BY 
 
 : SHBARMAN PETERKIN, M.D., F. A.C. S. 
 
 | SEATTLE, WASHINGTON 
 
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 A y 
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INSTRUCTIONS 
 
 FOR 
 RECUMBENT OR HOSPITAL TREATMENT 
 
 OF 
 
 ACUTE GONORRHEA 
 IN THE MALE 
 
 DECEMBER, 1918 
 
 BY 
 G. SHEARMAN PETERKIN, M. D., F. A. C. S. 
 SEATTLE, WASHINGTON 
 
| COPYRIGHTED ~ eh 
 ae . August, 1919 erates 
 
 By Guy Shearman Peterkin a 
 
CAbe ( 
 urn of @ ana 7 UAH Lf 
 
 CONTENTS 
 
 Page 
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 Pisieiciones.oL amen Ore lrrigatme «Wrathrayi.) tog). ae 12 
 ieetroneArticles, NUlsers tar, repare. tor Patient 18.282 See. 14 
 
 Preface to Diagrammatic Drawing of Male Sexual and Urinary Organs 19 
 Explanatory Key to Diagrammatic Drawing of Male Sexual and Urin- 
 
 ary Organs, Showing Their Relative Positions and Functions.......... 2h 
 
 APPENDIX 
 
 Hipter yom leel-—tresent, Gym pLomice went Msi fete aie ote 25 
 Pee MOCO) sD OTALOT Y) MAMOINO Bie eg yeas ce rece ren cs tue hiccteeny 24 
 Speculsinstructions.of Attending Physictant: cule ks 8 25 
 
Fig. L. 
 1 amare © 
 Fig. oe 
 Hig: eEW 
 Fig. Vi, 
 Jip hea, hi AVAL 
 Fig. sve 
 Fig. VIII. 
 Hig 
 Fig. DXi 
 Bigeye 
 Fig. XII. 
 Migs XA: 
 Hig) XB. 
 Big XV. 
 Fig. XVI. 
 
 LIST OF ILLUSTRATIONS 
 
 Basin containing 1-4000 bichloride solution and 
 COLTON: Sponge, ‘see pave Det ae (eae ee 
 Crepe paper towels for wiping hands, see pages 
 By ATV UV NAVI PI Re 
 Quart Mason Fruit Jar containing 1-500 bi- 
 chloride solution for sterilizing soiled dressings, 
 SOG AWC Oats Sie toes Uo te NT ae aca a a 
 
 Cotton, gauze and oil silk to be applied at meatus, 
 SOC PAW OO Leer cola a) As a ee Ue ee 
 
 PAGE— 
 16 
 16 
 
 16 
 16 
 
 Showing suspensory with safety-pin in flap to . 
 
 keep dressing in place, see page 6.000. 
 Genito-urinary suspensory devised by Dr. 
 Peterkin, showing size of opening that will 
 not. constrict organ, see page 6. Lau eae 
 Non-piston syringe with bulb advised for ‘ure- 
 thral injections; ‘see page:S:.00 i. (A) ae 
 Condiment bottle for sterilizing syringe, con- 
 
 Le 
 
 Li 
 
 17 
 
 taining envelope and bichloride tablet, see 
 
 DATO Bley eA Ss a Mee ome ea 
 
 Urethral syringe being sterilized—showing depth 
 
 of antiseptic in bottle, see page 8.000. 
 Four-ounce condiment bottle containing medi- 
 cine for injection, see pages 8 and 11.0. 
 Boracic Acid solution for sterilized syringe, see 
 PATS TA sy WOU NORE eV TA ei il eareceen ey A 
 Table, arranged for patient’s bedside, containing 
 all. requisites for treatment..2000 0 
 Same as Fig. XII but covered to keep out dust 
 and. other:foreign particles apne si bee 
 Diagrammatic drawing of table MICE 
 with ‘explanatory skeyee ea hii oy 
 Glass nozzles, two, for irrigating. 
 Diagrammatic drawing of male sexual and urinary 
 organs showing their relative positions, the 
 body cut in half from before backwards................. 
 
 Ag 
 17 
 17 
 17 
 18 
 18 
 Bok 
 18 
 
 20 
 
«* 
 
 This pamphlet in a practical so 
 and utilitarian way outlines the uses 
 Standardtreatment for acute 3) )a.8 
 gonorrheal urethritis in the | | 
 male. < Meee | 
 
 It is a concise manual for a 
 physician, nurse, patient and 
 hospital. = 
 
THE PROEM 
 
 AOe 
 
 “The tune has come the walrus said, 
 To talk of many things, 
 
 Of shoes and ships and sealing wax; 
 And cabbages and kings.’’ 
 
 SLO 
 
 There are forces at work in the world today which medical men cannot 
 afford to ignore. No longer is it possible to cling with safety to the super- 
 annuated standard of Medical Ethics—a standard which erects an artificial 
 barrier between medicine and the applied sciences. As elsewhere, HFEF I- 
 CIENCY PRINCIPLES must govern the scientific treatment of disease. 
 
 A PRESENTATION OF THIS PROBLEM RESOLVES ITSELF INTO: 
 
 1. The creation of a standard. 
 
 2. An economic organization of workers, material, time 
 and methods so as not only to attain, but maintain this 
 standard. 
 
 The creation of an increased demand for scientific med- 
 icine as against pseudo-scientific medicine. 
 
 OS 
 
 4. A demonstration of the proposition. 
 
 Standard is created through application of principles of every natural 
 law that governs the treatment of disease. 
 
 Systematic, economic organization, by reducing costs, will place scientific 
 medicine within the purchasing power of all of the people. 
 
 An increased demand for scientific medicine will be obtained by such ad- 
 vertising as will enable the public to differentiate between scientific and pseu- 
 do-scientific medicine. Such a demand on the part of the publie will become 
 erystallized when the profession of medicine has created a standard of pro- 
 cedure so worded, illustrated, arranged and systematized that it will appeal 
 to the intelligence and logic of the layman’s mind, rather than to his emo- 
 tions. Then the public can and will make this differentiation and will de- 
 mand scientific, economic treatment based on EFFICIENCY PRINCIPLES 
 
 and not on tradition or obsolete theories. 
 I. 
 
2 INSTRUCTIONS FOR RECUMBENT OR HOSPITAL 
 
 Increased demand will bring the physician more patients because it will 
 make such treatment accessible to a larger group of people. An increased 
 volume of business without a corresponding increase in overhead expense will 
 bring an increased profit to the physician, reduce costs of scientific treat- 
 ment and place such treatment within the reach of a greater proportion of 
 the public. 
 
 To demonstrate the proposition: HFFICIENCY PRINCIPLES must 
 govern scientific treatment of disease, the author has selected the disease of 
 gonorrhea, because: 
 
 1. It is a universal disease, hence of interest to the ma- 
 jority. 
 
 bo 
 
 Its existence is so detrimental to social, civic and eco- 
 nomic welfare that the Federal Government deems it 
 essential to maintain an active educational propaganda 
 against it. 
 
 It is rarely scientifically treated due to the false mod- 
 esty which surrounds sex problems. 
 
 we 
 
 Therefore, if it can be demonstrated that EFFICIENCY PRINCIPLES 
 are applicable to a disease of such importance, the advisability of applying 
 the same principles to other diseases would seem sufficiently self-evident. 
 
 In the present status of scientific knowledge, the efficient, therefore stand- 
 ard, method of dealing with gonorrhea is recumbent or hospital treatment. 
 
