ART. 243. In no case shall money be paid to a seaman or to his family or friends by the Marine-Hospital Service as reimbursement for expenses incurred during his sickness or disability.

ART. 244. When an applicant's claim for relief is rejected, the cause or causes for such rejection must be indorsed on the certificates or other papers in each case, which must then be filed and preserved.

ART. 245. Seamen who may be injured during street brawls or while committing a breach of the peace, and are therefore confined in jail or taken to civil hospitals by the local authorities for such acts, shall not receive treatment at the expense of the Marine-Hospital fund.

ART. 246. Seamen taken seriously sick or injured while actually employed on a documented vessel shall be entitled to treatment at relief stations without reference to the length of their service.

ART. 247. A certificate of discharge may, at the discretion of the officer in charge of the case, be given to a hospital patient, but such certificate when presented at another relief station shall not be taken as sufficient evidence of the applicant's title to marine-hospital relief, but may be considered as collateral to other satisfactory data submitted by the seaman.

ART. 248. Temporary relief only is contemplated and admission to hospital is not intended to permit an indefinite residence therein for cause other than actual disease or injury.

OUT-PATIENT RELIEF.

ART. 249. Sick and disabled seamen entitled under these regulations to the benefits of the Marine-Hospital Service whose diseases or injuries are of such a nature that they can properly be relieved by medicines, dressings, or advice, without admission to hospital, shall be .treated as out-patients, and furnished medicines, dressings, surgical appliances, or advice, as the case may require.

ART. 250. Seamen will not be furnished relief at their own homes, except by special authority from the Supervising Surgeon-General, and then only an allowance for medical attendance and medicines will be made at rates fixed by the Treasury Department.

STATIONS OF THE FIRST CLASS.

ART. 251. The evidence of each out-patient's right to relief will be recorded in the register of out-patients, over

the initials of the officer making the entry, and the certificate and papers in the case filed.

STATIONS OF THE SECOND CLASS.

ART. 252. The evidence of each out-patient's right to relief will be recorded in the register of out-patients, over the initials of the officer making the entry, and the certificate and papers in the case filed.

STATIONS OF THE THIRD CLASS.

ART. 253. When out-patient relief of any kind is furnished, its nature (prescriptions, medicines, etc.) will be briefly specified on the relief certificates.

ART. 254. When an applicant's claim for relief at the expense of the Marine-Hospital Service is found to be valid, a relief certificate, on Form 1915, will be made out by the customs officer, or acting assistant surgeon, if such an officer be in charge of the relief station, setting forth specifically the data on which, under these regulations, relief is granted; and this relief certificate, the facts contained therein having been recorded in the proper register of patients, will be forwarded to the Supervising Surgeon-General as soon as issued.

STATIONS OF THE FOURTH CLASS.

ART. 255. When out-patient relief of any kind is furnished, its nature (prescriptions, medicines, etc.) will be briefly specified on the relief certificates.

ART. 256. When an applicant's claim for relief at the expense of the Marine-Hospital Service is found to be valid, a relief certificate, on Form 1915, will be made out by the customs officer, or acting assistant surgeon, if such an officer be in charge of the relief station, setting forth specifically the data on which, under these regulations, relief was granted; and this relief certificate, the facts contained therein having been recorded in the proper register of patients, will be forwarded to the Supervising SurgeonGeneral as soon as issued.

ART. 257. Whenever an application for relief is presented, the proper customs officer at the port (or the acting assistant surgeon, if an officer of that grade is on duty and in charge of the station) is authorized and directed to cause out-patient relief (medicines, etc.) to be furnished in accordance with Article 249, or to request authority from the Supervising Surgeon-General to furnish transportation to a relief station of the first class.

ART. 258. One dollar will be allowed physicians (not officers of the Marine-Hospital Service) for the medical examination of each out-patient who is referred by a customs officer for such examination, whether accompanied by a prescription or not, unless otherwise previously directed by the Department (by the terms of special agreements or contracts). In cases where an out-patient is relieved more than once, by direction of the proper customs officer, a written request will be made to the physician to that effect, which written request will be attached to the bill of the physician as a subvoucher.

ART. 259. No separate compensation or allowance will be made for the medical examination and certificate made by physicians in cases where the applicants examined are placed under hospital treatment or its equivalent at the relief station where the examination is made, except when treated in hospital by another physician.

ART. 260. Out-patient relief will not be furnished except in cases of emergency, such as acute illness or injury requiring not more than one or two visits.

ART. 261. Unreasonable charges for relief furnished in emergency cases will not be allowed by the Department.

ART. 262. Foreign seamen or employees of the various Government services, not beneficiaries, shall not be treated at stations of the fourth class.

