and subject to serious penalties, as 
well as the loss of any Legislative 
grant in aid. Section 11 of the Act 
Returns. 8 
relating to Hospitals and Charitable 
Institutions reads as follows:- 
Penalty. 
"Any person who knowingly makes, 
or is party to the making or procuring 
to be made, directly or indirectly, any 
false return, shall incur a penalty of 
$1,000, which may be recovered, with 
costs, by action at the suit of the 
Crown only." 
New Buildings. 
Plans to be 
submitted 
to the 
inspector. 
5. The Board of Management of any 
Public or Private Hospital, House of 
Refuge, Refuge, Orphanage or Infants' 
Home or other Public Charity shall, 
before proceeding to erect any new 
building for the purposes of such in- 
stitution and before proceeding to 
erect an additional building or recon- 
struct or make structural changes or 
alterations in any building now occu- 
pied by such Institution or connected 
therewith, cause to be prepared and 
transmitted for the consideration and 
approval of the Inspector of Hospitals 
and Public Charities for Ontario, 
plans and specifications for such new 
building or buildings or structural 
changes or alterations. Tt is also sug- 
gested that preliminary plans should 
be submitted for early consideration 
by the Inspector in order to give 
proper time for inspection and ap- 
proval. 9 
Site, Location and General Plan of 
Construction. 
6. The following information and 
suggestions for the erection and im- 
proved construction of Hospitals, 
Houses of Refuge, Refuges, Orphan- 
ages, Infants' Homes and other Pub- 
lic Charities are submitted for the con- 
sideration of all interested and es- 
pecially of the Board of Management 
of such Institutions. 
(1) The plans and specifications of 
all Hospitals and Public Charities in 
Ontario and any structural alterations 
in existing Institutions must be ap- 
proved of by the Inspector. 
Hospitals should be so situated that 
dust, smoke, noise and traffic or any 
unpleasant environment may be avoid- 
ed as far as possible and ample air 
space secured on all sides of the build- 
ing. Hospital grounds should also pro- 
vide an open air space for convales- 
cent patients, with shade trees and 
flowers if possible. An elevated loca- 
tion is very desirable, and special at- 
tention should be given to drainage 
facilities. A chalky, gravelly or rocky 
subsoil is the best. There should be 
no doubt of the water supply; 40 gal- 
lons per day per head should be 
guaranteed. > 
Site of 
hospital. 
The pavilion style of construction 
with the long axis running approxi- 
Pavilion. 10 
mately north and south affords great 
advantages in regard to securing the 
maximum of air and sunshine and the 
necessary quietness and desirable 
classification and separation of pa- 
tients. 
Accommodation for the male and fe- 
male patients must be kept distinct 
and separate. 
Corridors. 
The various wards and departments 
may be connected by covered ways or 
corridors. Corridors should in no case 
exceed eight feet in width. Steps in 
corridors should be avoided as far as 
possible, but no incline should exceed 
one in thirty. Stairs must not be too 
steep, and a handrail must be pro- 
vided. 
✓ 
Outlook. 
As a rule, buildings should, where 
possible, be placed with southern ex- 
posure to as many rooms as practic-i 
able. A good view or outlook should 
be secured. 
Site and plan 
of other 
public 
charities. 
All other Public Charities should, as 
far as possible, have a country site, 
with garden and farm land, where 
transportation facilities are good, pre- 
ference being given to the cottage plan 
of construction, and offices, waiting 
rooms, reception rooms and other ad- 
ministrative rooms should be grouped 
round the main entrance and should 
have proper toilet accommodation. 11 
(2) Daylight should be secured in 
all parts of a Hospital or Public Char- 
ity by a sufficient number of windows 
properly placed, and of a simple and 
pleasing pattern and arrangement. The 
total window area should bear a pro- 
per ratio to the floor area and win- 
dows should be easily opened and 
closed. There should be no dark 
rooms, corridors or corners in any 
Hospital or Public Charity, except 
such as may be required for stores or 
for X-ray departments. Any Hospital 
or Public Charity that has to use arti- 
ficial light in the daytime has been 
imposed upon by architectural blund- 
ers which add greatly to the cost of 
maintenance. Indirect lighting at 
night for wards has many advantages. 
Lighting. 
(3) Good natural ventilation should 
be secured by windows on opposite 
sides of the rooms or wards, such 
windows to extend to near the ceiling. 
With a sufficient number of windows 
so placed the air may be kept fresh 
and renewed at least twice every hour 
without harmful draft, especially if 
the top of the window is an inward- 
opening transom hinged at the bottom. 
Doors and fireplaces help to secure 
good ventilation. Artificial ventilating 
systems are usually more or less ex- 
pensive and unsatisfactory, and should 
never be installed unless with a posi- 
tive assurance and guarantee that they 
Ventilation. 12 
will prove workable. At the present 
date all ventilating systems have 
proved largely speculative. The open 
windows with draft shields afford 
probably the best method of securing 
pure air in a satisfactory manner. 
Windows and doors should be properly 
screened. Every room must be pro- 
vided with means for direct outside 
ventilation. Air should be admitted 
near each radiator. 
Open fires. 
In places where the aged are cared 
for an open screened fireplace is a 
great aid to ventilation, and is desir- 
able. It also tends to the comfort and 
content of the aged. 
Floor space 
in hospitals. 
(4) - (a) The floor space required 
in wards for each Public Hospital pa- 
tient is 100 square feet, and the num- 
ber of cubic feet required is 1,200, 
provided that the air is completely 
changed at least twice every hour. 
Private 
hospitals. 
(b) The floor space required in Pri- 
vate Hospital rooms or wards for 
each patient is 120 square feet, and 
the number of cubic feet required is 
1,500, provided that the air is com- 
pletely changed at least twice every 
hour. 
(c) The floor space required in dor- 
mitories for each inmate of a House 
of Refuge or other Public Charity for 
adults is 80 square feet, and the num- 
Public 
charities. 13 
ber of cubic feet 900, provided that 
the air is completely changed at least 
twice every hour. 
(d) The floor space required in dor- 
mitories for each inmate of an 
Orphanage, Infants' Home or other 
Public Charity for Children is 70 
square feet and the number of cubic 
feet 800, provided that the air is com- 
pletely changed at least twice every 
hour. 
Orphanages. 
(e) The general height of each 
storey should not be less than twelve 
feet from floor to floor. 
Height. 
(/) Day rooms should provide 9% 
square feet of floor space, for each 
patient or inmate. 
Day rooms. 
(5) The water supply shall be 
approved of by the Provincial Board 
of Health, and specimens should be 
submitted for analysis from time to 
time. Rain water should be utilized 
for laundry and other purposes. The 
drainage system should be approved 
of by the Provincial Board of Health. 
Water 
drainage. 
(6) The provision of (balconies and 
sun rooms is one of the chief im- 
provements in the modern construc- 
tion of institution buildings. They 
should be wide enough to receive beds 
and protect them from the weather. 
Balconies. 14 
They should have an eastern western 
or southern exposure and may be pro- 
tected by roofs, glass, wire screen, 
netting or awnings as may be required 
by circumstances, by the age of the 
inmates or patients or other important 
considerations. It is advisable and 
necessary that the floor of the balcony 
and the floor of the adjoining room, 
ward or corridor should ibe on one 
level and the doors giving entrance 
to the balcony should be wide enough 
to allow a bed to be wheeled through. 
These open air balconies should be 
fireproof, and if connected by iron 
stairways from floor to floor make 
suitable fire escapes. They are of 
great value in providing open air for 
the aged, for the infirm and for 
infants and children as well as for the 
open-air treatment of patients. The 
ventilation and lighting of the wards 
must not be interfered with by the 
verandah, and where necessary prism 
glass flooring may ibe of advantage. 
Laundry. 
(7) A properly equipped laundry 
turning out good work systematically 
and punctually i^. a great comfort and 
means much to the smooth running of 
any institution. It is likewise a great 
economy. A poor laundry is one of 
the greatest extravagances a hospital 
can have. 
The laundry should be located so 
that the noise, odours, and jar of 15 
machinery will not disturb the resi- 
dents of other parts of the hospital; 
hence, it should never be immediately 
under a ward. It should be fairly 
central to facilitate collection and 
delivery from all divisions of the hos- 
pital. Space permitting, the laundry 
is best located in a separate building 
and should at most be limited to two 
working floors. 
The size of the laundry depends 
upon the number of patients and the 
number of pieces to be turned out 
weekly. It is always best to plan for 
the future, either by allowing suffi- 
cient surplus space to permit the in- 
stallation of additional machinery or 
by so planning as to permit of future 
extension, at the same time preserving 
the proper arrangement. 
For a hospital of 1001 beds, six set 
tubs are required, also two washers, 
one mangle, one extractor, one body 
ironer, three ironing tables, gas or 
electric irons, one 40-gallon soap tank, 
one separate sterilizing tub. Where 
clothes cannot be dried in the open air 
a steam-heated drier is essential, 
smaller hospitals should arrange their 
equipment in proportion. 
Equipment 
required. 