 This form of treatment alone permits recognition of and compliance 
 with the principles of the immutable laws of nature, whether physiologic, 
 biologic, anatomic, therapeutic, hygienic, economic, governing the disease. 
 
 Under present conditions, however, when the physician attempts to cope 
 with this disease, he faces two alternatives. He may send the patient to 
 a hospital where he will receive such treatment as hospital facilities now offer, 
 the expense of which in time and money is usually beyond the ability of the 
 average person to meet; or the physician may give such time and treatment 
 in his offices as he can afford for the compensation received and rely on the pa- 
 tient’s ability to further follow out instructions. 
 
 Neither of these methods brings results, and as a consequence, the disease 
 is made an ever-increasing menace to humanity. Yet this condition of affairs 
 
 is totally unnecessary. 
 
 Systematic, economic organization while omitting no essential detail will 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE | 3 
 
 bring hospital treatment within the purchasing power of any individual. The 
 truth of this assertion is emphasized by the following: 
 
 1. Ninety-eight per cent of all nursing is done and will 
 continue to be done by women. Any logical pretext 
 which may exist for the prudery and false modesty 
 that surrounds the nursing of this disease by the 
 female nurse, thus increasing the cost of treatment 
 by the unnecessary employment of a special attend- 
 ant, is removed by the systematic arrangement of the 
 details of treatment, with the result that any female 
 nurse can attend a patient so afflicted without any 
 loss to her self-respect. 
 
 bo 
 
 The method is so systematized that no hospital can 
 charge exorbitant prices or refuse admission to gon- 
 orrheal patients, either on the grounds of pseudo-mor- 
 ality or increased cost of caring for an infectious dis- 
 ease of this character. 
 
 3. Iifficiency in treatment is attained by a clear and con- 
 cise outline of the duties of physician, nurse and pa- 
 tient. Responsibility is definitely placed and any neg- 
 lect of duty readily detected and rectified. Cost is 
 reduced through the saving of time, money and en- 
 ergy to the physician, nurse, patient and hospital. 
 
 (See page 10, ‘‘Duties of Physician,’’ ‘‘Duties of 
 Nurse,’’ and ‘‘Duties of Patient.’’) 
 
 It is believed that a large part of this information finds accessible expres- 
 sion for the first time, and that Recumbent or Hospital Treatment of Gon- 
 orrhea as here outlined must be accepted as a Standard Treatment of this 
 disease, because it is worded, illustrated, arranged and systematized to ap- 
 peal to the intelligence and logic of the people and yet comply with the prin- 
 ciples of every natural law governing the treatment of gonorrhea. 
 
 THH AUTHOR. 
 Seattle, December, 1918. 
 
 * “Scientific knowledge logically applied to acute gonorrhea in the male urethra.’—Medical 
 Record, Jan. 16, 1915. 
 
INSTRUCTIONS FOR RECUMBENT OR HOSPITAL 
 TREATMENT OF ACUTE GONORRHEA 
 IN THE MALE 
 
 GENERAL INSTRUCTIONS 
 
 The patient must be confined to bed. 
 Gonorrhea is not contagious. 
 
 Gonorrhea is communicable only 
 when the germs are carried to the 
 mucous membrane of the urinary 
 tract, sexual organs, eyes and rectum. 
 Therefore, carefully observe the fol- 
 lowing precautions: 
 
 PATIENT AND NURSE MUST NOT PER- 
 MIT HANDS TO COME IN CONTACT WITH 
 FACE, ESPECIALLY THE EYES, for dis- 
 charge entering the mucous membrane 
 of EYES will cause IMMEDIATE BLIND- 
 NESS. 
 
 Ir THERE IS ANY IRRITATION OF EYES 
 OF PATIENT OR NURSE, REPORT IMMEDI- 
 ATELY TO PHYSICIAN. 
 
 The nurse, in handling dressings or 
 bed-linen, need not wear gloves. It is 
 essential that she keep her hands 
 from her face and wash hands thor- 
 oughly with soap and hot water im- 
 mediately on finishing her task. After 
 washing hands, towel or linen used 
 must be put where there is no danger 
 of anyone using it before it is laun- 
 dered. | 
 
 Place on bedside table, within easy 
 reach of patient: 
 
 1. Twelve pieces of loose cotton 
 about size of a dollar in basin 
 (Fig. I) containing 1/4000 bi- 
 chloride solution. If this strength 
 irritates, use 1/6000 or 1/10,000. 
 
 If bichloride tablets are used, 
 see that they are thoroughly dis- 
 solved, so that solution is uniform 
 
 in strength; otherwise severe irri- 
 tation of the mucous membrane 
 might occur. 
 
 bo 
 
 In a second basin or other conven- 
 ient receptacle, place twenty 6-inch 
 squares of non-sterile gauze, to be 
 used by patient as towels for dry- 
 ing fingers after dressing the or- 
 gan. Each time after using a 
 square, patient should place it in 
 fruit-jar for soiled dressings. 
 (Fig. IIT.) 
 
 To reduce cost, pieces of crepe 
 paper toweling neatly folded may 
 be substituted for gauze and ba- 
 Slee hip Lh) 
 
 A quart Mason fruit-jar one-half 
 filled with 1/500 bichloride solu- 
 tion. Empty and change solution 
 daily—more frequently if neces- 
 sary. Label jar: ‘‘Poison—for 
 soiled dressings only.’’ (Fig. III.) 
 
 wo 
 
 Patient is to take a piece of cotton 
 from basin (Fig. I.), squeeze out ex- 
 cess of solution, and place cotton so 
 as to cover well mouth of penis 
 (meatus). 
 
 If a long foreskin is present, pull 
 it over moist cotton to keep cotton in 
 place. Do not put in a thick piece. 
 Do not pack it too closely against 
 mouth of organ; this will prevent es- 
 cape of discharge (free drainage). 
 
 If foreskin is short or absent, pa- 
 tient should wear a suspensory that 
 will retain the dressing in place with- 
 out constricting the organ. 
 
6 : InNstTRUCTIONS FoR RECUMBENT OR HOSPITAL 
 
 To dress penis without foreskin em- 
 ploy moist medicated cotton as di- 
 rected; use a piece large enough to 
 cover well the area around meatus. 
 Over cotton place a 5-inch square of 
 gauze, over gauze a 95-inch square of 
 oil silk. (Fig. IV.) Wrap both loose- 
 ly about the organ, then button flap 
 of suspensory so as to keep dressing 
 in place. 
 
 In case the space in flap of suspen- 
 sory is too big to hold dressing in 
 position loosely about meatus, use a 
 safety-pin, sticking it through flap on 
 left side. (Fig. V.) Placing dress- 
 ing too close or tight about meatus 
 prevents escape of discharge and ster- 
 ilization of bacteria by antiseptic on 
 cotton. 
 
 Patient should: 
 
 1. Change dressings about meatus 
 every two hours (more frequently 
 if discharge is profuse); also af- 
 ter each act of urination. 
 
 Sponge head of organ thoroughly 
 
 with bichloride solution at each 
 
 change of dressing. 
 
