US, NARA, Freedmen's Bureau, Officer's Manual - IV, Medical Department

This article contains a transcription of a portion of an officer's manual published by the War Department in 1866. The manual was published "...for the information and government of the Officers of this Bureau." The manual identified the records, forms, reports, etc. bureau agents and other personal were required to create and use in the day to day operations of their offices. Sample images of bureau forms begin on page 29 or image 40.

The manual contains the following sections:
 * Article I - Book keeping and official correspondence
 * Article II - Accounts and expenditures of public property
 * Article II - Disbursements of public funds
 * Article IV - Medical Department
 * Article V - Subsistence
 * Article VI - Miscellaneous Provisions

Article IV - Medical Department
Pages 20-27

Section I
The Medical Department of the Bureau will consist of one Chief Medical officer, on duty at the Headquarters of the Commissioner, one Surgeon-in-Chief at the headquarters of each Assistant Commissioner, and such additional medical officers detailed from the Army, or employed, under contract, as the Commissioner may deem necessary.

Section II
The Chief Medical Officer of the Bureau will have the general supervision of medical matter connected with refugees and freedmen.

Section III
The Medical Officer assigned to duty as Surgeon-in-Chief of a District will ascertain and report to the Assistant Commissioner the number of persons in the District requiring medical attendance who are entitled to the benefits of this Bureau: he will recommend the establishment, at proper points, of hospitals and dispensaries for such patients as cannot otherwise be properly cared for, and of an asylum, if deemed necessary, for the permanently disabled: he will also designate the number of medical officers and attendants required to supply the same. If a sufficient number of medical officers cannot be obtained in the district, by detail, or contract, he will make application for them to the Chief Medical Officer of the Bureau.

Section IV
The Surgeon-in-Chief on duty at the Headquarters of each Assistant Commissioner will direct medical officers having charge of patients to forward to his office requisitions (Form 43), for the necessary medical and hospital supplies. The Surgeon-in-Chief will approve or modify the requisitions, his discretion, and, in ordinary cases approve and transmit them to the nearest purveyor for issue.

Section V
Requisitions for medical and hospital supplies are to be made in triplicate. In preparing them, medical officers will conform to the Standard Supply Table for refugees and freedmen, both in the articles and quantities asked for, avoiding fractions in quantities. When increased quantities or additional articles a required, satisfactory reasons therefore must be assigned, or they will not be supplied.

Section VI
All requisitions for medical and hospital supplies will exhibit the quantity of each article on hand of which more is wanted; the number of beds to be supplied, and whether they are needed for hospitals, asylums, homes, colonies, dispensaries, or quarters; and if for two or more of the foregoing objects the proportion required for each. Having constantly in view the strictest economy in medical affairs consistent with the purposes of the Bureau, the approving officer will reject all demands for articles not deemed by him absolutely necessary.

Section VII
When it is necessary to purchase medical supplies, they may be procured by the Chief Disbursing Officer of the Bureau, on a special requisition, (Form 44) and account, (Form 45), the requisition to be approved by the Assistant Commissioner. Stores thus obtained will be taken up and accounted for according to Section 3, Article - of this Manual.

Section VIII
The approval of the Chief Medical Officer of the Bureau, or Surgeon-in-Chief of the District, will be required for the transfer of medical and hospital supplies. An officer transferring medical and hospital supplies will furnish a certified invoice and packer's list to the officer who is to receive them, and transmit a duplicate of the invoice to the Surgeon-General, and a triplicate to the Chief Medical Officer of this Bureau. The receiving officer will furnish a receipt to the officer making the issue, with a report on the quality and condition of the article, and transmit a duplicate of the receipt and report to the Surgeon-General, and a triplicate to the Chief Medical Officer of this Bureau. A medical officer who turn over medical supplies to a quartermaster for storage or transportation, will forward to the Surgeon General, with the triplicate invoice, the quartermaster's receipt for the packages.

Section IX
Medical officers having charge of medical and hospital supplies will make, semi-annually, and whenever relieved, returns (Form 46) to the Surgeon-General, in the form prescribed by paragraph 1272, Revised Army Regulations, 1863. Invoices and receipts will be forwarded at the time of the issue or transfer of the property.

Section X
No officer will drop from his return any medical or hospital property as worn out or unserviceable, until it shall have been condemned after proper inspection, and ordered to be so dropped. Articles purchased with the hospital or freedmen's fund. (see Circular No. 21, Bureau R.F. and A.L., Series 1865, will not be accounted for on the regular return of medical supplies the articles will be entered in the order of the supply table.