As a measure of safety as little 
wood as possible should be used in 
the construction of a laundry. Walls 
Fireproof 
construction. 16 
of glazed brick are best. Neither 
plaster nor tile is (satisfactory for 
laundry walls, because steam loosens 
tiles and softens the plaster. Cement 
or plain smooth-faced bricks painted 
a light colour are very good and are 
easily cleaned. 
Machinery 
protected. 
All machinery should be set away 
from the walls a sufficient distance to 
permit of easy cleaning on all sides, 
and all machinery, belts, etc., must be 
protected by wire screens. 
Every hospital should have in its 
laundry a large cement receiving tub 
in which all soiled articles brought to 
the laundry should be soaked for at 
least twelve hours before being laun- 
dried. This provision not only facili- 
tates washing, but is a great saving 
to clothing. 
All floors, walls, tables, and machines 
should be kept clean and free from 
dust, oil, and grease. If this is done 
quantities of linen will be saved. 
Tables and mangles should be thor- 
oughly dusted every morning, for dust 
works mischief if allowed to come in 
contact with damp clothes. Cover 
machines and tables at night. Clean 
the entire laundry regularly and often. 
Inspect driers frequently for accumu- 
lated lint. 
Formula, 
for soap. 
Every hospital should make is own 
soap: 25 lbs. of potash, 36 lbs. of soap 
grease. Mix in caldron, add 15 gals. 17 
of water; simmer for 18 hours, then 
add water to make 100 gallons. 
Careful rules should be laid down 
for the care and use of blankets. They 
should be well cared for in the hospi- 
tal wards and not washed too fre- 
quently. Experience teaches that it 
is economy to have blankets dry- 
cleaned. Blankets are very seldom 
properly washed in an ordinary hos- 
pital laundry. 
The prudent and economic manage- 
ment of the laundry is of the utmost 
importance in every public institution. 
Care of 
blankets. 
Saving of Labour. 
(8) In the erection of all new 
buildings and additions, and in any 
reconstruction of buildings to be used 
for Hospitals, Houses of Refuge, 
Refuges, Orphanages, Infants' Homes 
or other Public Charities, each ward 
or dormitory should be self-contained, 
and special attention should be paid, 
having due regard to economy and 
fire risk, to all plans, conveniences 
and contrivances which save labour 
and assist in the routine and other 
work of the Institution. Thus, provi- 
sion should be made for clothes and 
linen closets, elevators or waiters, 
house and other telephones, laundry 
chutes for soiled linen, chutes for 
ashes, dust and other waste, dustless 
cleaning apparatus, convenient trans- 
Rooms self- 
contained. 
Labour 
saving. 18 
portation of persons, food and supplies 
and the collection of waste. Special 
facilities should be provided for the 
handling of bread, coal, ice, etc. Eleva- 
tors should be of fireproof construction 
and of such size that stretcher or bed 
may be conveniently carried by the 
elevator. The elevator shaft should 
also be fireproof, and the building 
made as fireproof as practicable. 
Woodwork. 
(9) Woodwork and ornamentation 
should be dispensed with as far as 
possible. Door and window frames 
and wainscoting should never be seen 
in a building where economy in 
domestic service is desired and where 
all resting places for dust and dirt 
Can ibe avoided. No cracks, crevices, 
dark corners or other places where 
dust collects or from which it is hard 
to remove dust should be allowed. 
All junctions where two' plane sur- 
faces meet should be rounded, not 
right-angled. 
Floors and 
walls. 
Walls and floors should be plane 
surfaces, easy to wash, polish or 
otherwise clean. Floors or floor cover- 
ings should have a certain resiliency, 
where the walls meets ceilings or floors 
the corners should be rounded to a 
cove. The floors and walls of operat- 
ing rooms must be made as non-absor- 
bent as possible. 19 
(10) No living-room, including re- 
fectory, dining-room, dormitory, bed- 
room, sitting-room, laundry, kitchen, 
workshop, school-room', recreation- 
room or other living room should have 
its floor below ground-level. Living- 
rooms should have the long axis, if 
possible, running approximately north 
and south so as to have free air space 
and sunlight, both morning and after- 
noon. 
Location of Utilities. 
No deep 
basements. 
(11) Operating-rooms should be 
placed so as to be easily accessible 
from stairways and the elevator and 
should have one large window (north- 
erly exposure preferred) if possible, 
directly opposite to and above the 
operating table. Special attention 
should ibe given to providing reliable 
artificial light to be used when re- 
quired. Ansethetizing rooms, recovery 
rooms, sterilizing equipment and 
dressings, also washrooms for surgeons 
and nurses should be adjacent to the 
operating-room, and the entrance of 
the operating-room should be wide 
enough to admit a bed. Means of 
rapid ventilation and heating should 
be provided. Every operating-room 
should be provided with an auxiliary 
form of artificial lighting ready for 
instant use if required at night in the 
event of the light regularly used sud- 
denly failing during an operation. 
Operating 
rooms. 20 
Toilet 
rooms. 
(12) Toilet-rooms should be as acces- 
sible to wards as possible, but must 
not be placed so that the air from 
them will find its way into other 
rooms or corridors. They may be 
placed either in a sanitary tower or 
at the corners of the building, with a 
cross-ventilating lobby, and should 
have, if possible, windows on two sides 
opening directly into the outside air, 
the windows being placed so that the 
cross current of air is between the 
toilet fixtures and the entrance door. 
The crescent form of seat is to be 
preferred. 
The floors of toilet-rooms must never 
be made of wood or other absorbent 
material. 
At least one toilet should be pro- 
vided for every twelve patients. Separ- 
ate toilet must always be provided for 
the staff. 
Accessory 
rooms. 
(13) Bathrooms (tub and shower), 
diet-kitchens, serving rooms and work- 
rooms and other accessory rooms 
should all have outside ventilation 
and should be placed as conveniently 
as possible to the wards to which they 
are respectively accessory. This facili- 
tates good organization and economi- 
cal management. Sinks and hoppers 
should never be placed in dark 
corners, nor where there is not good 
ventilation. 21 
The placing and equipping of a 
kitchen is of great importance. Gas 
and electricity should, if possible, be 
made available for cooking. 
(14) Basements and cellars may be 
divided and subdivided for store- 
rooms, and other suitable purposes. 
Food of every kind should be properly 
classified and stored in or on suitable 
receptacles, placed in cold rooms, re- 
frigerators or other appropriate places. 
The kitchen should not be in the base- 
ment. 
Basements. 
(15) Suitable mortuary rooms must 
be provided. 
Mortuary 
rooms. 
Fire Prevention and Protection. 
(16) The presence of furnaces, 
boilers, engines, stoves and laundry 
machinery in the main building of an 
Institution increases |the danger of 
fire. The laundry should be in a 
separate building, and no living rooms 
should be placed over it. The appli- 
ances for the drying of clothes should 
be of the most efficient description. 
Laundry machinery should have at- 
tached to it all approved guards and 
other safety appliances. If possible, 
the heating plant should also be placed 
in a separate building, or if it appears 
to be necessary to place it in the main 
building the floor, walls, ceiling and 
all the immediate surroundings should 
Furnaces. 
Laundry. 22 
be made fireproof. The coal bins 
should be placed as near the furnaces 
as safety will allow, and the furnaces 
should not be too close to the main 
stairways. 
Boilers. 
All boilers in Hospitals, County 
Houses of Refuge, Refuges, Orphan- 
ages and Infants' Homes will here- 
after be regularly inspected and cer- 
tified by the proper officials. All re- 
quirements must be provided. 
Fireproof 
construction. 
(17) Fireproof construction is now 
regarded as necessary in all new build- 
ings and additions erected for Hospi- 
tals and Public Charities unless these 
are two storeys or less in height. 
Fire escapes. 
In buildings already occupied out- 
side iron stairway fire escapes or 
enclosed "fire-tower" stairways, should 
be so placed in relation to interior 
stairways that sufficient means of es- 
cape from the various parts of each 
floor may be provided. Fire escapes 
should be reached through doors or 
windows cut down to a level with 
the floor and the stairway should not 
descend at an angle of more than 
forty-five degrees and should be of 
such construction as to permit of any 
patient or helpless inmate being 
carried down safely. A sufficient num- 
ber of exits must be provided and 
exits from the first floor and basement 
should be located near the stairway. 
Exits. 23 
No timber inserted in any wall 
shall be placed within nine inches of 
any smoke-flue. Electrical wiring, gas 
pipes and all other appliances must be 
of such a character and in such a 
position that fire-risk is reduced to a 
minimum. All electric wiring must be 
in conduits. 
Electric 
wiring and 
gas. 
7.- (1) In all Public and Private 
Hospitals, Houses of Refuge, Refuges, 
Orphanages, Orphans' Homes and 
other Public Charities, especially 
where the buildings not being of 
recent construction are not wholly or 
even partly fireproof, every care must 
be taken to prevent fire, and every 
preparation must be made so that in 
case of any fire occurring it may be 
extinguished immediately. The lives 
and safety of the inmates must have 
first consideration. 
Precautions 
against fire. 
(2) No gasoline, coal oil, paint or 
other easily inflammable substance is 
to be stored within any Institution. 