 3. Pull foreskin (if present) well 
 back so that glands can be thor- 
 oughly cleaned. 
 
 4. Place soiled dressings and cotton 
 at once in jar provided for this 
 purpose. 
 
 5. Dip fingers in bichloride solution 
 immediately after changing dress- 
 ing or handling organ. Dry fin- 
 gers on gauze sponge or crepe 
 paper toweling, which is then 
 placed in fruit-jar labeled ‘‘Poi- 
 son—for soiled dressings.’’ (Fig. 
 19 By) 
 
 The suspensory, oil silk, and gauze 
 dressings should be used by every pa- 
 tient abed, especially at night. These 
 prevent dressings from contaminating 
 bed-linen or patient’s clothes by get- 
 ting displaced or lost among them. 
 GCA Ba) 
 
 i) 
 
 The object of medicated cotton is 
 LON 
 1. Destroy gonococci (germs of gon- 
 orrhea) that are discharged from 
 mouth of urinary canal, and 
 thus prevent the inflamed and 
 everted mucous membrane at 
 mouth (meatus) from reinfecting 
 urinary canal, through being 
 bathed in this discharge contain- 
 ing active instead of dead organ- 
 isms. 
 Prevent pus-producing micro-or- 
 ganisms, always present on out- 
 er side of meatus, from enter- 
 ing urethra and causing mixed 
 infection. This mixed infection 
 is the chief cause preventing an 
 early cure of gonorrhea. In other 
 words, to the inflamed urinary 
 canal is to be applied the general 
 surgical principle of keeping 
 every wound sterile and prevent- 
 ing reinfection by suitable dress- 
 ings. 
 
 bo 
 
 ‘3. Prevent discharge caking up mea- 
 
 tus, thus interfering with free 
 drainage. 
 
 4. Prevent extra-genital infection 
 and infection of the eyes, by ap- 
 plying an antiseptic and destroy- 
 ing germs as soon as they escape 
 from the inflamed organ. 
 
 Erections aggravate and prolong 
 the disease by producing congestion 
 of the inflamed lining membrane of 
 urinary canal, causing swelling and 
 edema, preventing escape of dis- 
 charge (free drainage) and. interfer- 
 ing with the attacking hosts of the 
 body that are trying to repel and de- 
 stroy the invading gonococci. There- 
 fore strictly observe the following: 
 
 1. Avoid sexual intercourse, kissing, 
 loving, all scenes, exhibitions, 
 literature, conversation and com- 
 pany that will cause sexual ex- 
 citement. 
 
 See illustrations pp. 16 and 17. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 2. Avoid sleeping under heavy cov- 
 ering or on light-weight mattress. 
 Sleep on a hard bed; use little 
 covering, because erection may 
 take place if body becomes over- 
 heated. 
 
 Lying on back while asleep may 
 
 cause erection; if it does, patient 
 
 should avoid this position while 
 sleeping. He can do so by tying 
 
 a towel around his waist, knotting 
 
 it in the back so that he will 
 
 awaken when he lies on knot. 
 
 4. Avoid erection by wearing a prop- 
 erly fitting suspensory, with an 
 opening (through which the organ 
 is put) large enough not to con- 
 strict the organ either when in re- 
 pose or when erection takes place. 
 Such an opening is well illustrated 
 MEP VL. 
 
 If, after following hygienic instruc- 
 tions as given above, erections still 
 occur, patient should ring for ice-bag 
 and place it over sexual organs. 
 
 Never strip or squeeze organ to see 
 if discharge has stopped. By rubbing 
 the inflamed membranes together this 
 act causes congestion, bruises the in- 
 flamed tissue and thus aggravates the 
 inflammation and retards recovery. 
 
 we) 
 
 DIET. 
 
 Avoid fried-stuffs, red meats, acid 
 fruits, pastry, rhubarb, asparagus, 
 tomatoes, and condiments such as 
 mustard, pepper and horseradish and 
 stimulating sauces. Light meals only 
 should be taken, and patient should 
 never overeat. Less food is required 
 while lying in bed and not exercising, 
 and digestive tract should not be over- 
 worked. In fact, the lhght diet as 
 served in hospitals may be followed 
 in preference to regular diet as here 
 modified. 
 
 Take absolutely no alcohol; use to- 
 bacco moderately, not more than three 
 cigars or equivalent daily. . 
 
 “I 
 
 Drink at least eight glasses of 
 water daily. (Do not use carbonated © 
 water). <A pitcher of water with 
 drinking glass should be placed with- 
 in patient’s reach so that he can take 
 the fluid freely and regularly. 
 
 The object of taking this amount of 
 water is to: 
 1. Prevent congestion and _ irrita- 
 
 tion of the inflamed mucous 
 membrane by concentrated or acid 
 urine, which acts like pouring 
 vinegar over an inflamed or open 
 cut. 
 
 2. Wash out the accumulated dis- 
 ‘charge and gonococci in the canal, 
 thus facilitating drainage and de- 
 stroying the rapidly breeding or- 
 ganism, which cannot live outside 
 the human body. 
 
 The amount of water to be taken by 
 every individual will vary. The means 
 of regulating the quantity is as follows: 
 The urine must be bland (alkaline). 
 Therefore, after each act of urination, 
 if patient complains of frequency 
 or of burning sensation on urination, 
 nurse should drop a piece of red lt- 
 mus paper into urinary receptacle; if 
 the paper turns blue a_ sufficient 
 amount of water is being taken; if it 
 does not, the amount of water should 
 be increased until the litmus paper 
 turns blue readily. 
 
 TREATMENT. 
 
 After doctor has given instructions, 
 patient is to treat himself. The nurse 
 is simply to supply the articles neces- 
 sary for treatment, and through her 
 intelligent knowledge of treatment 
 and orders given, supervision of 
 baths, medication, etc., see that the 
 orders are carried out as per sched- 
 ule, 
 
 When the fact is borne in mind that 
 the gonorrheal germs duplicate them- 
 selves every fifteen minutes night and 
 
 See illustrations p. 17. 
 
§ INSTRUCTIONS FoR RECUMBENT OR HOSPITAL 
 
 day unless they are checked by per- 
 sistent and regular treatment, the 
 nurse and patient must realize the 
 ' necessity of applying this treatment 
 regularly. This persistent and regu- 
 lar treatment is not for 6 to 10 hours, 
 but must continue throughout the 24 
 hours of each day. There must be no 
 deviation from this rule. 
 
 Technique of local treatment: An- 
 terior urethra is to be washed out 
 with hot boracic acid solution, or 
 
 at least every two hours during day 
 and every four hours during night. 
 (See Instructions to Patient for Tak- 
 ing Injections, page 11. 
 
 The syringe used for these injec- 
 tions is to be of the non-piston kind, 
 preferably a bulb syringe. (Fig. VII.) 
 To prevent reinfection or mixed in- 
 fection, syringe should be sterilized 
 (cleaned) in the following manner 
 after each treatment: 
 
 Syringe should be boiled or thor- 
 oughly cleansed by filling and refilling 
 a number of times with very hot run- 
 ning water. After this has been done, 
 place syringe in glass bottle contain- 
 ing bichloride solution marked: ‘‘ Poi- 
 son —for sterilizing syringe. Don’t 
 inject? GtHio), EX.) Inv ithessbottle 
 there is originally an envelope con- 
 taining bichloride tablets for making 
 the solution and labeled: ‘‘ Poison — 
 for external use only.’’ (Fig. VIII.) 
 Remove this envelope from bottle and 
 place one of the tablets init. Full bot- 
 tle with hot tap water to the top of 
 label. This is the amount of water to 
 be used to dissolve the tablet. The 
 solution is POISONOUS. Don’t in- 
 ject. 
 
 Instructions for keeping syringe 
 sterile: The nurse is to keep syringe 
 as per instructions, pp. 14 and 15; 
 thus the responsibility of misusing 
 the bichloride solution is placed on 
 nurse. If patient cares for syringe, 
 he should rinse it in the boracic acid 
 
 solution previously used for injection, 
 or in very hot water, and then place 
 syringe in bichloride solution. Each 
 time before using, syringe should be 
 filled three or four times with hot 
 running water, and washed off, to 
 prevent bichloride solution in which 
 it has been sterilized from being in- 
 jected into the canal and burning and 
 injuring it. 
 
