PROJECT For the foundation of an Hospital, to be called the Samaritan, proposed to be attached to the Medical Department of the University of the City of New York. In no Institution is order and system more necessary than in an Hospital. Diet, medicine and nursing, are the means offered to the sick, and from the number of in- mates it would be impossible, probably, to dispose of these comforts, unless they were dispensed under the most criti- cal care. For this purpose several persons are necessary to be employed, whose duties should be appointed them, and who should be held responsible for their proper perform- ance. This performance can only be watched, by its being made necessary, that each should keep records of their acts and practices; having them certified from time to time, by others alternately employed, and in a manner that the whole being properly vouched, should come yearly before the public. It is surprising to view the vast expenditures annually occurring in the New York Hospital and Bloomingdale Asylum, compared with the number of patients they sus- tain. It would seem that liberality had been let loose to- ward these establishments. It were hoped the Public is proportionately benefitted ! at all events the progress of medical science, I am bold to say, has not been advanced by them a whit. tf-6 Doc. No: 94.] 28S An Hospital has great advantages connected with it; it is ostensibly designed for the benefit of numerous sick per- sons ; and it is the cradle for the nurture of the young me- dical man; but without order it is ineffectual and in- jurious in both eases.—My purpose is to propose a system for the government of the Samaritan Hospital. The Persons to be employed should be in the capacity of Purveyor. With Salary Clerk to do. do. Steward. do. Matron. do. Men and Women Nurses. do. Laundress. do. Cook. "°- Out-door Servants. Physicians. Surgeons. Board and Lodging Clerks to do. who shall also be Librarians. Apothecary. 8alary Clerk and Servant to do. do Chaplain, The Pin veyor should be a gentleman of responsibility whose duty it shall be to superintend the performance of the dut.es of the Steward, to give directions for the supply of provisions, bedding, utensils, and other necessaries, up- on the application of the Steward, approved by the Physi- cians and Surgeons. He should receive and dispense all monies, and render yearly accounts to the public from ap- proved vouchers submitted from time to time by the super- mtendant officers of the Hospital. The Purveyor should 2S9 [Doc. No. 94. be allowed pay for a Clerk, who might be a medical stu- dent, and the medium of communication, when it might be necessary to exact examination and enquiry between him and the several <>liters of the Hospital—also to inspect and make up the yearly accounts.* The Steward should be a man with a wife, but without small children. His wife should be the Matron of the Hos- pital. The duty of the Steward will be, to superintend all the Men Nurses and other men servants under him. To be in frequent communication with the Purveyor's Clerk ; to act under the direction of the Purveyor in all matters connect- ed with his province ; and of the Physicians and Surgeons in the more immediate concerns of the sick. He shall ren- der a weekly account with a monthly and quarterly return of the receipts and expenditures of the Hospital, each ap- proved by the Medical Attendants. He shall see to all the requests and complaints of the patients, and of whatever nature, shall report them to the Medical Attendants at their daily visitation. He shall engage and pay all Nurses and Servants, and be responsible for their propriety of action. He shall be allowed the salary of per annum, and with the Matron, together with all the Nurses and other Servants the Hospital shall be charged for each, at the rate of one ration of full diet daily. The form of his accounts shall be as follows : For the direction of the Steward the following shall be the formulary of the Diets, used in the Hospital: Full Diet.—F. Beef, mutton or veal, 1 lb., or pork £ lb., bread 1 lb., po- * There are certain items which the Purreyor de ipse must include in his yearly accounts, as Insurance, Taxes, Repairs, Library, Funeral eipen- «e«, Ac. Doc. No. 94.] 