HOSPITAL RELIEF.

ART. 263. A sick or disabled seaman entitled to the benefits of the Marine-Hospital Service shall be admitted to hospital only in cases where the gravity of the disease or injury from which he suffers is such as to require hospital treatment, in the opinion of an officer of the Service or of a reputable physician designated by the Department to act at a place where no officer is stationed.

ART. 264. Marine-hospital officers and customs officers are required to discharge patients promptly upon the termination of the necessary hospital treatment, and without awaiting the expiration of the period authorized in the permit.

ART. 265. Officers shall not be required to attend sick or disabled seamen on board vessels or to visit them in harbor, except at the discretion of the officer to whom the application is made.

STATIONS OF THE THIRD AND FOURTH CLASS.

ART. 266. Customs officers, or acting assistant surgeons when in charge of the station by special authority of the

Bureau, shall issue hospital permits for the care and treatment of such applicants as may be found to be entitled to the benefits of the Service and require hospital treatment. The period for which treatment is authorized by the permit should be based upon the certificate of the acting assistant surgeon or attending physician, as given in the relief certificates, but should in no case exceed twenty days.

ART. 267. Whenever a seaman applies for hospital relief, and in the opinion of the customs officer it is a case requiring immediate attention, and the papers presented by the applicant show him to be entitled to relief, a competent physician, in the absence of an acting assistant surgeon, shall be called to decide whether hospital relief is necessary; and if so advised, and the seaman is not in a condition to be transferred to a marine hospital, the customs officer shall make suitable arrangements for the care and treatment of the patient and report immediately by letter to the Supervising Surgeon-General, giving rates charged therefor and inclosing the relief certificate.

ART. 268. Whenever a seaman entitled to the benefits of the Marine-Hospital Service applies for hospital relief at a station where an acting assistant surgeon is in charge by special authority of the Bureau, in whose opinion it is a case requiring hospital treatment, and the seaman is not in a condition to be transferred to a marine hospital, that officer shall make suitable arrangements for the care and treatment of the patient and report immediately by letter to the Supervising Surgeon-General, giving rates charged therefor and inclosing the relief certificate.

ART. 269. The hospital permit, before being delivered to the applicant for relief, must be inclosed in an envelope, sealed, and addressed to the person authorized to receive the patient. The seaman should at the same time be informed that unless presented on the day it is issued the permit will be invalid.

ART. 270. Hospital permits will be numbered consecutively, in annual series, commencing with the unit on the 1st of July of each year.

ART. 271. Continuous relief for periods exceeding twenty days will in no case be granted except by special authority from the Bureau.

ART. 272. Whenever in any case a patient is unable to bear transportation to a marine hospital, and hospital treatment is required beyond the period for which the permit was originally issued, application for an extension

(Form 1918) must be made to the Supervising SurgeonGeneral one week prior to the expiration of the permit. Application will be made by the attending physician and forwarded through the officer issuing the original permit. An application for the extension of a hospital permit must set forth the reasons why it is necessary, the actual condition of the patient at that time, and the additional period, not to exceed twenty days, during which treatment will probably be required.

ART. 273. In all cases where relief is extended by special authority from the Bureau the date of the letter authorizing the relief must be indorsed upon the permits in each

case.

ART. 274. Whenever a patient admitted to hospital for given disease or injury satisfactorily progresses to convalescence from such disease or injury, but before being sufficiently recovered to be discharged, contracts or develops some other disease not properly a sequel or complication of the original affection or injury, the facts will be immediately reported by the attending physician, through the officer keeping the register of permits, to the Supervising Surgeon-General, and application made by letter for a new permit, a new medical certificate, made out and signed accordingly, to be inclosed with said letter. Should a new permit be issued, the permits will refer to each other by indorsing on the new the date, number, and diagnosis of the old, and vice versa.

ART. 275. Upon the termination of treatment of a patient or the issue of a new permit the certificate, on the outer middle fold of the permit which has expired, will be filled out and signed by the attending surgeon, and the permit will be immediately forwarded to the Supervising Surgeon-General by the officer keeping the register of permits.

ART. 276. In all cases where treatment in hospital is required the diagnosis shall, where it is practicable to form one, be stated in the relief certificate by the officer or attending physician, and, should he deem it necessary, the relief certificates may be retained a day or two for that purpose.

ART. 277. An approximate or general diagnosis (such as "heart disease," "renal disease," etc.) in the medical certificate will be accepted as sufficient in cases where it is found impracticable to make a specific diagnosis; but in all cases where a specific diagnosis is not given in the medical certificate it must be afterwards supplied by let