 Note: If instructions are given to irrigate 
 instead of use syringe, directions given under 
 “Instructions to Patient for Irrigating Ure- 
 thra” are to be followed out. Page. 12. The 
 instructions for keeping syringe sterile apply 
 to glass nozzles, if these are supplied for ir- 
 rigating urethra. 
 
 After urinating and washing out 
 canal with hot boracic acid  solu- 
 tion patient should inject gently 1% 
 ounce of medicine, or enough to thor- 
 oughly distend anterior urethra. The 
 medicated injections should be taken 
 every two or four hours, according to 
 the reaction produced on the mucous — 
 membranes of each patient. Medi- 
 cine: 4 of 1 per cent protargol solu- 
 
 tion; Ore, Ss 
 
 epee dg OE Sn OPE en ee ee This 
 medicine should be held in the urethra 
 for 10 minutes as directed, unless it 
 causes irritation, in which case the 
 doctor should be notified. 
 
 HOT SITZ-BATHS. 
 
 Two or more to be taken daily, 
 in an ordinary bath-tub, if possible, 
 so that legs can stretch and be cov- 
 ered with water. The water should 
 be allowed to go up to umbilicus or 
 ‘‘belly button.’’ The baths should 
 have a temperature of 106° to 120° 
 F., and last from 3 to 15 minutes. It 
 is well to begin these baths at a tem- 
 perature of 100° and gradually in- 
 crease heat with each bath, until 
 water is as hot as patient can bear. 
 Temperature should be such as will 
 cause redness of skin. 
 
 Patient should be instructed to uri- 
 
 See illustrations p. 17. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 8) 
 
 nate before getting into tub, to cleanse 
 urethra, so that no discharge will get 
 into tub. After each sitz-bath scald 
 the tub with hot water so that no 
 one else will catch the disease. Hot 
 or even warm water kills this infect- 
 ing organism. 
 
 Be careful not to cool body sud- 
 denly after bath. The tone of blood 
 vessels should be restored gradually, 
 instead of producing sudden contrac- 
 tion by a chill, and destroying the 
 good effect of bringing the blood to 
 the surface and away from the dis- 
 eased area. Chill can be prevented: 
 1. By having hot water bottles in 
 
 patient’s bed, seeing that he has 
 slippers, and is thoroughly wrap- 
 ped in blankets while going from 
 bath to his room or bed. If pa- 
 tient’s room has bath attached, 
 and temperature of both is alike. 
 you need not do this. 
 
 2. When the condition is not very 
 bad, by dashing a bucket of cold 
 water over patient’s lumbar re- 
 gion while he is still standing in 
 bath-tub. 
 
 If the hot sitz-bath makes patient 
 perspire badly, then, as soon as per- 
 spiration stops, he should immediate- 
 ly drink from one to three cups of 
 lukewarm water. The object is to 
 dilute the urine and still keep it 
 bland, thus making up for the amount 
 of fluid lost through perspiration. 
 If this is not done, the urine becomes 
 concentrated and causes irritation of 
 the inflamed mucous membrane, and 
 to overcome this is the very reason 
 the bath is taken. 
 
 In the daytime during interim be- 
 tween treatments a hot-water bottle 
 should be applied to perineum and 
 one to pubes. 
 
 CONSTITUTIONAL TREATMENT 
 
 Santal oil should be taken: two 5- 
 min. capsules every two hours for 
 eight doses; then one 5-min. capsule 
 every four hours, provided patient 
 
 has not already taken the eight doses 
 and is on the four-hour dose. The 
 object of this medication is exactly 
 the same as that given for drinking 
 water (p. 7). If this drug is fresh, 
 it will not cause irritation of kidneys 
 or backache. 
 
 Sodium bicarb may be substituted 
 for the santal oil, if the latter cannot 
 
 be obtained fresh. Sodium biecarb dos- 
 
 age may be regulated by testing urine 
 
 ‘with litmus paper to see that it is 
 
 alkaline (the dose that keeps urine 
 alkaline is the proper one), and it 
 may therefore vary from one-half to 
 one teaspoonful, in a glass of water 
 every four hours. 
 
 CARE OF BOWELS. 
 
 First night on entering hospital, 
 commencing two hours before bed- 
 time, give 14 grain calomel every 15 
 minutes for eight doses; next morn- 
 ing 1 oz. magnesium sulphate. 
 
 After the first day patient may take 
 one teaspoonful Epsom salts night 
 and morning, or one-half to one tea- 
 spoonful fluid extract of cascara at 
 night. There should be at least one 
 free movement daily. If this medica- 
 tion does not produce results give a 
 high SS enema. No day should pass 
 without movement. 
 
 The object of this medication of 
 bowels is not only to maintain normal 
 resistance of the body by keeping up 
 the activity of these organs, but also 
 TOs 
 
 1. Keep the bowels from clogging 
 and throwing extra work on the 
 already overtaxed and inflamed 
 urinary tract. 
 
 2. Keep bowel contents in a fluid 
 state, so that when in the rectum 
 they will not press against the 
 inflamed sexual organs (prostate, 
 urethra, and seminal vesicles), 
 and by mechanical pressure ag- 
 gravate the congestion which ex- 
 ists. 
 
10 INSTRUCTIONS 
 
 DUTIES OF PHYSICIAN, NURSE AND PATIENT 
 
 (A) The duties of the PHYSICIAN 
 are limited to: 
 
 1. Emphasizing to all concerned, 
 that whatever method of treat- 
 ment is used, it must comply with 
 the principles of natural laws 
 governing this disease. 
 
 For example: 
 and regularity of treatment is dic- 
 
 tated by the rapid rate of propa- . 
 
 gation of the germs that cause the 
 
 disease, gonorrhea. 
 
 Instructing the patient about use 
 
 of syringe. 
 
 3. Giving him printed instructions 
 and illustrations, and seeing that 
 he reads and understands them. 
 
 4. Giving duplicate instructions and 
 illustrations to nurse, or placing 
 them in a sealed envelope and 
 having patient deliver to nurse. 
 
 do. A short inspection at the next 
 eall and a possible explanation of 
 some detail that will place the 
 system of treatment on a work- 
 ing basis and require a minimum 
 of time and effort on the part of 
 all concerned. 
 
 6. Taking slide specimens P. R. N. 
 Even when the gonococci (germs) 
 are absent from the slide speci- 
 mens and the urine is clear, the 
 physician should continue to take 
 slides daily for one week, and 
 the urine and discharge should be 
 clinically and microscopically ex- 
 amined during the same period 
 to make sure there is no recur- 
 rence of the gonococci. 
 
 7. In brief, to advising and direct- 
 
 ing treatment. 
 
 (B) The duties of the NURSE are 
 limited to: 
 
 1. Reading all the instructions so to 
 
 The frequency 
 
 iy; 
 get a comprehensive ide 0 
 
 disease and know what she 
 
 do. | 
 
 2. Bringing REGULARLY syrl 
 and boracie acid solution, pr 
 ing bath, ete. 
 
 3. Placing in systematic order 
 bedside table the articles ne 
 sary for treatment and coverir 
 them with a_ small opera 
 sheet. 
 
 4. Seeing that this table and article 
 are kept in order as per instruc- 
 tions, so that she can ascertain if 
 patient is following directions re- 
 garding frequency of treatment — 
 and asepsis. 
 