290 tatoes i lb. or other vegetables £ lb., tea or coffee 1 oz., sugar 2 oz., milk 1 gill, salt $ oz., butter 1 oz. Half Diet.—II. Bread J lb., tea, coffee or chocolate 1 quart, rice 2oz., raisins 1 oz., soup 1 quart, vegetables £ lb., salt 1 oz., vin- egar 1 oz. Low Diet.—L. Flour or meal £ lb., raisins 2 oz. tea 1 oz., sugar 2 oz., milk A pint, bread £ lb., salt 1 oz. 291 [Doc. No. 94. FORM OF THE DIET TABLE, TO BE HUNG UP IN EACH WARD EVERY MORNING. Diet Table for Ward No. 1, Monday Jan'y 183 PATIENT'S NAMES. John Thoma....... George Brown,.... William White,... George Smith,.... John George,...... Timothy Wise,... George Black..... Samuel Mooro,... David Earle........ William Brown,... Edward Smith,... James Ware......, Edward Collins,... Henry Smith,..... William Miller,... George Hopkins,.. Edward Snuyder,. Henry Withers,... Henry McVea..-. Samuel Knapp,... John Fellows,..... William Wethers,. Samuel Orr,...... James Powers,..... William Andrews,. TOTAL, DIETS 3-, S;-j EXTRAS. k i5 ■*} cq >pt ptpt 2 ] 2; 2 1 7|l0 81827 3J16H19 5!li 3 1 9\ 2 8 dr The time of admission with the name of the disease shall be written on a ticket, and kept constantly at the bed's head of every patient. Form of the weekly account of expenditures embracing nil the Hospital collectively; rendered by Steward to the Purveyor, countersigned by the Physicians and Surgeons. Doc. No. 94.] 292 Weekly account of Receipts and Expenditures of the Sama,' ritan Hospital, from Monday the day of January, 1S3 //// Sunday the i net it si re. To Beef, at..........Dr. Veal................ Pork,................ Tea,................ Milk,............... j Salt,...........c___ Extras. Poultry.............. Arrow Root,.......... FlTirs,............... IJnttcr,....... i Servants. Steward's Wages,......... Other Servants,..... Contingencies,........ Cr. By amount from Patients during the period at per diem,...... t 1 i i 1 i ' \ •s ! 293 [Doc. No. 94. Monthly Return of Receipts and Expenditures of the Sama- ritan Hospital, from Monday the day of January, to Sunday the day of February 183 inclusive. s g 5 EXTRAS. | Poultry. | Fish. s 6 fcrj 5J s 1 o 1 7 8 10 Full Half Low , ■ , -J Appended to this is to be an account of the items and their quantities as in the weekly account. n Quarterly Return of Receipts and Expenditures of the Samaritan Hospital from inclusive. to o o Q 32 H H 1—1 ft o « w pa - — ■■■■■* 1 « EXPENDITURES. PP d o — "3 3 Ph O be cs m 3 32 -a c} 1. o ♦J o Ph 73 it > £ o 5 be s 32 | Salt. | Vinegar. | Mustard. d o DO a 'go 3 l 3 -5 <-> "5 o 3 1 6 c CO u 33 be o 32 5e o 3 ! i count. Appended to this is to be an account of the items, the (pumtity and cost as in the monthly ac- 295 [Doc. No. 94. | Beef. 1 to 1 O ! < w o CO M "Mour. Jork. M ^ ? ^ | Tea. si s^ j S ugar. a3? | Coffee. 2 * | Butter. | Potatoes. 8 -t | Rice. ^.2 | Indian Meal. ^ 2' 1 | Iron bedsteads W H O to w 73 -*." >> 1 Pailliasses. Linen Sheets. Cotton Sheets © 5" 1 a ^ 1 8. **- | Blankets. 1 Chairs. TabiesT- 1 <|<^ 1 Coals. Wood. n r r-93 ^-.^ 1 ^ -> ~ I Axes. Wood Horses. 9 ? 1 1 cc J- | Washing tubs |'linckets._2_ Kitchen. 1 5 H 1 ______ s~j^ ---------- 1 1 ^ ^ ■-----------------------------" I Rakes. J___._ i s ------------ | snoveis. THoes. _ I'-l j fY\ atennii- |><>t* ^ 1 — 1 - £* i Curry Com'j*. y ~.j^ — 1 Saddles. Halters. " r" l *" ^ "Sets Harness. 1 1 cember, 183 , inclusive. articles Remaining 1st Jan'y 183 . Total. Expended. Condemned and Sold. Condemned and Destroyed. Remaining ser-viceable. V3 I i i l i \ i Provisions Furniture Utensils... Apotheca-ry's si or a Bedding.. Sfc. i i ! Doc. No. 94.] 298 To this there shall be appended an account current or balance sheet of the whole of the annual expenditures of the Hospital made up from the Purveyor's accounts pro- perly vouched for; and approved by an adequate Board appointed annually for the purpose; all which shall be sub- mitted for publication. THE MEDICAL DEPARTMENT. The Medical Department must be governed in the best possible manner. The Physicians and Surgeons having the ultimate res- ponsibility of the success of the Institution, should be punc- tual in their daily attendance. Patients under all diseases, but especially those in which nervous symptoms predomn nate, are on the look out to a moment, for the visit