Fires in Institutions have sometimesi 
been traced to the accidental ignition 
of such materials as oily rags and 
oiled paper. The greatest care must 
be exercised to prevent any such 
material being left Carelessly about. 
Inflammable 
materials. 
(3) Matches should not be in the 
possession of inmates. Safety matches 
only should be used. 
Matches. 24 
Protection 
of gas and 
stoves. 
(4) No gas jet, gas stove or other 
fixtures should be near or in contact 
with wood, furnishings or other such 
material. Zinc or tin should cover 
and protect walls, tables, woodwork, 
etc., in proximity to such fixtures. 
Swinging gas jets are not to be used 
under any circumstances. 
Candles and 
lamps. 
(5) Candles and lamps must not be 
used unless no better artificial light 
can be had. Electric light should now 
be available and the wiring must be 
properly placed and insulated in con- 
duits so as to avoid fire risk. 
Night watch. 
(6) Except in very small Institu- 
tions with less than twenty inmates 
a night watch or night nurse should 
be employed to guard against fire as 
well as to supervise the inmates. 
(7) All officers, nurses, attendants 
and other members of the staff should 
each have an appointed station and 
duty in the case of fire or fire-drill, 
and all such persons should be required 
to be perfectly familiar with the 
means to be employed to remove help- 
less patients. 
Fire-alarms. 
iTire drill. 
(8) A special fire signal and fire- 
drill in large Institutions are recom- 
mended. 
Chimneys. 
(9) All chimneys should be kept 
clean and swept at least once a year. 25 
(10) In all Institutions approved 
appliances for extinguishing fires must 
be provided on each floor. These are 
(a) chemical fire extinguishers; (6) 
standpipe and hose of sufficient 
length to reach any part of the floor, 
or (c) water pails or fire buckets on 
each floor. Stretchers for carrying 
out helpless persons are requisite. 
Appliances. 
(11) Wide interior stairways, pre- 
ferably of fireproof construction, must 
be provided and placed so that every 
inmate may be quickly and safely 
removed in case of fire. Elevators and 
elevator shafts must be fireproof, and 
must be regularly inspected and cer- 
tified by the proper officials. Fire- 
proof walls and fire-doors should be 
provided. 
Stairways and 
elevators. 
(12) Iron stairways or fire escapes 
of approved construction must be 
placed on the outside of all Hospitals 
and Charitable Institutions. Such iron 
stairways must be joined to iron 
platforms and balconies on each floor 
and easily accessible through a door 
or window. Enclosed " fire-tower " 
stairways, capable of being isolated 
from the rest of the building by fire- 
doors and of fireproof construction 
may also be used. 
Fire escapes. 26 
Sanitation. 
Water and 
drainage. 
8. Water supply, drainage system 
and the system of sewage disposal in 
all Public or Private Hospitals, Houses 
of Refuge, Refuges, Orphanages and 
Infants' Homes, where these systems 
cannot be connected with those of any 
municipality, must be approved of by 
the Provincial Board of Health. 
Garbage.. 
9. Garbage, ashes, dust and other 
forms of dirt and waste should be 
disposed of with promptness and 
rapidity. Basement doors should ibe 
provided so that ashes may be taken 
away in the least laborious and most 
economical manner possible. The col- 
lection of garbage and all other waste 
should be thoroughly supervised so 
that nothing but waste matter shall 
find its way into the garbage tins, and 
this waste should be dry. The garbage 
tins must also have securely-fitting 
lids, and no unpleasant odour should 
be allowed. Everything that can ibe 
burned should be disposed of in that 
way. An incinerator should be a part 
of the equipment of all large Institu- 
tions. Garbage should be removed at 
least once daily, and in no case can 
it be allowed to remain longer than 
three days. Rubbish should never be 
seen either inside or outside any public 
Institution and anything whatever 
that will be liable to attract flies must 
be strictly prohibited. 27 
10. Flies must not be tolerated in 
any Hospital, House of Refuge, Refuge, 
Orphanage, Infants' Home or other 
Public Charity. When flies are seen 
in any public institution their presence 
is always due to culpable negligence. 
Officers of Institutions are always at 
liberty to avail themselves of the 
Government Bulletins on this and 
similar subjects, where full informa- 
tion may be obtained. Attention is 
specially drawn to the importance of: 
Flies. 
(1) Destroying the one or two 
winter flies which are aften concealed 
behind pictures, under furniture, or in 
warm places, such as the kitchen and 
the furnace-room, and destroying at 
once the first flies, that appear in 
spring. 
Winter and 
spring flies. 
(2) Allowing no gabage, manure, or 
other material where flies can breed to 
remain about or near the Institution 
for more than one day in summer or 
three days at other seasons of the 
year. 
Manure. 
(3) Wrapping garbage in news- 
papers or otherwise making it fly- 
proof and using flyproof covers on 
garbage tins. 
Garbage. 
(4) Providing wire screens for 
every window and door, to be placed 
in position in May and kept on as long 
Screens. 28 
as may be necessary. Excellent 
screens have been made by the in- 
mates in some Houses of Refuge. 
Sweeping 
and dusting. 
11. Cleaning, dusting, sweeping and 
all similar processes in any Hospital, 
House of Refuge, Refuge, Orphanage, 
Infants' Home or other Public Charity 
shall be done with due regard to the 
laws of health and sanitation. Dry 
dusting and sweeping cannot be 
allowed, and in every case some effec- 
tive mode of preventing the dust from 
rising and being carried from place 
to place must me employed. Painted, 
stained and polished surfaces and 
those that can be cleaned without hard 
labour are suitable for the floors, walls 
and other parts of public institutions, 
and all carpets and rugs should be 
easy to remove and clean in the open 
air. 
Purchase of 
stores and 
supplies. 
12. The cost accounting of all sup- 
plies, stores, food, drugs, alcohol and 
other things received and used in Hos- 
pitals and Public Charities form an 
important part of the management of 
an Institution. It should be clearly 
understood that the Superintendent is 
responsible for the care and distribu- 
tion of all and each of the above and 
for keeping a record of the same. 
Proper and separate places should be 
provided and used for the safe keep- 
ing of supplies and stores, and as a 
Care of Supplies. 
Stock book 
must be 
kept. 29 
rule they should be under lock and 
key. Poisonous substances should be 
properly labelled, always under lock 
and key, and under the charge of a 
competent person. Supplies should be 
frequently inspected and articles of a 
perishable nature should be refri- 
gerated and otherwise cared for so 
that no waste will occur and that the 
best possible use may be made of 
everything. In purchasing supplies 
regard should be had to season, 
quality, quantity, state of the markets, 
personal inspection, local considera- 
tions and all other suitable and 
advantageous matters, and the relative 
merits of open purchase and tender 
should not be forgotten. Eggs and 
butter may often with great! advantage 
be contracted for about June 1st of 
each year. Supplies received should 
be carefully weighed on scales and 
checked over to prevent mistakes. 
Fruit, vegetables, meat, poultry, 
dairy products and all other farm and 
garden products, should be, as far as 
possible, produced and supplied for 
each Institution from its own garden 
or farm. 
Care of 
stores and 
supplies. 
At the end of each month a record 
of the cost of food supplies per in- 
mate should he made and reported to 
the Board of Management. 30 
Beds. 
Beds. 
13. All beds for use in Hospitals 
and Public Charities should be of 
standard length, height and width (6 
ft. 3 in. x 3 ft. x 25 in.) and for the use 
of one person only. They should be of 
metal, constructed at Ontario Refor- 
matory Industries, and should be 
furnished with springs attached to 
metal sides of bed, a mattress, properly 
protected, and sheets (which should 
be changed at least every alternate 
week) and a sufficient quantity of 
warm bedclothing. Cots for infants 
and young children may be of smaller 
size and lower in proportion. 
Admission 
of inmates. 
14. On admission to any Hospital, 
House of Refuge, Refuge, Orphanage, 
Infants' Home or other Public Charity 
an inmate should receive a full bath, 
and his or her clothing should be 
fumigated, if necessary. 
Baths. 
All inmates should have a full bath 
at least once a week, and there should 
be at least one bath for every ten or 
twelve inmates. Shower baths should 
be provided for men in every institu- 
tion. 
Disinfection, 
rules for. 
The instructions on disinfection 
issued by the Provincial Board of 
Health of Ontario should be followed 
whenever disinfection is required. The 
simple method of generating gas by 
pouring formaldehyde solution over 
Formaldehyde 
-perman- 
ganate of 
potash method 
recommended. 31 
the crystals of potassium perman- 
ganate in an open vessel is strongly 
recommended. It has the advantage 
of absolute simplicity in operation, 
requires no special apparatus, nor the 
use of fire, and in practice has -been 
found to be unusually efficient. 
15. The condition of these sanitary 
conveniences is always important and 
nothing more clearly indicates the 
standard of cleanliness and the faith- 
fulness with which proper supervision 
is carried out. Toilets should be 
easily accessible and should have out- 
side cross ventilation. At least one 
toilet should be provided for every 
ten or twelve persons. In the case of 
the aged and young children one toilet 
should be provided for every eight or 
nine inmates. Inattention to such 
matters causes suffering and distress. 
Toilets should always be private and 
properly screened. 