 5. In brief, to supervising and seeing 
 that physician’s orders are car- 
 ried out. 
 
 (C) The duties of the PATIENT 
 are limited to: 
 
 1. Asking questions if he does not 
 understand directions. 
 
 2. Doing all of the detail work,— 
 which he will do willingly, be- 
 cause: 
 
 a. It occupies his time. 
 
 b. He has intelligent interest in» 
 what he is doing, knows why he 
 is doing it and that he is doing 
 it correctly, but most of all he 
 knows that he is getting full 
 value for money and time ex- 
 pended. 
 
 e. His intelligence and logic have 
 been appealed to, and he real- 
 izes that the detailed and com- 
 plete instructions employed are 
 scientific and will attain max- 
 imum efficiency since they per- 
 mit no slacking on the part of 
 physician, nurse, hospital or 
 ‘even the patient himself. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 11 
 
 INSTRUCTIONS TO PATIENT FOR TAKING INJECTIONS 
 
 Urinate. 
 
 Place within easy reach syringe, 
 medicine, hot water or boracic 
 acid solution. 
 
 Place towel over thighs, under 
 sexual organs, to protect cloth- 
 ing and bed-linen. 
 
 Place empty wash-basin over 
 scrotum, under penis, so that head 
 of penis is well over basin. 
 
 Draw back foreskin well and 
 clean head of penis thoroughly 
 with bichloride solution from 
 
 . basin. 
 
 Grasp penis behind the head, with 
 thumb, first and middle fingers 
 of left hand, so to hold organ 
 firmly. 
 
 . Full syringe with hot water or. 
 
 boracie acid solution. 
 
 Place syringe to mouth of ure-. 
 
 thra. Gently squeeze bulb of syr- 
 inge until there is a feeling of 
 fullness or shght pain. Hold fluid 
 in urethra from one-half to one 
 
 minute. Then remove syringe 
 from mouth of urethra; let out 
 fluid. Do this five or six times, 
 or until the solution used for ir- 
 rigation returns clear. The ure- 
 thra is washed out in this way 
 with hot water in order to get all 
 the discharge from between the 
 folds of the mucous membrane 
 (lining) of the urethra, so that 
 when the medicine is injected it 
 will touch every part of the in- 
 flamed canal and not just the top 
 folds. 
 
 Now fill syringe with medicine 
 for injection. Grasp penis as 
 directed in (6) and inject medi- 
 cine slowly until there is a feel- 
 ing of fullness or slight pain. 
 When injection is in canal, re- 
 move syringe, and immediately 
 place first finger over mouth of 
 urethra to keep in the injection. 
 This injection is to be held in 
 for from one to ten minutes, or 
 for as long a time as physician 
 directs. 
 
 LIBRARY ~~~ 
 
 UNIVERSITY OF ILLINOIS 
 
INSTRUCTIONS FOR RECUMBENT oR HOoSprTraL 
 
 INSTRUCTIONS TO PATIENT FOR IRRIGATING 
 URETHRA 
 
 APPARATUS USED: 
 
 Two-quart douche bag or irrigat- 
 
 ing can, preferably the latter; glass 
 nozzles, two. 
 
 GENERAL INSTRUCTIONS: 
 
 1. 
 
 bo 
 
 Before using bag, irrigating can 
 or nozzel for first time, boil for 
 ten minutes. 
 
 Each time nozzle is used after 
 
 - the first time, clean it in bichlo- 
 
 ride solution according to direc- 
 tions for keeping syringe sterile 
 (see page 8). For shape of noz- 
 zle to be used see illustration, 
 page 18, Fig. XV. Shape of noz- 
 zle depends upon size of meatus, 
 or mouth of canal. 
 
 Always let boiling or very hot 
 water from tap run through can, 
 bag, tube and nozzle each time 
 before putting medicine in same. 
 
 Use for irrigation, solution of 
 
 according to doctor’s orders. 
 
 Irrigating fluid should be as hot 
 as can possibly be borne—110 de- 
 grees F’. in irrigating can. © 
 
 Test the temperature of irrigat- 
 ing fluid by allowing it to run 
 over back of hand before putting 
 
 into bladder. 
 
 Do not place fingers in can or 
 bag and unsterilize same. 
 
 If medicine burns or hurts, tell 
 physician and ‘nurse. 
 
 Metuop oF IRRIGATION: 
 
 ah 
 
 ) 
 
 ade 
 
 OO 
 
 “I 
 
 10. 
 
 A 
 
 Pass all the urine in bladder. 
 
 Hang douche-bag or irrigating 
 ean up (about six feet high) in or- 
 der that force may be given to 
 solution. 
 
 Sit in bed or on edge of chair, 
 bath-tub, or toilet; if necessary, 
 may stand. 
 
 Place basin beneath penis so to 
 eatch the irrigating fluid. 
 
 Loosen the clasp which shuts off 
 the solution. 
 
 Control the flow by clasping the 
 tube just behind the nozzle point- 
 ing toward the palm of the hand. 
 
 See that no air is left in the glass 
 nozzle. Hold the nozzle in an up- 
 right position and let the fluid 
 flow through tube and nozzle until 
 no air bubbles appear. 
 
 Draw back foreskin. 
 
 Grasp penis with thumb and first 
 finger of left hand; wash off the 
 mouth and head of penis well with 
 the irrigating fluid, so that germs 
 on outside of it will not be forced 
 into canal and complicate disease. 
 
 Apply nozzle loosely to the mouth 
 of the urethra, meatus. 
 Wash out the front part of the 
 
 canal every......hours with 
 of fluid. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 12. 
 
 13. 
 
 After repeatedly cleansing the 
 front part of canal, if the method 
 of irrigating posterior canal has 
 been actually demonstrated, and 
 if physician has instructed pa- 
 tient to use it, patient is to allow 
 fluid to flow back into the bladder 
 until it is full. This will cleanse 
 the posterior urethra. (The fluid 
 will readily enter the bladder 
 when the shut-off muscle is open. 
 This muscle is under the control 
 of the will and can be opened by 
 patient thinking he is going to 
 urinate. ) 
 
 Fill the bladder every.........:......... 
 hours according to physician’s di- 
 rections. At time of each irriga- 
 tion, fill two, three or four times. 
 Irrigate gently. Never try to 
 force medicine back into bladder. 
 Do not allow the fluid to suddenly 
 
 14. 
 
 15. 
 
 16. 
 
 13 
 
 distend the canal and crack the 
 lining membrane. 
 
 Irrigation completed, hang up 
 douche-bag or irrigating can. 
 Place clean towel over it so that 
 no dirt or dust can get into it. 
 This act makes it unnecessary to 
 reboil douche-bag or can at each 
 treatment, provided it is used for 
 irrigating fluid only and is kept 
 clean as directed in 3, page 12 (In- 
 structions to Patient for Irrigat- 
 ing Urethra). 
 
 If these instructions are followed 
 out, and irrigating can is cared 
 for as directed, much time will 
 be saved in not having to sterilize 
 by boiling. 
 
 If the inside of can or bag be- 
 comes soiled or unsterile, clean 
 same by boiling for ten minutes. 
 
INSTRUCTIONS FOR RECUMBENT OR HospPiraL 
 
 .LIST OF ARTICLES NURSE IS TO PREPARE FOR PATIENT 
 
 lorAda 
 
 Basin (size 7” diameter, 214” 
 depth) with 1/400 bichloride so- 
 
 lution for moistening cotton 
 sponges, Fig. 1. (See instruc- 
 tions, p. 9.) 
 
 Twelve pieces of loose cotton, 
 approximately size of a dollar, 
 to be placed in basin with bi- 
 chloride solution. (See instruc- 
 tions, p. 5.) 
 