of their medical attendant. They require no watch or clock to give them the idea of time for this purpose ; they are a watch and clock within themselves, which is equal to the best chronometer. The daily visitation to the Hospital by the Physicians and Surgeons shall be in winter from 9 A. M. and 8 P. M. In summer from 8 A. M. and 9 P. M. The Physician's and Surgeon's Clerks shall always be in attendance, with the daily prescription book, and ready to note symptoms, change of treatment, and the reasons therefor ; always attending to insert alterations in diet or extras, with details of medical prescriptions ; to enable both the Steward and the Apothecary to make up their ac- counts. 299 [Doc. No, 94. And the following is the form of the daily precription book. 1 t Names J1 "o 6 6 Q Symptoms Prescriptions Remarks The Physicians and Surgeons at every morning visit, shall sign the Diet Tables of the Wards of the preceding day ; which shall be the voucher wherewith the Steward shall make up his account for provisions. They shall monthly inspect the bedding, furniture and other property of the Hospital; and shall certify to the Steward for the same. They shall designate also, what are servicablc, unservicable, and wanting repair; and give also a list of what is required, to the Steward, in the shape of a requisition, to be delivered to the Purveyor ; who, if he has funds in hand, shall act upon it, as an order to be obeyed. The Physicians and Surgeons shall require of their Clerks, to have every month made up, from the daily pre- cription book, a posted record of every case in the Hospital into a Medical Register, of the nature, history and conse- quence of every disease, with all the minutiae of circum- Doc. No. 94.] 300 stances that may have attended it. And the following is the form of the Hospital Register. Names of the 'patients, when admitted, dis-ease, birth, age, stature, constitution, habits and oc-cupation. i Progress of symptoms, ef-fects of medi-cines, with ac-cidental cir-cumstances. Treatment Remarks | The Medical Register shall have selected from it an- nually, cases for publication, which when in print shall be intituled, THE ANNUAL MEDICAL REPORT OF THE SAMARITAN HOSPITAL IN CONNEXION WITH THE UNIVERSITY OF THE CITY OF NEW-YORK. The Apothecary of the Hospital may be a reputed Druggist of the city of New-York, who shall be responsi- ble for the qualities of the medicines and hospital utensils, supplied the Hospital upon the requisition of the Physicians and Surgeons made through the Purveyor. He shall visit 301 [Doc. No. 94, the Hospital every Saturday, in company with the Medical Attendants j and be responsible for the qualifications and the performance of duties by his Clerk. The Apothecary's Clerk shall attend the visitations of the patients, as often as made by the Physicians and Sur- geons. He shall put up all medicines prescribed, with di- rections for their use ; and he shall be held responsible for the action of the nurses in their administration. He shall keep regular books and render a monthly return to the Pur- veyor of the receipts and expenditures of medicines. He shall see to the manipulation and composition of all phar- macuetical remedies ; in order, that, the Hospital be char- ged by the Apothecary, only, with simples, or as near as the case may be. The following is the form of the Apothecary's Monthly account: c Doc. No. 94.] 302 Monthly Return of Apothecary's Stores of the Samaritan Hospital, from to inclusive. ________ ARTICLES. Medicines.... Surgical In- struments. Comforts. Apothecary's Furniture ■3 2 Kl ft? "£ be © X ft? S5 ^ ft! bo <^ Cm ft? Approved, A. B., Physician. C. D., Surgeon. ft? (Signed) E. F., Apothecary. C03 [Doc. No. 94. The preceding also, shall be the form of the yearly ac- count made up from the several monthly accounts, which shall be signed and approved of in the same manner. In the yearly account the prices of medicines shall be super- added by a similar statement as appended to the other re- turns. I have thus given an outline of what should be the me- thod in hospital management. I will now make a few re- marks that may have a tendency to complete the system. The Inmates of this Hospital comprehending male and female patients, may be classed also, into