Toilets. 
16. In Hospitals or Public Charities 
where the aged or young children or 
infants are cared for the temperature 
should not be allowed to fall below 
68° to 70°. Thermometers should be 
placed in the different wards ana 
dormitories. Bathing and dressing in 
the case of the aged or infants should 
be attended to in a room where the 
temperature is about 70°. Means of 
external warmth, such as hot-water 
Heating. 32 
bottles, are essential to the proper care 
of young infants. At night, if such 
means of external warmth are pro- 
vided, the temperature of sleeping 
rooms and dormitories may be from 
60° to 65° in the case of infants and 
the aged. For robust and healthy 
persons a temperature of about 60° to 
65° in the daytime and 55° to 60° at 
night is preferable. 
Temperature. 
Family Life. 
Visitors. 
17. It is important that inmates of 
Hospitals and Public Charities should 
be kept in touch as far as it is possible 
consistently with their own best 
interests with the outside world. 
Suitable opportunities should be made 
for visitors and friends of the inmates 
to visit the Institution, and the 
relatives and friends of any inmate 
should at once be notified of illness, 
accident or any other important event 
happening to such inmate. It is 
especially necessary that children 
should be kept in touch with the out- 
side world, so that they can take their 
part in normal family life as soon as 
possible. Orphanages, Infants' Homes 
and other Public Charities for children 
are not to be looked upon as places 
where children are to remain from 
year to year. They should, if possible, 
be sent to Public (Schools where they 
will associate with children other 
than those belonging to the Institu- 33 
tion. An Institution is merely a place 
where children are cared for and 
sheltered for a brief period until they 
can be replaced in their own homes or 
a home found for them. It is a grave 
wrong to a child to deprive him or 
her of the best preparation for life, 
which can only be given in a home 
and to a member of a family circle. 
The one great exception to this rule 
is the feeble-minded child. Under no 
circumstances should such children be 
sent out to homes where they will only 
do great harm to themselves and 
others. Provision should be made 
for such children by the school authori- 
ties of the municipality. 
In connection with all these matters 
it is of very great importance that a 
correct and full record of the history 
of each child should be kept. 
Family 
training 
18. Any grave or alarming symptoms 
of illness in, or serious accident to any 
patient, inmate, orphan, child, infant 
or other resident in any Hospital or 
Public Charity must ibe reported at 
once to the physician in charge and 
also to the Superintendent, and it shall 
be the duty of the Superintendent to 
cause the friends of such inmate or 
resident to be informed at once of 
such condition or occurrence. 
Serious 
illness. 
19. Any death occurring in any Hos- 
pital or Public Charity shall be noti- 
Deaths. 34 
fled immediately to the Superinten- 
dent, and it shall be the duty of the 
Superintendent at once to inform the 
friends of the deceased or the respon- 
sible authority or person by whom 
he or she was placed in the Institu- 
tion, in writing, of such death and to 
see that every attention and respect 
is paid to the remains and that the 
body is properly prepared and clothed 
before being removed from the insti- 
tution. The coroner must be notified 
of any death which there is any reason 
to suspect was due to unnatural 
causes. Facilities should be afforded 
for pathological work. Autopsies 
should be permitted with the approval 
of the Superintendent and friends of 
the deceased. 
Religious 
services 
and recrea- 
tion. 
20. Clergymen of the different 
churches and other church workers 
should at all suitable times be wel- 
come visitors to public institutions 
and every opportunity should be given 
to the inmates to attend religious ser- 
vices from time to time. All reason- 
able recreations, such as reading, 
playing games, music, open air walks 
and other enjoyments in the grounds 
and in the open air are to be encour- 
aged. Where at all possible rooms 
should be provided for play, rest and 
recreation. 
Indoor and 
outdoor 
recreation. 
21. Provision shall be made in exist- 
ing Institutions as directed by the 35 
Inspector, and in all buildings and 
Institutions hereafter constructed, for 
suitable indoor recreation and living 
rooms in addition to rooms used for 
dormitories and refectories, and there 
shall also be adequate grounds and 
outdoor facilities for change and 
recreation. 
The Feeble-minded. 
22. There are found in all Hospitals 
and Houses of Refuge, Orphanages, 
Infants' Homes and other Public 
Charities persons who are so feeble- 
minded that they are not able to care 
for theqiselves. These should be 
reported immediately on admission to 
the Inspector of Feeble-minded, Parlia- 
ment Buildings, Toronto, so that steps 
may be taken to have the municipality 
to which these feeble-minded children 
or adults belong make provision for 
the same in order that they may have 
proper custodial care and be prevented 
from propagating their species. 
Mentally 
defective 
persons must 
have strict 
custodial 
care. 
Recreation and Home Comforts for 
Officers and Staff. 
23. In all Institutions it is desirable 
that in addition to separate bedroom 
accommodation for domestic employees 
a sitting-room should be provided. It 
is also required that two weeks' holi- 
day in the year, and some time off 
duty during the day, in addition to 
time for meals, should be given, and 
Employees' 
rooms. 
Holidays. 36 
that a record of this should be open 
to inspection. Bedrooms for men-ser- 
vants and women-servants should be 
in different parts of the building and 
proper and separate toilet and bath 
accommodation must also ibe provided. 
Rooms for 
staff. 
24. The accommodation assigned to 
the Superintendent, officers and staff 
who make their home in the Institu- 
tion should be of the most comfortable 
and convenient character consistent 
with the work, needs and financial 
position of the Institute. In Hospitals 
and other Institutions where nurses 
and others are on duty at night care 
should be taken to provide sleeping 
accommodations for them during the 
day in a quiet part of the building and 
never in beds that have been occupied 
during the previous night. Each 
officer and nurse should have a separ- 
ate bed-room. 
Night 
nurses. 
Hours. 
The hours of work for members of 
the staff should be arranged so as to 
allow sufficient time for meals and an 
hour or two off duty every day 
between 7.00 a.m. and 7.00 p.m. Nurses 
should never be on duty more than 
twelve hours out of the twenty-four 
and should have an afternoon off duty 
each week. The eight-hour system is 
on trial. A reasonable vacation should 
be allowed to each member of the staff 
during the year, a satisfactory substi- 
tute being provided by the manage- 
ment, if necessary. 37 
Additional Regulations for 
Hospitals. 
25. The standard of Hospital ac- 
commodation for cities of 100,000 popu- 
lation is at least five beds for every 
1,000 inhabitants, for a corresponding 
number in smaller cities, four or five 
beds, and in towns three or four beds. 
The modern tendency is to decrease 
the number of beds in each ward to 
12 or even 6. A Hospital, either Pub- 
lic or Private, shall be deemed to be 
any building or other place where the 
sick or injured are received and 
treated or where maternity patients 
are cared for. 
Hospital 
accommoda- 
tion. 
Definition. 
For every Hospital there shall at 
all times be a chief executive officer, 
appointed by the Board of Governors 
or other responsible authority, resi- 
dent on or near the premises, who 
shall be responsible for the general 
conduct and management of all the 
affairs of the Hospital and shall be 
known as the Superintendent thereof. 
Superin- 
tendent. 
On appointment of such Superin- 
tendent a statement of his or her 
qualifications shall be notified to the 
Inspector by the Secretary of the Hos- 
pital within seven days of the date 
of such appointment. 
26. Nurses must not be overworked. 
From five to seven patients, according 
to circumstances, should be the limit 
Nurses. 
Number to be 
employed. 38 
of ordinary ward work for a nurse, 
except in typhoid fever, when no nurse 
should have more than two patients. 
Health 
centre. 
Chaplains, visitors, social service 
officers, paid and voluntary, and other 
outside officials may be appointed at 
the will and discretion of the respon- 
sible authority or governing body, and 
every effort shall be made by all Hos- 
pitals through their Governors, Staff 
and Officers, not only to cure and re- 
lieve the patients, but to be an edu- 
cational health centre for the com- 
munity and to co-operate with other 
benevolent agencies in effective social 
service. 
Medical Advisory Board. 
Medical 
Advisory 
Board. 
27. Every Hospital receiving aid 
under The Hospitals and Charities 
Institutions Act shall, in addition to 
the Board of Governors, or Board of 
Trustees, have a Medical Advisory 
Board of not fewer than five mem- 
bers of the Medical staff of the Hospi- 
tal. selected by themselves, whose duty 
it shall be to advise the Board of 
Governors or other governing body of 
the Hospital on all matters affecting 
the Hospital which may have any 
reference to or ibearing upon medical 
or professional matters, and whose 
advice shall be laid before the Board 
as often as may be necessary, but not 
less frequently in any case than once 
during the year. 39 
Dispensing of Drugs. 
28. No nurse or other person in any 
hospital or charitable institution in 
Ontario shall be allowed, without the 
special order of a legally qualified med- 
ical practitioner, and then only under 
exceptional circumstances in an emer- 
gency, to prescribe, dispense or com- 
pound Morphine, Strychnine, Arsenic, 
Aconite, Digitalis, Atropine, or other 
poisonous drugs, but a nurse may, 
when necessary, be permitted to dis- 
pense the remedies named in sub-sec- 
tion A of Section 28 of The Pharmacy 
Act, Chapter 164, R.S.O. 1914. 