 Basin containing 12 to 20 6-inch 
 squares of non-sterile gauze to 
 be used as towels. 
 
 (Crepe paper towels may be 
 substituted for basin with gauze, 
 Fig. II.) (See instructions, p. 
 5.) . 
 
 Basin, preferably ordinary round 
 enamel wash-basin (12” diame- 
 ter, 314” depth) for patient to 
 use when' treating himself. After 
 patient uses it nurse will cleanse 
 with hot running water and re- 
 place on table. 
 
 Also unsterile hand-towel to 
 protect clothing and bed-linen, to 
 be placed by patient under basin. 
 (See instructions, p. 11.) 
 
 Basin for hot boracic acid solu- 
 tion or hot water, temperature 
 110° to 115,° for washing out 
 urethra. 
 
 Note: Total basins required 4 (only 3 if 
 crepe paper towels are used). 
 
 A quart Mason fruit-jar one-half 
 filled with 1/500 bichloride solu- 
 tion. “Label jar: ‘‘Poison—for 
 soiled dressings,’’ Fig. III. (See 
 instructions, p. 9.) 
 
 Pitcher of water and drinking 
 glass. (See instructions, p. 7.) 
 
 10. 
 
 as Bs 
 
 12. 
 
 - bichloride solution. 
 
 An 8-ounce bottle for morning 
 specimen of urine (or glass uri- 
 nal). Patient is to urinate into 
 bottle (or urinal) just prior to 
 using protargol solution in the 
 morning. This urinary specimen 
 is to be saved for the physician, 
 so that he can inspect progress 
 of treatment. 
 
 Note: After 12 o clock at night irriga- 
 tion should be done with boracic acid or 
 hot water only, so that urinary specimen 
 will not retain residue of protargol. 
 When specimen of’ urine is desired for 
 microscopic purposes patient should not 
 irrigate from midnight till 6:00 a. m., at 
 which time he is to urinate into a sterile 
 8-ounce bottle, after first washing mea- 
 tus with a sponge from basin containing 
 Save specimen for 
 physician to inspect. Later send to lab- 
 oratory if so desired. 
 
 Four-ounce condiment bottle to 
 contain protargol solution, la- 
 beled: ‘‘Medicine for injection.”’ 
 This kind of bottle is used so that 
 solution can be easily taken up in 
 syringe. (Fig. X.) (See instruc- 
 TLONS, D. Gains 
 
 ‘Urethral bulb syringe, as made 
 
 by Mueller & Co., of Chicago. 
 (Fig. VIL.) 
 
 Four-ounce condiment bottle 
 (Fig. IX), labeled: ‘‘Poison— 
 for sterilizing syringe. Don’t in- 
 ject.’’ This bottle to be filled. 
 with bichloride solution for ster- 
 ilizing syringe as per instruc- 
 tions, p. 8. Change this solution 
 once in 24 hours. 
 
 Four-ounece condiment bottle 
 (Fig. XI), labeled: -‘‘Boracic 
 acid solution for STERILIZED 
 syringe.’’ Change this solution 
 at least four times in 24 hours. 
 (Fig. IX shows how syringe is 
 put in bottle to be sterilized.) 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 Wey 
 
 14. 
 
 15. 
 16. 
 
 ae 
 
 18. 
 
 ’ Nurse, 
 
 NOTE: The basin of boracic acid solu- 
 tion, syringe, and bottle containing the 
 syringe should be taken out of rooms by 
 nurse, who will wash syringe in running 
 hot water and replace in bichloride solu- 
 tion until again prepared for next treat- 
 ment by rinsing and putting in boracic 
 acid bottle for syringe. 
 
 Both bottles for syringe to be 
 kept by nurse, who is to take 
 syringe out of bichloride solu- 
 tion, rinse in hot running water, 
 and place in bottle containing 
 boracic acid solution just before 
 giving it to patient every two or 
 four hours, or according to di- 
 rections. 
 
 Santal oil capsules of sodium 
 bicarb. (See instructions, p. 9.) 
 Ice-bag (if patient rings for it). 
 Place on table for patient to use 
 as directed, p. 7. 
 Two hot-water bottles. 
 structions, p. 9. 
 Suspensory. (See instructions, 
 p. 6; see Figs. IV, V and VI.) 
 Bottle of red litmus paper, as 
 put up by Squibb & Co. (See 
 instructions, pp. 7, 9.) 
 
 Bedside table. (See Duties of 
 ae Te igs tekell: Xx LE 
 
 -) 
 
 (See in- 
 
 and XI 
 
 How 
 
 bo 
 
 15 
 
 The success of treatment depends 
 upon your intelligent understand- 
 ing of the capse and effect of 
 gonorrhea. So if you do not fully 
 understand any of the instruc- 
 tions, why they are given, or the 
 object in giving them, you should 
 at once ask the attending physi- 
 cian. Also, report immediately 
 if patient fails to comply with di- 
 rections given. 
 
 to Remove S7aAIns: 
 
 A few crystals of oxalic acid 
 dropped in one pint of hot water 
 will make a solution that will re- 
 move permanganate stains. 
 
 Two bichloride tablets in one pint 
 of hot water will make a solution 
 that will remove argyrol stains. 
 (If drinking glass is employed 
 for making solution, extreme cau- 
 tion must be exercised in wash- 
 ing glass: thoroughly, for bichlo- 
 ride is very poisonous and should 
 be used for external purposes 
 only.) 
 
16 INSTRUCTIONS FoR RECUMBENT OR Hosprtau 
 
 Fig. I. Fig. II. 
 
 ° 
 
 ai 
 Diagranmn ave view \ case ey, 
 of basin Showing ee ee 
 ‘in bichloride. Sofulion S) aS 
 Diamerer of 4hasi12— J inches i 
 Depth of basin 2/2 inches 4 
 
 Crepe paper Jaw els 
 gper and Joltee 
 
 \) 
 
 ——— 
 
 Crepe paper towels for wiping hands, see Pages 3 
 and 6. 
 
 Basin containing 1/4000 bichloride solution, 
 and cotton sponge, see Page 5 
 
 Fig. III. 
 
 POISON 
 
 fr SOILED DRESSINGS 
 
 Showing adressiag and 
 a ad Silke (F inch sguare) 
 
 method. of Plating Same 
 Lint or Gauze 
 
 Boul organ but rol" 
 as tightly oS 172 Cotton 
 
 Mu str ation. 
 
 Ww 
 
 ———— 
 
 Quart Mason fruit jar containing 1/500 bichloride Cotton, gauze and oil silk to be applied at meatus, 
 solution for sterilizing soiled dressings, see Page 5. see Page 6. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE iff 
 
 eile 
 Sity Pi 
 Showing suspensory with safety-pin in flap to keep Genito-urinary suspensory devised by Dr. Peterkin 
 dressing in place, see Page 6. showing size of opening that will not 
 
 constrict organ, see Page 6. 
 
 Fig. VII. 
 
 Fine: Fig. XI. 
 
 Urettra/ 
 Syringe 
 Creeter +@) 
 
 i, een’ -- ~Deoth 
 Sf Antiseplic. 
 POISON 
 
 For STERILIZING 
 SYRINGE 
 
 MEDICINE = fF BoRAcIC ACID 
 FOR : SOLUTION } 
 
 INJECTION * FOR STERILIZED j 
 
 SYRINGE 
 
 4-ounce condiment 4-ounce condiment bot- 
 
 Non - piston syringe Condiment bottle for Same bottle with bottle, the form best tle containing boracic 
 with bulb, advised _ sterilizing syringe, tablet dissolved in adapted for con- acid solution, in which 
 for urethral injec- showing contained it, showing method taining medicine so nurse or patient is to 
 tions, see Page 8. envelope with bi- of sterilizing syr- that syringe can be place syringe after it 
 chloride tablet, see inge, see Page 8. easily filled and still has been removed from 
 
 Page 8. kept sterile, see sterilizing bottle, see 
 
 Pages 8 and 11. Page 14. 
 