those who pay for their subsistence and medical benefits, and those who are paupers; which last maybe admitted through orders by the city authorities, and who may be contracted for accord* ingly. I propose that these should be received for the bare cost of their maintenance; while the other class, although paying but a pittance, will give rise to a fund, both benefi* cial to the Hospital, and the Medical College. As one acknowledged benefit to be derived from the hos- pital is the induction of young men into the practice of medicine, the Purveyor's Clerk should be a medical stu- dent ; who should direct his particular attention to the re- ceipts and expenditures, with the orderly management of the Hospital, for his services he shall be entitled to a small salary with board and lodging. The steward and wife (matron) should be persons of be* coming and benevolent deportment, and they should be paid a liberal salary, so as to be able to calculate upon the hos* pital as a permanent home. The men and woman nurses should be persons selected as described, and have their duties ordered for them ; which shall at least keep them in constant employment. They should be so paid, that their wages may be always some- Doc. No. 94.J 304 what in arrears ; to be a forfeit, in case it should at any time be necessary suddenly to dismiss or discharge them; and so also with all the other subordinate servants. The Wards should be so arranged and apportioned, that as much of a particular disease may be comprehended in one apartment as possible.—Thus we will have an Accident Ward, an Opthalmic Ward, an Ulcer Ward, a Fever Ward, a Lying-in Ward, an Epidemic Ward, a Dropsy Ward, one for Diseases of Lungs, and one for patients who may have undergone, or who may be about to under- go, Surgical Operations. The nurses should be apportioned to the patients, on an average, say, one to about ten of surgical patients, one to ten of fever patients, and one to five of lying-in pa- tients, &c There should be at least two days in the week set apart for the admission of patients, who should be entitled to be received, upon the signature of the attending physician or surgeon. The patients should be clothed similarly, or as much so as may be ; and after the Hospital shall have been for some time established, it will be to the general interests of cleanli- ness and order to have them provided with uniform hospi- tal dresses, to be worn by those who are able to appear out of bed. One or more watchmen should be provided, to preserve the safety of the establishment during night; to visit the wards during sleeping hours, to watch the nurses, and to be in readiness to call medical or other assistance when re- quired. The hours for meals for the patients should be desig- nated. The friends of patients should have the privilege of visit- ing them on certain days and hours ; except in emergent 305 [Doc, No. 94. cases, when an explanation with the porter will always se- cure admission. For the benefit of medical students, the attending Phy- sicians and Surgeons shall deliver twice a week Clinical Lectures, in an appropriate apartment; upon the cases in Hospital; to which physicians of the city may be admitted. Days should be appointed for the visitation of a certain number of city practitioners. The time at which the performance of surgical opera- tions is to take place, shall be designated by a flag hoisted in the hospital yard, and which shall be understood as an invitation to all medical practitioners, whose convenience may permit them to attend. It may be observed that many minutiae are omitted in the foregoing detail; but they are of equal moment and each necessary to the perfection of a system :—as, the manner of cooking—a form for soups—for the composition of puddings—the hour of rising and going to bed—the pe- riods for cleaning wards and washing clothes—the number of beds in a ward, with the distance of beds from each other, and withal the directions for the taking of medicines to be carefully written and placed at the bed side of the patients, &c. &c, all which shall be from time to time di- rected by the Physicians and Surgeons. * Doc. 1V0. 94.] 