Dispensing 
of medicines. 
Admitting Department. 
29. Every Public Hospital receiving 
aid under the Hospital Act 
should provide and set aside one or 
more suitable wards or rooms properly 
equipped and furnished, to be known 
as an Admitting Department or Obser- 
vation Ward, and every Superinten- 
dent or other Officer, upon receiving a 
new patient, for admission to such 
Hospital, should before admitting such 
new patient to contact with the other 
inmates or patients, cause him' or her 
to be placed in such Admitting Depart- 
ment until he or she has been seen 
and examined by the physician on 
duty and certified by such physician 
to be free from any communicable 
disease. Such certificate shall include 
Observation 
wards. 40 
a statement in the case of children as 
to the bacteriological report of a cul- 
ture taken from the throat of such 
new inmate or patient. Sections 19 
and 20 of the Act relating to the neces- 
sity of hospitals admitting all patients, 
not suffering from a communicable 
and notifiable disease, are applicable 
only to patients residing in the Prov- 
ince of Ontario. 
Supply of 
vaccine to be 
kept on hand. 
Every such hospital shall also keep 
at all times an adequate supply of 
vaccine matter in accordance with the 
provisions of the Vaccination Act. 
Non-paying 
patient. 
30. A non-paying patient is a 
patient who is admitted and cared for 
free except what is contributed to his 
or her support by the municipality, 
but in no case shall a patient be 
classed as a non-paying patient if a 
gratuity, bequest or gift is received 
by the hospital in lieu of any charge 
that might have been made. 
Payment for Patients. 
Indigent 
patient. 
31. An indigent patient must be con- 
sidered as one without means to pay 
at least one dollar per day for Hospi- 
tal care and treatment at the time of 
his admission, having regard not only 
to the patient's available means, but 
also to those dependent upon; the 
patient at home. 41 
The Hospital Act provides (section 
23) that for any charges paid by a 
municipal corporation the patient or 
his executors or administrators shall 
be liable as for a debt due to such 
municipal corporation. 
" Resident " as applied to a muni- 
cipality shall mean and include any 
person who has resided in such muni- 
cipality continuously for three months 
or who not having resided therein 
continuously for such three months 
was actually employed therein immedi- 
ately prior to being admitted to any 
hospital. 
Resident. 
32. Any person who within a month 
previous to his admission to a Hospi- 
tal was employed as outlined in sec- 
tion 7 of section 23 of the Act relat- 
ing to Hospitals shall be deemed an 
employee as named in the above- 
mentioned section. 
Employee. 
33. When an indigent patient is 
admitted to a Hospital without a 
municipal order for such admission, or 
when no arrangement has been made 
by the municipality for the care of 
its indigents at that hospital, a printed 
notice in accordance with section 23 
of the Act relating to Hospitals should 
be sent in the following form: 
Indigent. 42 
Notice to 
municipalities. 
Name of Hospital. 
Location 19 
To the Clerk of the Municipality of 
You are hereby notified that 
who represents self as being a 
resident of the Municipality of 
was admitted as a patient to 
the above-named Hospital on the 
day of 19 
The ages of the said is 
stated to be year. 
The said has been a resident 
of your Municipality for the past , 
residing at 
The said is an indigent 
person under Provincial Regulations 
for Hospitals and under the provi- 
sions of the statute in that behalf 
made and provided the Municipality 
of is liable to pay 
to this Hospital the charges for the 
treatment of the said patient at a rate 
of $1.50 per day and in case of death 
to pay burial expenses. 
Unless within fourteen days after 
the mailing of this notice you notify 
the Superintendent of the Hospital by 
registered post that such patient is 
not a resident of the said Municipality, 
with a satisfactory proof thereof 
will be deemed to be a resident of it. 
Yours truly, 
Superintendent. 43 
All accounts for maintenance of a 
patient in a Hospital or Sanatorium 
for Consumptives must be rendered to 
the Municipality every three months 
and shall then become payable. 
Accounts. 
Provincial Grants. 
34.- (1) An annual Provincial grant, 
as fixed from time to time by the 
Lieutenant-Governor in Council, is 
made for all patients in a hospital 
during the first ten years of its 
existence irrespective of what sum is 
contributed by the patients them- 
selves. 
Grants. 
(2) After a hospital has been in 
existence for ten years the grant is 
paid only for patients for whose main- 
tenance $10.50 per week, or less, is 
contributed. 
Non-paying 
patients. 
(3) In all cases the limit is 120 
days, and if patients remain in the 
hospital longer than that period, the 
Refuge rate of ten cents per day is 
allowed. 
Time limit. 
(4) Patients admitted and dis- 
charged on the same day are not 
allowed for. 
One day. 
(5) The day of departure must not 
be included in the number of days' 
stay of any patient. 
Last day. 44 
(6) Monthly returns, on forms sup- 
plied by the Inspector, showing admis- 
sions, discharges and deaths during 
the month, must be forwarded to the 
Department on the first day of each 
month. These are tabulated at the 
Department and form the basis upon 
which the Provincial grant is allotted 
to each Hospital according to the 
number of days' stay of patients. 
(7) Patients should not be entered 
on the monthly " Discharge " sheets 
until they are actually discharged from 
the hospital wards; nor should they 
be entered as discharged at the end 
of the fiscal year (30th September) 
if they are still remaining in hospital. 
Discharge. 
Inspection. 
(8) No Provincial grant shall be 
paid to any Hospital or Charitable 
Institution unless the Inspector reports 
that all the requirements, such as 
accommodation, ventilation, discipline, 
management, etc., have been found on 
inspection to be perfectly satisfactory. 
(9) In the case of the death of a 
patient the name and number of days' 
stay should not be repeated by an 
entry on both the "Discharge" sheet 
and the "Death" sheet. Report the 
same on the "Death" sheet only. 
Death. 
(10) The checking of the monthly 
Returns in the Inspectors' Depart- 
ment would be greatly facilitated if 
N umbers. 45 
the marginal numbers opposite the 
names of the patients were made to 
correspond on the Admission and 
Discharge sheets. For example, the 
number given to a patient on the 
Admission sheet should also be the 
number given to the same patient on 
the Discharge sheet, or Death sheet, 
as the case may be. 
(11) The columns in the Monthly 
Returns showing the days' stay of 
patients should be added up at the 
foot of each page and the totals 
carried forward to the end. 
Totals. 
Tuberculous Patients. 
35. All Hospitals receiving public 
aid shall admit and care for patients 
having tuberculous disease who apply 
for admission thereto, provided there 
is no Sanatorium for Consumptives in 
the County in which the Hospital is 
located, and shall treat and isolate 
them as may be necessary in their best 
interests and in the best interests of 
others, and such patients shall not be 
discharged except when improved or 
cured so as to be able to care for 
themselves, unless their immediate 
and comfortable removal to a Sana- 
torium has been provided for. In no 
case, however, shall the number of 
patients having active tuberculous 
disease exceed five per cent, of the 
total capacity for patients at any 
single Hospital. 
Tuberculous 
patients. 46 
Maternity Wards. 
Maternity 
patients. 
36. Maternity patients and their 
young infants shall in no case be 
placed in wards along with other 
patients, but shall be placed in a 
suitable and separate ward, and a 
properly equipped room for accouch- 
ment shall ibe provided and also a 
nursery where the infants may be 
cared for which shall have, if possible, 
a southern exposure and a balcony or 
other outdoor ward attached. 
In small hospitals a private ward 
may be temporarily utilized for a 
maternity ward, if necessary. 
Feeding of 
infants. 
37. In all Maternity Hospitals, in- 
fants must be nursed by their mothers. 
Members of the nursing and medical 
staff, especially the head nurse of the 
Maternity Ward, must in future give 
personal attention to this matter, and 
secure it as a first consideration in 
infant care, as it often means the 
infant's life. Only on a written order 
stating the cause which prevents the 
mother from nursing her child, signed 
by the Hospital Superintendent and 
the attending physician in the Mater- 
nity Ward or Hospital, is this regula- 
tion to be set aside. Infants must be 
fed and nursed at regular hours 
according to a schedule. In excep- 
tional cases where an infant cannot 
be nursed by the mother, the feeding 
of such infant should be under the 47 
direction of a physician and the rules 
of surgical cleanliness mlust be 
observed in the care of the feeding- 
bottle and nipple and of the care and 
preparation of the milk. No person 
or persons shall take away or cause 
to be taken away a newborn or young 
infant from his or her mother, thus 
interfering with the child's right to 
life and health. 
Dietary. 
38. Great care and attention shall be 
given to the food provided for the 
patients and also for the officers, 
nurses, staff and employees in every 
Public Hospital to secure: - 
Dietary. 
(1) Proper nutrition of the patients 
and others under the direction of the 
medical staff and dietitian. 
Nutrition. 
(2) Careful and economical pur- 
chasing and storing. 
Economy. 
(3) Appetizing and skilful prepara- 
tion and cooking with perfect cleanli- 
ness and proper serving. 
Preparation 
(4) The avoidance, as far as pos- 
sible, of monotonous or routine 
arrangement of the daily menu. 