Fig. XII. 
 
 Fig. XV. 
 
 ee tes 
 a ne 
 
 12 
 \ 
 13 
 DIAGRAM OF TABLE z 
 Upper Shelf : | 
 +. Basie with bickloride 
 2."  * Sponges or crepe huek Nozzles for irrigating; form depending on size of 
 Raa A « boracre acid So/djiopn 
 
 4 Syringe in ‘ : meatus, see Page 12. 
 
 S$ Tedici7e fT 12 27 jo72. / 
 
 6. Saria/ off capsules 
 
 J- Veale piriTeher 
 
 es Drinking Pass 
 
 3- Bichlorida saleuiior. for dressings 
 
 Lower shelf. 
 
 o- Ordinary wash -basyr2- : k 
 4- Bore or glass arigl 
 (2-Red lifipys paper 
 9. Twels to place under basin Cas & wrigaHioj2— 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 19 
 
 STUDY NEXT PAGE 
 
 DIAGRAMMATIC DRAWING OF THE MALE SEXUAL 
 
 AND URIN- 
 
 ARY ORGANS, SHOWING THEIR RELATIVE POSITIONS 
 
 This diagrammatic drawing (page 
 20), made easily accessible when most 
 needed, enables the physician to an- 
 swer patient’s questions about the 
 sexual and urinary organs and the 
 treatment of gonorrhea, in such a way 
 that his lay mind can readily grasp 
 the information imparted and he ean 
 follow out the instructions given. 
 
 The article itself, on the other hand, 
 presents facts concerning the rapid 
 rate of propagation of the gonococci, 
 ete., and thus acquaints the physician, 
 nurse and patient with the necessity 
 
 of complying with the immutable 
 laws, both organic and inorganic, gov- 
 erning the disease. 
 
 Given the opportunity to acquire 
 the above knowledge, the laity can 
 use their intelligence and logic, and 
 as purchasers can protect their lives 
 and health by differentiating between 
 scientific and pseudo-scientific treat- 
 ment of gonorrhea, instead of relying 
 merely upon the ethical standing or 
 moral reputation of the followers of 
 Aesculapius, who offer the treatment 
 for sale. 
 
90 INSTRUCTIONS FoR RECUMBENT oR HOSPITAL 
 
 DIAGRAMMATIC DRAWING OF MALE SEXUAL AND URINARY 
 ORGANS 
 
 | Kidney cael 
 o~__—__ —_ 
 
 Wrote bee) permatozoa 
 
 4 Bladder 
 
 ii Prostatic 
 LZ Duct 
 
 3 Seminal 
 
 ase 10.Prostate 
 
 Gland 
 
 QGjaculatory Se 
 Ducts _.4 Urethra 
 15.Rectum . (2. Sphincter 
 
 al i WAM Ce \e Penis 
 7 Vas aS , : 
 Deterens oe 
 © Epididymes 5.Testi¢les 
 
 Mien oo IZ Meatus 
 
 4A Mucous Gland ce), 
 
 Body cut in half from before backwards. Explanatory key on Pages 21 and 22. 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 21 
 
 EXPLANATORY KEY TO DIAGRAMMATIC DRAWING 
 
 bo 
 
 4 
 
 10. 
 
 (FIG. XVI., PAGE 20), MALE SEXUAL AND URIN- 
 
 ARY ORGANS, SHOWING THEIR RELATIVE 
 POSITIONS AND FUNCTIONS 
 
 Kipnry—U rine 
 here. 
 
 manufactured 
 
 Ureter—Tube which carries ur- 
 ine to bladder. 
 
 Buiapper-—Reservoir for holding 
 urine until passed. 
 
 Urnerura—Tube which carries ur- 
 ine from bladder (No. 3) and se- 
 men from seminal vesicles (No. 
 8) through the penis (No. 16.) 
 
 TEsticLes —'T’ wo organs that 
 manufacture semen that contains 
 the spermatozoa (No. 18), the 
 male seed. Made up of compart- 
 ments filled with coiled tubes to- 
 taling two miles in length. 
 
 EpipipymMes—T'wo, the collecting 
 tubes for semen. 
 
 Vas DererENS—Two, transporta- 
 tion tubes, continuation of No. 5. 
 These carry semen from testicles 
 (No. 5) to reservoirs, or seminal 
 vesicles (No. 8). 
 
 Seminat VuESICLES—Two, reser- 
 voirs for storing semen until 
 emptied by sexual intercourse or 
 expelled during sleep (wet 
 dreams) or by pressure of con- 
 tents of bowels against same at 
 stool—all normal acts. 
 
 Ezacuntatory Ducts—Two, tubes 
 to carry semen from reservoir 
 (No. 8) to urethra (No. 4) to be 
 expelled from body. Tracts se- 
 men must follow: 5, 6, 7, 8, 9 and 
 full length of urethra, 4. 
 
 Prostatr GLAND—Surrounds ure- 
 
 thra (No. 4) from bladder (No. 
 
 ae 
 
 3) to shut-off muscle (No. 12). 
 It is made up of glands shaped 
 like bunches of grapes, sixteen 
 to twenty in number, which open 
 into the urethra. Its secretion 
 is discharged with the semen. 
 This organ manufactures the 
 prostate fluid (1) to dilute the 
 seminal fluid so that the sperma- 
 tozoa can freely move about; (2) 
 to neutralize the acid secretion 
 of the vagina so that it will not 
 destroy the spermatozoa; (3) to 
 give bulk to semen so that the 
 muscles that ejaculate this fluid 
 will give greater force to same, 
 thereby increasing the possibil- 
 ity of the spermatozoa (male 
 seed) getting into the womb, and 
 fertilizing the ovum (egg of fe- 
 male). 
 
 A Prostatic Duct, and its gland, 
 spoken of in No. 12. 
 
 SPHINCTER UrietHra — Shut - off 
 muscle that controls urinary flow 
 by squeezing together surfaces of 
 urethra (No. 4). It divides No. 
 4 into two parts which are termed 
 respectively: Front-part, anter- 
 ior urethra; and back-part, pos- 
 terior urethra. This muscle is 
 under the control of the mind, for 
 one can urinate (empty the blad- 
 der) when so desired, or hold 
 urine in bladder by simply mak- 
 ing up his mind to keep this mus- 
 cle closed. Knowledge of the fact 
 that this muscle is under the con- 
 trol of the mind permits the pa- 
 tient, by voluntarily opening this 
 muscle, to readily irrigate the 
 bladder and posterior urethra— 
 
bo 
 bo 
 
 14. 
 
 ‘bladder (No. 3). 
 
 Instructions FoR RecuMBENT oR HospiTau 
 
 a method of treatment often es- 
 sential to the successful treat- 
 ment of any disease of the blad- 
 der and urethra. 
 
 CowprR’s GuaNps—T'wo, one on 
 each side of the body. They open 
 into the urethra. 
 
 A Mucous Guanp—!n the urethra 
 (No. 4) from mouth (No. 17) to 
 There are hun- 
 dreds of similar glands so small 
 that they cannot be seen by the 
 naked eye, yet large enough to 
 hold thousands of bacteria. These 
 glands oil the urethra so that this 
 canal can expand or contract dur- 
 ing urination or intercourse with- 
 out cracking the membrane, 
 which would occur if it were dry. 
 