3U6 The writer, since he has penned the text, has by authority, had opportu-' nitvof inspecting the Hospital Establishment at Bellevue, and having for many years watched the operations of the New York Hospital with the Bloomin^dale Lunatic Asylum, feels it his duty to urge the necessity of in- stituting a more systematic hospital economy towards the receptacles of the Medicine is yet an uncertain or rather unfinished science; and it is held the duty of medical men not only to follow its prescribed rules, but to endeavor to improve them. Now in private practice there are so many interfering cir- cumstances, that order can hardly obtain between physician and patient; in consequence, the whole medical world looks to improvements made in hospi- tals as sources which, in an especial manner are looked to for the advancement in professional knowledge. Hospital records from a multitude of establish- ments in Europe are yearly sent forth, and from these we are mainly depen- dant in our country for the practical experience we possess. About thirty years ago the profession in England, France and Germany thought of fouading some new Lunatic Asylums, and by noting the effects of means made use of towards these cases, they have been enabled to introduce a new era in the treatment of maniacs, by which the world has been enlightened, and from the introduction of a moral in connection with a medical treatment, a vast many that were previously considered incurable have readily yielded to a suc- cessful issue. Such labours should not only be encouraged but commanded by the public authorities. What might the Island of New York not hava done in this cause for the last twenty years, if this had been the case; for this period we have had three hundred continually in the Bloomingdale Asylum and the Hospital at Bellevue, but what has been the Medical practice and where are the records? The writer has been chilled in having it confessed to him by the medical attendants at Bellevue within the last three weeks, that among the hundred Lunatics in that establishment; the ordinary num- ber always; no systematic treatment had ever been instituted in their cases, and does not now exist, and that there are no records of these cases or any of the other sick, but that, when they require a cathartic it is given them, or a cough medicine; and when they are obstreperous they are put into the cells, and this is confessed to be the maximum of professional treatment for 100 Lunatics, daily throughout the year. Explanatory of the pains taken to detail the diets of the sick, the writer con- tends that diet has as much to do and in many instances more to do, with medical treatment than the administration of medicine itself; and attention to careful prescription in the former is as imperative as in the latter case. There has been of late much complaint made of the influx of foreigners into our city, and of the increased exaction to provide for their protection when they might become subjects of the Alms House and its Hospital. These feelings will cease as soon as it is known that the authorities have directed that the best possible care shall be secured to the poor, they are entitled to it by the laws of God ; and it should not be withheld. 307 [Doc. No. 94. To His Honor, Aaron Clark, Mayor of the city of New- York. Sir,—I have taken the liberty to present you with the preceding detail, in the hope that one day, we shall see in our city an Hospital established on a similar plan. In the mean time, I may urge the inspection of the Hospitals under your government, in the relation. I have the honor to be, respectfully, Your obedient servant, WM. ANDERSON, M. D. New-York, August 18th, 1837. Doc. So. 94.] 308 MA YOR'S OFFICE, New-York, Sept. 4th, 1837. Gentlemen of the Common Council: I herewith transmit a project for the foundation of an Hospital to be called « The Samaritan." It was prepared by Dr. Anderson and intended for the Medical Department of the University of the City of New-York. That gentle- man has been so kind as to allow this copy to be submitted to your ^deration. It is the more worthy of attention as it assumes to produce a considerable saving of expense m hospital establishments; and especially as it is in con- templation soon to remove and rebuild the Alms House of this City, and all the buildings connected therewith. AARON CLARK, Mayor.