Section XI
The Surgeon-in-Chief will require medical officers in charge of sick and wounded refugees and freedmen to forward to his office the weekly report, (Form 47), on the last day of the week, and he will compile and forward on the following Monday the consolidated weekly report to the Chief Medical Officer of the Bureau. He will require the monthly report of sick and wounded soldiers under treatment of medical officers of this Bureau to be made, according to regulations, through the Medical Director of the Department, to the Surgeon-General, and will also require the monthly report of sick and wounded refugees and freedmen, (Form 48) to be forwarded to him within five days after the expiration of the month, and will promptly transmit it, together with a consolidated monthly report on regular blank (separate for each in all cases,) to the Chief Medical Officer of the Bureau. Surgeons-in-Chief will see that the surgeons under their direction are kept daily supplied with blank forms necessary for the above reports and returns.

Section XII
Surgeons-in-chief will promptly forward to the Chief Medical Officer of the Bureau a copy of all reports made, contracts made or annulled, circulars and orders issued, and requisitions approved.

Section XIII
The medical officer in charge of a hospital, asylum, or colony will distribute the patients, according to convenience and the nature of their complaints, into wards or divisions, and will visit them each day, as frequently as the state of the sick may require, accompanied by the steward and nurse. His prescriptions of medicine and diet will be written down at once in the proper register, with the name of the patient, and the number of his bed. The assistants will fill up the diet-table for the day, and direct the administration of the prescribed medicines.

Section XIV
To promote health and prevent contagion, he will insist upon scrupulous cleanliness, frequent changes of bedding, lien, & and see that the rooms are ventilated and not crowded.

Section XV
He will instruct his acting steward, commissary- clerk, dispensing clerk, and ward-master, to have a books ready for inspection at any time. He will require the steward to enter in a book daily (Form 49) the issues to the ward-master, cooks, and nurses; and to see that the dispensing and commissary clerk! and ward-master properly discharge their respective duties.

Section XVI
The dispensing clerks will have charge of the dispensary, will enter in a book for that purpose, the prescriptions of the Surgeon, and see that the medicines are properly administrated, and the dressings skillfully applied.

Section XVII
The commissary clerk will prepare the provision-returns, statement of the hospital- fund, and quarterly return of articles, not immediately perishable, purchased with the hospital-fund; will keep in ; book for that purpose a debit and credit account with the Subsistence Department (Form 50); receive and distribute the rations, and have general supervision of the kitchen.

Section XVIII
The ward-master will take due care of the hospital stores ad supplies, have charge of the effects of the patients, register them in a book, (Form 51) and have them numbered, and labelled with name and residence of the patients, receive from the steward the furniture, bedding, cooking utensils, etc. for use, and keep a record of them, (Form 52,) and how they have been distributed to the wards kitchens, & Once a week he will take an inventory of the articles in use, report to the steward any loss or damage to them, and return to him such as are not required for use.

Section XIX
The steward will make such disposition of his subordinates as will secure a through policing of the grounds, cleanliness of the wards and kitchens, of the patients and attendants, and of all articles in use.

Section XX
At surgeon's morning call, all patients will be required to be in their wards, and the attendants at their respective posts for duty. The surgeon shall then determine what duties the convalescents are capable of performing, who should be discharged, and who are permanently disabled.

Section XXI
All attendants will be mustered for pay on the last day of each month by the surgeon in charge, and no attendant's name should appear on the pay-roll (Form 53) that is not also accounted for on the report of attendants made on the fifteenth of the month (Form 54) to the Chief Medial Officer.

Section XXII
When a patient is transferred from one hospital to another, the medical officer will send with him an account of his case, and of the treatment.

Section XXIII
The regulations for the services of hospitals apply, as far as practicable, to all relief-establishments.&mdash;Each Surgeon-in-chief will keep proper records of the official business passing through his office, and the medical officer in charge of any relief establishment will, so far as practicable, keep the following records, and when relieved from duty, deliver them, to his successor, viz: a register of patients, (Form 55)-a prescription-book, in which the diet will be recorded (Form 50),&mdash;copies of his requisitions;&mdash;all property-returns;&mdash;reports of sick and wounded;&mdash;and an order and a letter-book, in which will be transcribed all orders and letters relating to his duties.

Section XXIV
When any medical office, or relief-establishment, is discontinued, all records will be transmitted to the Surgeon-in-Chief by the Surgeon in charge of the same.

Section XXV
The medical officers in charge of relief-establishments will report to the Surgeon-in-Chief of the District such attendants, not exceeding the number specified in Section twenty (26) of this article, as they may require to be detailed or employed under contract, at rates to be determined by the Surgeon in-chief, subject to the approval of the Chief Medical Officer.

Section XXVI
Ordinarily, hospital-attendants are allowed as follows : to a hospital of the capacity of one hundred beds, one acting steward, one dispensing clerk, one commissary clerk, one nurse as ward-master, and other attendants, as nurses, cooks, matrons, &c., not to exceed ten per cent of the number of patients (beds) in hospital.