Domestic Science must he regarded 
hereafter as a necessary part of a 
nurse's practical training, and to that 
end each Hospital of 40 beds or more 
must have a regularly qualified dieti- 
tian. 
Variety. 48 
Social Service. 
Clothing 
and shelter. 
39. It shall be the duty of the Hos- 
pital, through its Social Service 
Department or otherwise, as the 
Superintendent may direct, to see that 
patients discharged from the Hospital 
are properly clothed, and also, 
especially if they are strangers or 
foreigners, that they have somewhere 
to go, unless they are fully recovered 
and furnished with money or employ- 
ment. 
Furnishing 
and equip- 
ment. 
40. Wards, operating-rooms, kitchens 
and all other rooms shall be furnished 
and equipped in a simple but suitable 
and adequate manner. 
Furnishing and Equipment. 
Additional Regulations for Private 
Hospitals. 
41. A Private Hospital shall be 
deemed to be a house in which two 
or more patients are received and 
lodged at the same time. 
Section 27 of The Hospitals and 
Charitable Institutions Act provides 
as follows: - 
License. 
" No house shall be used as a Pri- 
vate Hospital except under the 
authority of a license issued by the 
Provincial Secretary under the Act. 
Penalty. 
" If any house is used as a Private 
Hospital in breach of this section the occupier and all persons concerned in 
the management of the Hospital shall 
severally incur a penalty not exceed- 
ing twenty-five dollars ($25.00) for 
every day during which such use is 
continued." 
49 
42. Every house used as a Private 
Hospital shall be reasonably clean, 
well ventilated, comfortable, and 
suitably furnished, and otherwise 
properly managed and conducted, and 
no room or apartment of the same 
shall be allowed to be untidy or un- 
sanitary or neglected or lacking in 
cleanliness in any way. 
Condition 
of house. 
43. Every patient in a Private Hos- 
pital shall have a separate bed for 
his or her own use, and every infant 
or child in a Private Hospital shall 
have a separate bed or cot for his or 
her own use. 
Bed. 
44. No person or persons in any 
Private Hospital shall give to any 
infant, child or other patient any 
medicine or drug or any alcoholic 
liquor without the order of a legally 
qualified physician. 
Drugs. 
Every infant under nine months of 
age in a Private Maternity Hospital 
shall be nursed by his or her mother 
and as in Regulation 37 abov<> except 
that the signature of the ^Medical 
Feeding of 
infants. 50 
Officer of Health of the Municipality 
or his Deputy shall be required instead 
of the signature of the Hospital 
Superintendent. No person or persons 
shall take away or cause to be taken 
away a newborn or young infant from 
his or her mother, thus interfering 
with the child's right to life and 
health. 
Returns. 
45. Accuracy and exactness in all 
returns is required. Any inattention 
to this matter is illegal and subject 
to serious penalties. This applies to 
any failure or omission to enter 
immediately the name of any patient 
admitted or of any operation what- 
ever performed. 
Penalties. 
Section 38 of The Hospitals and 
Charitable Institutions Act is as 
follows: - 
" Every person who knowingly 
makes in the Register an untrue entry, 
shall incur a penalty not exceeding 
$200.00. 
" Every licensee who fails to make 
or cause to be made any entry in the 
Register required by this Act to be 
made therein, shall incur a penalty 
not exceeding $50.00." 51 
Additional Regulations foe Houses 
of Refuge, Refuges, Orphanages, 
Infants' Homes and Refuges for 
Women, Including Maternity Hos- 
pitals± 
46. For every House of Refuge, 
Refuge, Orphanage or Infants' Home 
or other Public Charity there shall at 
all times be a Chief Executive Officer, 
appointed for Houses of Refuge by 
the County Council and in other 
Institutions by the Board of Directors, 
Board of Management or other proper 
authority, who shall be resident on 
the premises, and shall be known as 
the Superintendent or Matron of such 
Refuge, Orphanage or Infants' Home, 
and shall be responsible for its general 
conduct and management and shall 
make written reports thereon to the 
proper authorities as directed. The 
appointment of such Superintendent 
or Matron shall be notified to the 
Inspector by the Secretary of the 
Institution within seven days of the 
date thereof. 
Superin- 
tendent. 
47. The Superintendent of every 
Refuge, House of Refuge, Orphanage, 
Infants' Home or other Public Charity, 
shall be assisted by such Assistant 
Superintendent, Matron, Housekeeper, 
Nurse, Orderly, Attendant, domestic 
or other employee or employees as 
shall be necessary, proper and suffi- 
'Officers and 
employees. 52 
cient to secure to the inmates, orphans 
and infants due and proper care and 
attention as to their personal cleanli- 
ness, health, nourishment and reason- 
able comfort, both iby day and night, 
and shall to this end set apart a 
suitable ward, room or rooms for the 
care of such inmates as are less able 
to care for themselves, under the 
charge of a nurse or nurses. 
Physicians. 
Physician. 
48. Every House of Refuge, and also 
every Refuge, Orphanage or Infants' 
Home or other Public Charity shall 
have attached to it a legally qualified 
Physician or Physicians to have the 
care of the health of the inmates of 
such Institution, and such physician 
shall visit such Institution at least 
once a week, or oftener if necessary, 
and shall thoroughly examine and 
inspect the entire Institution and 
report in such form as may be 
required, to the Board of Management 
of such Institution, the condition of 
the health of the inmates, orphans, 
infants or other children, and the 
existence or non-existence, as the case 
may be, of any communicable disease 
among them, and shall also report as 
to their food, clothing, cleanliness 
and reasonable comfort, and as to 
whether they are properly cared for, 
and in the case of infants, orphans 
and other children or younger adults 53 
whether they are being kindly and 
carefully trained and educated, with 
recommendations. 
Such physician shall also report 
upon the general condition and clean- 
liness of the building, especially as to 
baths, sanitary conveniences of any 
and every kind, dormitories, refec- 
tories, sitting-rooms and other rooms, 
plumbing appliances and other provi- 
sions and accommodation. 
49. Great care and attention shall be 
given to the diet of the inmates, 
orphans, infants and staff in Houses 
of Refuge, Refuges, Orphanages, 
Infants' Homes and all other Public 
Charities and Maternity Hospitals, so 
as to secure: 
Dietary. 
Dietary. 
(1) Careful and economical produc- 
ing, purchasing, preparation and stor- 
ing of supplies. 
Economy. 
(2) The avoidance, as far as possible 
of monotonous or routine arrange- 
ment of the daily menu, and the 
presenting of a suitable variety of 
diet. 
Variety. 
(3) Appetizing and skilful prepara- 
tion and cooking, with perfect cleanli- 
ness and good serving, so that the best 
results may ibe obtained from the good 
food provided by the responsible 
authorities and that none of it may be 
wasted. 
Preparation 54 
Nutrition. 
(4) Proper nutrition of the inmates, 
having regard to their age and con- 
dition. This food for all should be 
plain, simple, wholesome and nutri- 
tious, but the aged require food which 
is appetizing and easily digested, but 
not too coarse or heavy. On the other 
hand, children require an abundance 
of plain, simple wholesome food and 
must be taught how to thoroughly and 
slowly masticate their food, and should 
also learn how to help themselves and 
others at the table properly and 
courteously. Everyone needs a drink 
of water between meals once or twice 
a day. 
The aged. 
Children. 
(5) That children from nine months 
to two or three years of age should 
begin to learn the proper way to eat, 
beginning with a crust of bread when 
they have six or more teeth and 
gradually having their diet list added 
to, not being kept on soft food too 
long, as this is a serious disadvantage. 
Feeding of 
infants. 
(6) Every infant must be nursed by 
the mother till such infant is about 
nine months of age, unless the Medi- 
cal Officer of Health of the Munici- 
pality or his Deputy and the Physician 
in charge of the Institution gives an 
order in writing to the contrary, with 
reasons, in a book kept specially for 
the purpose. Under special circum- 
stances, to be recorded in the same 55 
book and with an order in writing 
signed as above, an infant may be 
weaned at six months of age. Great 
attention should be paid to the in- 
crease of weight, or otherwise, in 
infants under one year and a record 
of this should be kept unless the baby 
is evidently thriving. Infants must 
be nursed and fed at regular hours 
according to a schedule. In excep- 
tional cases, where an infant cannot 
be nursed by the mother the feeding 
of such infant must be under the 
direction of a physician, and the 
rules of surgical cleanliness must be 
observed in the care of feeding- 
bottle and nipple, and in the care 
and preparation of the milk, and the 
infant must bp held in the arms of 
the mother or nurse during the feed- 
ing, which should take about fifteen 
or twenty minutes, in order that the 
feeding should be successful. 