 15. 
 
 16. 
 
 18. 
 
 Rectum. End of bowels or in- 
 testines and its opening (anus). 
 Prenis—Organ that protects the 
 urethra and.directs the flow of 
 urine so as to prevent the indi- 
 vidual soiling himself; also di- 
 rects the spermatozoa through 
 the vagina into the mouth of the 
 womb, so that the ovum, or egg, 
 in the woman will become ferti- 
 lized. ) 
 
 Meratus—KEind of urinary and sex- 
 ual tract. (Route urine must fol- 
 low; 1) 2, 3,4:and 17, | 
 SprERMATOZOA—Male seed. Has 
 power to move like tadpole. Rate 
 of motion one inch in seven min- 
 utes; 10,000 drscharged with each 
 ejaculation. Size 1/500 to 1/600 
 of an inch. 
 
2] 
 to) 
 
 TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 APPENDIX 
 
 HISTORY 
 Beemer Me eeIPO TSA ar: ee a een eee Dates eines, os) 
 MERE ec mrnae teem aes, Me ee ye Te oe rs INO OS ewe sae 
 STULL yc), stl PRIA oi Aaa AST A auc RRS Coed CRS lO EE RN DRT 
 TR vc is Sat ts 20 eR OT IR EA a A Rx AU oe a BS SP 
 MSO Wel Si) oc. LS Ree ls De co ae bee A ral CE a OEE Ake 16 01 ee 
 C1 Su SCOPES Res SRR OL ARMM ee Rs A HP De ace 
 eas VATA se, Sea or ery tbe + GC-Complement fixation :....2......-.02.... 
 
 Gonorrhea 
 (lis (EN ie (og: Bes a a oe VBE R ph GU eo sake CM SP namiee ake CURRIN Seater meee 
 PL ESAS Tie 22) AM SESE oc ei Pe COPY. RUE a SA ea 
 Poti earn eS OE (ioe Mech eel og, Go AGL a ee ee pera i Sek 
 ret eee CEY TGS) a aie AC ete ae eo Mu wl) et ee ae 
 
"HISTORY Continued 
 
 f “al it Pad ©] 
 
 Sie 
 
 ae 2 
 ee 
 ig 
 
bo 
 On 
 
 TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 SPECIAL INSTRUCTIONS OF ATTENDING PHYSICIAN 
 
ON an 
 
TREATMENT OF ACUTE GONORRHEA IN THE MALE 
 
 INDEX 
 
 PAGE 
 
 MmIGOHOLs MUSE NOt US O..--c. 5 c----2-xeceseteseranecenveees 7 
 Apparatus used for irrigating urethra........ 12 
 Articles nurse is to prepare for patient...... 14 
 Nurse is to place on bedside table.......... 5 
 Baths, Hot Sitz, instruction for taking........ 8-9 
 
 Blindness caused by gonorrheal discharge 5 
 
 Bottle, hot-water, apply to perineum and 
 [URMLOVS SI = Oe oR SRT Oe cee ee ae 9 
 
 CWC Lom GCAt Og Ole tt om t,o Soe eens eee 9 
 
 Cotton, medicated, instructions for using 5 
 
 WO ONGCHMOlE SIMS tee oes on el ee eee 6 
 TORREY: ster toe eli eat a ea ne ih 
 Resse s PaADDIIGALION ‘OL 20.0. 222..---ece.-c stn Ae 5-6 
 Duties of physician, nurse and patient........ 10 
 
 Efficiency principles must govern scientific 
 treatment, Of GISCASE.....2 2. .-.-2ac2ee-coe- ee - ale A 
 
 Eryections aggravate and prolong the dis- 
 SAS Cun Oreniie Fe MeV Fh Rd oy th oe 6 
 
 LOND TeVGMtCd: sleek eee 8 6-7 
 
 Explanatory key to diagrammatic drawing 
 
 of male sexual and urinary organs...... 21-22 
 Foreskin, long, keeping cotton over............ 5 
 Mowraress: penis awalhout.:2 32.8 6 
 
 Gonococci, destruction of by medicated 
 (LOTS RGU Ee at pe ee Pea ale Pe ae tte ete oe eo 6 
 
 Gonorrhea, why author chose to write 
 
 LOGU Ces ettee eee a tates DAE RA) ee oe yA 
 Not contagious, but communicable.......... 5 
 History sheets (memoranda)................-.......-- 23-24 
 Hospital treatment of gonorrhea ...........2.... 258 
 Infection, mixed, prevention of._.................... 6 
 COUR ENACT) Sah Saal Oe AL aN Ta Re OE ae es ele 6 
 Injections, instructions to patient for 
 (TUONO ot Ne LE eee Ares, A Pee 11 
 Instructions, after doctor has given........... 
 For keeping nozzles sterile.__.................. 12 
 
 27 
 PAGE 
 For keeping syringe sterile.................... 8 
 AROS TT Tare, Bret rte hes gnc genet se ees aye et 5 
 Special, of attending physician....._............ 29 
 To patient for irrigating urethra................ 12 
 To patient for taking injections................ ld 
 Litmus paper, test of urine with.................. feos) 
 Meatus, changing dressing about.................. 6 
 Preventing discharge caking.................... 6 
 Wheremilocdted) Rac ves ows ae eee 22 
 IMEC GIGS LHCII 6 tee pee pea retreive Sate A eee ee it 
 Medicine, demand for scientific.................... 1-2 
 INJECTION cOL, ee ea ate ee oe ee SA Soe 
 Nozzlés: kind! tisedges. 212s =. ee eee 12 
 Instructions for keeping sterile............... 12 
 Norse, (dutiess oly seeker ae eee STi teat Nt) 
 List of articles she is to prepare................ 14-15 
 Must realize necessity of applying 
 treatment, rezularly Be 2 42 eee 8 
 Orzganization..of medicine. 5. eee 1-2 
 Patient tcontined to 2bed (ee see een tee 5 
 Duties Mor #iuklaceck ee er ees ee eee 6-7, 1 
 TSE LI ONS Op eee ee eee oe Aalto MR 11-12 
 Physician. duties: Ole) 2 es eens Se 10 
 IPTOGINE BURG Sysstat ee ee ee 1-3 
 Stains show. tor remover 2a ee eae 15 
 Standard, creation of in medicine................ i) 
 Suspensory, directions for using.................... 
 WING MUSOU cape eee es a ee Pe Wh wk 
 Syringe, howl stenilizedae. 2 a es 
 Instructions for keeping sterile................ 
 FRING SCCM Sans SS eee ee ee ee ei 
 Table, bedside, articles nurse shall 
 DIAGEO OT aes ee AER Ss Rae 5 
 MreAtment ) CONSLEUCION A] yee eee eens 
 Blospital ty. 238 dace Se ee re 2, 
 Mechnique sO POCA s ss western eee 
 Urethra, anterior, washing with boracic 
 UCT Sah eae od Carey. eine RAS, bea aer ea pee ks 8 
 Postervion, -irriga tion. Ofve eee 1053 
 
 Water, reason for drinking large amount 7 
 
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 eee aes 
 
 QQ, additional copies of this pamph- 
 aid. When ordered in quantities 
 
 eceipt of $ 
 
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 ed postpaid. When it 
 onately. Address all orders: 
 
 IRS 
 
 educed proporti 
 ‘Tun Aurion, ea 
 Seattle, Washington. 
 
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