Section XXVII
The medical officer in charge of a hospital, colony, or asylum, will transmit monthly to the Chief Medical Officer, a copy of the "Statement of the Hospital Fund," (Form 57,) which must be a true copy of the monthly statement embraced in the commissary's abstract of provisions.

Section XXVIII
As attendants employed in the Medical Department of this Bureau (not to exceed the number authorized by this Manual) are Government employees, and are allowed the army-ration, while all others receive the contraband ration, separate provision-returns will be used for each class, and the number under each head will be noted on the abstract of issues and statement of the hospital-fund.

Section XXIX
The Surgeon-in-Chief of the District will regularly furnish the issuing commissary for his information a certified copy of the report of attendants for the fifteenth of the month.

Section XXX
The name of the issuing commissary will, in all cases, be given on the statement of the hospital fund, and also the amount, (but not the items in detail,) of outstanding and unpaid debts chargeable against the same.

Section XXXI
The hospital-fund may be expended for the purchase of the following articles only:
 * 1st. Food, solid or fluid, for the diet of the sick which is not furnished by the commissary or medical departments.
 * 2d. Articles to be used in either the preparation or serving of the food, embracing, principally, cooking utensils and table-furniture, not furnished by the quartermaster's or medical departments.
 * 3d. Gas, oil, and other means of illumination.

Section XXXII
A return will be made to the Chief Medical Officer by the surgeon in charge of every hospital, asylum, or colony, of all articles of a nature not immediately perishable which have been purchased out of the hospital fund. This return will be made in a form similar to the returns of hospital-furniture now required, (see Form 46) and will be made quarterly, upon the last day of March, June, September, and December.

Section XXXIII
Medical officers will be required to account strictly to this department for all such articles as ma1 be purchased out of the hospital-fund.

Section XXXIV
Every medical officer will report in writing to the Chief Medical Officer, and Surgeon-in-Chief of the District, when he arrives at a station, or when he leaves it, and his orders in the case, and at the end of each month, whenever not at his station, whether on duty, or on leave of absence, and when on leave of absence, his post-office address for the net month. The Surgeon-in-Chief will make to the Chief Medical Officer a monthly return of medical officers serving within the District, (Form 58.)

Section XXXV
The Surgeons in charge of relief-establishments will make monthly to the Chief Medical Officer a report of any patient or patients under their charge who have been soldiers, or any relative of a soldier, or discharged soldier, giving degree of relationship, (Form 59.) All reports, returns, and statements called for by this Manual will be transmitted through the office of the Surgeon-in-Chief of the District.

Section XXXVI
When necessary, the Commissioner will employ a private physician as Chief Officer of the Bureau or as Surgeon-in-Chief of a State, by written contract, at rates equivalent to the compensation provided by law for commissioned officers now performing the duty.

Section XXXVII
Surgeons-in-Chief, when necessary, may employ additional medical officers by written contract, conditioned as in Form 60, at a stated compensation, to be proportional to the extant of interference with his business and time. But when he is required to abandon his own business, and give his whole time to the public service, the contract may be not to exceed $100 per month, besides transportation in kind, to be furnished by the Disbursing Officer of the Bureau. And when from the nature of his duties his health is endangered, or when he is required to furnish medicines, he will be allowed, besides the stipulated pay, from twenty-five to fifty per cent, thereon, as shall be determined by the Chief Medical Officer.

Section XXXVIII
In all cases, a triplicate of the contract will be transmitted forthwith by the Surgeon-in-Chief to the Chief Medical Officer; and the former will at once discontinue it whenever the necessity for it ceases or for any other sufficient cause, or whenever the Chief Medical Officer may so direct. This is also applicable to attendants employed under contract, (Form 61.)

Section XXXIX
The physician's account of pay due must be sent to the Chief Medical Officer for payment, supported by the certificate of the Surgeon-in-Chief of the District that it is correct and agreeable to contract; that the services have been duly rendered; and that the account is final, or not, as the case may be.

Diet Table for Hospitals
Pages 101 through 104 of the manual give a sample week's menu of meals and recipes that can be prepared from the foodstuffs which were to be supplied to each hospital. The manual provides this instruction: This Diet Table will be used in the Hospitals of this Bureau where it is possible. If the Hospital Fund should prove inadequate to the patients, according to this Diet Table, the Surgeon in Charge of the Hospital will make a written statement to the Surgeon-in-Chief of the District, setting forth the modifications deemed necessary, and the causes therefor; provided, however, that no modification shall be made without the written authority from the Surgeon-in-Chief of the District, which shall be submitted to the Surgeon-in-Chief of the Bureau for final action.