50. Houses of Refuge, Refuges, 
Orphanages, Infants' Homes and other 
Public Charities should have a country 
location, and should, especially in the 
case of Homes for Children, adopt as 
far as possible the cottage system of 
construction for new buildings. These 
cottages should be simple and com- 
fortable but inexpensive in construc- 
tion and furnishing. The number of 
inmates in each cottage should be 
about forty and should not in any case 
Site and con 
struction. 56 
exceed sixty, and every effort should 
be made to foster the home spirit and 
family ideals by placing in charge of 
each cottage a house mother or Matron, 
and by developing a good and kind 
character and spirit among the in- 
mates, towards each other, and to- 
wards the Institution. In the case of 
boys one of the men appointed on the 
staff should also reside in each cottage 
and have general charge of the dis- 
cipline. The mending, general house- 
work, reading, recreation and sleeping 
for the Inmates of each cottage should 
be provided for in the several rooms 
arranged for the purpose in each cot- 
tage, and suitable rooms should also 
be provided therein for the resident 
officers of the cottage and their assist- 
ants, if any. 
Farm and 
garden. 
51. Public Charities should in every 
case be placed, if possible, within 
grounds providing cultivable land for 
kitchen gardens, flower gardens, fruit 
orchards, lawns and farm work, hav- 
ing regard to the profitable outdoor 
occupation and training, and the best 
interests of the inmates and to due 
economy in regard to food supplies 
and other matters, the inmates con- 
tributing as far as possible to their 
own support. 
One acre per 
inmate for 
Refuges. 
52. Houses of Refuge, etc., should be 
amply provided for iby an amount of 
land equal to one acre per inmate. 57 
53. The Cottage (two-storey) system, 
with central kitchen and dining-rooms, 
separate heating plant, laundry, and 
storehouses with refrigerator accom- 
modation has been found most suitable 
for Charitable Institutions where clas- 
sification of inmates is desirable. In 
such Institutions there should be an 
administration building, where the 
offices, school-rooms and chapel or 
hall and other rooms for general use 
should be placed. 
Cottage 
system. 
Additional Regulations for County 
Houses of Refuge and Other 
Refuges. 
54. Houses of Refuge and other 
Refuges require grounds and many of 
the inmates can be usefully employed 
at outdoor occupations. The ideal 
House of Refuge is a comfortable 
Home, in which each inmate does all 
that he or she can according to age 
and ability to promote the general 
happiness, comfort and thrift and con- 
tributes something to the proper work- 
ing, care and maintenance of the 
House as being his or her own house. 
These Homes are not to be regarded 
in any sense as Poor Houses, which 
are believed to be opposed to the 
genius of the Canadian people. They 
are County Houses, or City Houses, 
provided by the community until our 
present social system shall have 
developed and improved far enough 
Occupation 
House of 
Refuge. 58 
Infirmary. 
to render such Homes and Refuges 
unnecessary. In every such Public 
Charity there shall be provided a 
quiet and comfortable ward or infirm- 
ary for men, and a similar ward or 
infirmary for women, in which in- 
mates who may at any time be ill or 
infirm may ibe cared for, and each 
Refuge must have a competent nurse 
to care for the sick and carry out the 
directions of the matron. The coroner 
must be notified immediately of any 
death occurring in the House of 
Refuge. 
Occupation. 
55. It shall be the duty of the 
Superintendent to provide, as far as 
possible, suitable work and occupation, 
both outdoor and indoor, for every 
inmate able to work, the younger and 
stronger inmates caring for the older 
and more helpless, as well as doing 
in a thorough and systematic manner 
all the general housework, but not so 
as to overwork any one. 
Outdoor 
instruction 
and recrea- 
tion. 
56. Every Institution having the 
care of inmates from 15 to 55 years 
of age shall provide for each such 
person at least three hours per day 
of physical work, exercise and recrea- 
tion, and industrial training, and 
education, such as gardening, farming, 
poultry raising, beekeeping, dress- 
making, mending, sewing, cooking and 
general housework. 59 
57. The By-laws of every House of 
Refuge must provide for committing 
and detaining therein indigent per- 
sons; and a warrant of committal to 
a House of Refuge shall be sufficient 
authority for the Superintendent to 
receive and detain the person men- 
tioned until he or she is discharged 
by a similar order, or by order of one 
of the Inspectors of Prisons and Pub- 
lic Charities. No indigent person 
shall be refused admission on account 
of a break of less than two years in 
his residence in such County. No 
child shall be an inmate of a House 
of Refuge nor reside as an inmate in 
any Institution where adults are cared 
for. 
Committal. 
No children 
in Refuges 
for adults. 
58. A careful and detailed account 
must be kept in a book provided for 
the purpose, of any punishment or 
restraint ordered by the Superinten- 
dent for any of the inmates, with 
exact dates and reasons therefor. 
Restraint. 
59. Due and proper measures must 
be taken to secure separate accommo- 
dation and occupation for men and 
women in Houses of Refuge. Super- 
vision should be constant and effective. 
Communication should not ibe allowed. 
Married couples should have rooms 
provided in a separate part of the 
House. Special attention should be 
given to inmates who are feeble- 
Supervision. 60 
minded or unable, for any reason, to 
take proper care of themselves. 
Tuberculous 
inmates. 
60. If any inmate of a House of 
Refuge is found to be suffering from 
tuberculous disease, such inmate must 
be isolated and due precautions taken 
for his or her care under the direction 
of the Physician to the House of 
Refuge, and he or she must be re- 
moved to a Sanitarium for Consump- 
tives as soon as possible. 
Furnishing. 
61. Houses of Refuge must be 
adequately and comfortajbly furnished. 
Clothing 
and general 
care. 
62. The clothing and personal hy- 
giene of all inmates in the House of 
Refuge shall at all times be under 
the special care and supervision of 
the Superintendent and (Staff of the 
House, and they shall endeavor to pro- 
vide in the best manner possible, 
according to their judgment, for suit- 
able and adequate clothing and for 
preserving the self respect of the 
inmates. The hair of the women 
should be well cared for and not cut 
short unless by special request and 
necessity, and the personal hygiene 
and comfort of both men and women 
should be considered and promoted in 
every way. 
Religious 
and social 
duties. 
63. Religious services, recreation, 
and social enjoyments as far as pos- 
sible should be arranged for and 
favored by the Superintendent and 61 
Staff, and grace should always be said 
before meals, either by one of the 
officers or one of the oldest inmates. 
Additional Regulations foe Refuges 
for Women, or Maternity Hospitals 
Where Mothers and Infants are 
Cared for. 
64. Refuges, Private Hospitals or 
other places where needy or deserted 
mothers, married or unmarried, are 
cared for, should be in close touch 
with the outside world both as regards 
receiving and placing out inmates. 
Whenever a new inmate is received, 
the Superintendent or field-worker 
should make a confidential, sympa- 
thetic and thorough private study of 
her social and industrial possibilities 
and should with the aid of all interested 
endeavor to make the very most of 
her character and capacities, and of 
the help of any one who has befriended 
or will befriend her or is responsible 
for her and for her child, especially 
the father of the child. 
Family- 
building. 
65.- (1) Every infant in such 
Refuge or Maternity Hospital must be 
nursed by the mother, and if any 
mother applies for admission to such 
Refuge or Private Hospital for her- 
self and her infant under six months 
of age or if any other person shall 
make such application on her behalf, 
Feeding of 
infants. 62 
and such mother is not nursing such 
infant, the case shall forthwith be 
reported (form A, 1 and 2) by the 
Superintendent to the Medical Officer 
of the Municipality, or his deputy, 
with full particulars, name of mother 
and child, place where the birth 
occurred, name of physician and nurse 
in charge and the reason why the in- 
fant was not properly nursed by the 
mother, and such mother and child 
shall be admitted to the Refuge or 
Hospital temporarily only until the 
Medical Officer of Health of the Muni- 
cipality after enquiry directs other- 
wise, and a proper entry (see above) 
of the name of mother and infant 
shall at once be made. No person or 
persons shall take away or cause to 
be taken away a new born or young 
infant from his or her mother, thus 
interfering with the child's right to 
life and health. 
Object. 
(2) The object of these Homes must 
always be to provide care for both the 
mother and the infant, and the system 
of taking an infant for a certain sum 
of money and agreeing that no further 
questions will be asked is wrong and 
must be condemned. 
Infant 
without 
mother. 
(3) If any person or persons apply 
to such Refuge for admission for an 
infant under six months of age and 
that infant is not accompanied by the 63 
mother, such application shall forth- 
with be reported to the Medical 
Officer of Health of the Municipality 
or to his deputy appointed for such 
purpose, and it shall be the duty of 
such officer or his deputy forthwith 
to see such person or persons and the 
mother, if living, and to make a con- 
fidential enquiry into all the circum- 
stances of the case, including name 
and address, place of birth, name of 
attending physician and nurse, and 
keep a confidential record (Form B, 
1, 2) thereof, one copy of which shall 
be kept on file at the Institution and 
the other at his office, and such infant 
shall be admitted temporarily only, 
until the Medical Officer of Health 
directs otherwise, and proper entry 
(see above) of the name of the in- 
fant shall at once be made. 64 
Form A 1 
(To be kept in Institution.) 
Name of Institution 
Place Date 
p.m a.m. 
To the Medical Officer of Health of 
I beg to inform you that: 
'-'03 r».jy.V'var'f « , * 
Name of mother 
Address 
has this day applied for admission 
for herself to this Institution and for 
her infant aged months, who is 
not being nursed iby her. 
Name of infant 
Place of birth 
Date of birth 
Name of doctor in charge 
Name of nurse in charge 
Reason for not nursing infant 65 
Report of the Medical Officer 
of Health. 
Form A 2 
(To be sent to the Medical Officer 
of Health.) 
Name of Institution ... 
Place Date 
p.m a.m. 
/ 
To the Medical Officer of Health of 
I beg to inform you that: 
Name of mother 
Address 
has this day applied for admission 
for herself to this Institution and for 
her infant aged months, who is 
not being nursed iby her. 
Name of infant 
Place of birth 
Date of birth 
Name of doctor in charge 
Name of nurse in charge 
Reason for not nursing infant 66 
Report of Medical Officer of 
Health. 
Form B 1 
(To be kept in Institution.) 
Name of Institution 
Place Date 
p.m a.m. 
To the Medical Officer of Health of 
I beg to inform you that: 
Name of person 
Address f 
has this day applied for admission to 
this Institution for an infant aged 
months, who is not being nursed by 
his or her mother. 
Name of infant 
Place of birth .* 
Date of birth 
Name of doctor in charge 
Name of nurse in charge 
Reason for not being nursed by the 
mother 
Name of the mother 
Address of the mother Report of Medical Officer of 
Health. 
Form B 2 
(To be sent to the Medical Officer of 
Health.) 
Name of Institution 
Place Date 
p.m a.m. 
To the Medical Officer of Health of 
I beg to inform you that: 
Name of person 
Address 
has this day applied for admission to 
this Institution for an infant aged 
months, who is not being nursed by 
his or her mother. 
Name of infant 
Place of birth 
Date of birth 
Name of doctor in charge 
Name of nurse in charge 
Reason for not being nursed by the 
mother 
Name of the mother 
Address of the mother 
67 68 
Report of the Medical Officer 
of Health, 
Occupation 
and instruc- 
tion. 
66. Every effort should be made by 
the management of such Refuge to 
establish and maintain for the benefit 
of the Institution and of the inmates 
various household and other industries 
and occupations so that the inmates 
may learn and improve as much as 
possible during their stay and may be 
better able to maintain themselves 
both during their residence and after 
their discharge. It is also right and 
desirable that any inmates whose in- 
struction in reading, writing, arith- 
metic has ibeen neglected, may learn 
these during their stay by the aid of 
voluntary helpers, other inmates or 
members of the staff. 
Making and 
finding homes. 
67. The ideal result of the work 
done in connection with such a Refuge 
would be to fit each of the mothers, 
with the aid of the father of the 
child, to .make a home, and this can 
often be done by the efforts of the 
field-worker and the aid of all those 
interested in the Institution and in 
social welfare. Where this is impos- 
sible, or undesirable on account of the 
character of the mother or father or 
both, and the child is healthy and 
suitable for adoption, the next best 
thing is to find a home for the child 
if possible before such child is one 
year of age, under the authority of 69 
the Act for the Protection of Neg- 
lected and Dependent Children and the 
Children's Aid Society. The best In- 
stitution is a poor substitute for a 
good home. Institutionalized children 
do not make good citizens, and the 
right policy is to find a home for 
every child where such child will be 
a member of the family. Careful and 
frequent visiting of such homes must 
be done by the field-worker and the 
Children's Aid Society. 
Additional Regulations for 
Orphanages. 
68. Every Public Charity where 
children or infants are received as 
inmates shall provide and set aside 
one or more suitable wards or rooms, 
properly equipped and furnished, to 
be known as an Admitting Depart- 
ment or Observation Ward, and every 
Superintendent or other Officer, upon 
receiving a new inmate for admission 
to such Institution shall, before ad- 
mitting him or her to contact with 
the other inmates, cause him or her 
to be placed in such Admitting De- 
partment, until he or she has been 
seen and examined by the Physician 
on duty and certified in writing by 
such Physician to be free from any 
communicable disease and a proper 
inmate to be received into such Insti- 
tution. Such (certificate in writing 
shall include a statement as to the 
Admitting 
Department. 70 
report of a bacteriological culture 
taken from the throat of such new 
inmate. 
Personal 
care and 
conduct. 
• 69. It shall be the duty of the Sup- 
erintendent and staff of every Hospi- 
tal, Orphanage, Infants' Home or 
other Institution where children are 
cared for, to take daily and constant 
care of all matters of clothing, clean- 
liness and personal hygiene and con- 
duct, and great regard should be paid 
to organizing these matters. 
Care of 
infants. 
(1) Infants under one year of age 
should be bathed daily in warm water 
with every attention to their comfort 
and the proper condition and cleanli- 
ness of the skin, especially at the 
flexures of the body. They should be 
clothed in simple, soft, inexpensive 
garments not applied too tightly, and 
the clothing should be changed fre- 
quently, and constant care must be 
given to keeping them clean and dry, 
and to their regular feeding and care 
according to a schedule which should 
be hung up in the ward or nursery. 
Infants under six months of age, and 
older infants if not thriving, should 
be weighed weekly and a simple 
record of this should be kept in the 
ward or nursery. Everything done for 
an infant should he done gently. 
Care of 
children. 
(2) Children from one to three 
years of age should be bathed daily 71 
or as often as possible, and in no case 
less frequently than two or three 
times a week, and clothing should be 
changed frequently. The test of 
proper attention to these matters is 
the sweet and clean odour of the ward 
or nursery of the children, and this 
must be secured because anything else 
means neglect. 
(3) The bathing and clothing of 
children over three or four years of 
age also requires great attention and 
must be carefully supervised and 
organized, so as to secure satisfactory 
results. 
Older 
children. 
(4) The personal hygiene of child- 
ren in Institutions is a matter that 
requires great care, work and watch- 
fulness, and means much to the 
Institution. Every effort should 
be made to train the children 
at as early an age as possible 
to assist in dressing and taking 
care of themselves and others and of 
their clothes and possessions. Great 
attention should be paid to preserv- 
ing and increasing their natural ad- 
vantages and attractions. The hair of 
boys should be cut short, but not the 
hair of the girls. The condition of the 
skin, hair, teeth, eyes, ears and nose 
as well as hands and feet should be 
carefully examined daily by the nurses 
and attendants, and anything amiss 
Personal 
hygiene and 
appearance. 72 
should be reported promptly to the 
Superintendent or Head Nurse for 
attention and quarantine if necessary. 
Clothing. 
(5) Clothing should be comfortable, 
simple and inexpensive and as taste- 
ful as possible. 
Habits. 
(6) Good habits must be formed and 
strengthened and bad habits must be 
prevented or eradicated. 
Organization. 
70. Proper organization of children's 
homes and Institutions is expected 
and due separation of the older boys 
and girls. 
Religious 
education. 
71. Every care and attention is to 
be given to the religious up-bringing 
and education of children, and family 
prayers, the saying of grace and of 
their own prayers are to be observed 
in such a way as to make them as 
easily understood and enjoyed by the 
children as possible. Every oppor- 
tunity is to be given to the clergy and 
others of the different Churches to 
which the children may (belong to 
visit and instruct and assist them. 
Play. 
72. In all Institutions for children 
every effort should be made to encour- 
age play for enjoyment and for its 
educational and disciplinary value and 
the opportunity it gives to develop 
character and ability and leadership. 73 
Playgrounds and playrooms and 
simple and wholesome recreation in 
the open air are a great boon and a 
great necessity in the upbringing of 
children and future citizens. Play 
should always be properly supervised 
by the members of the staff. 
73. (1) In any Children's Home, 
Orphanage, Refuge, Infants' Home, or 
other Institution where children are 
cared for it shall be the object of the 
Management and staff, except in the 
case of the Feeble-minded children, 
and such as are for any reason unfit 
to ibe members of a family circle, to 
prepare all to take their places in 
their own homes if there is any 
chance of that home ibeing properly 
re-established or if not, to find a home 
for each one. Education, training, in 
home duties, simple industrial occupa- 
tions, the care of their own persons 
and clothes are to be in every way 
promoted, encouraged and constantly 
and thoroughly attended to and the 
stay of children in Institutions should 
be, if possible, limited to one year at 
the most. Normal children over twelve 
years of age should not be in any 
Institution. 
Preparation 
for active 
life. 
(2) Every effort should made to 
encourage initiative, to develop char- 
acter, and usefulness, to avoid the 
institutionalizing of children and to 
Character. 74 
prepare them to be good citizens. The 
Institution should be kept in touch 
with the outside world by every good 
means, and the assistance of a Field 
Worker and of the Children's Aid 
Society shduld be made available as 
far as possible. 
The Feeble-minded. 
The feeble- 
minded. 
(3) In the case of feeble-minded 
and other mentally defective children, 
who are unable to care for themselves 
or take their places in the world, 
every reasonable and kindly effort 
should be made to train and educate 
all their powers and faculties, so that 
they may take their places in a train- 
ing school or Institution as useful and 
happy inmates who are able to con- 
tribute to their own maintenance ac- 
cording to their ability. They can in 
almost every case ibe taught habits 
of cleanliness, the care of their per- 
sons and clothes, household work, and 
simple industrial and agricultural 
occupations, and many of them can 
help to take care of other inmates.