BY : SHBARMAN PETERKIN, M.D., F. A.C. S. | SEATTLE, WASHINGTON ‘i y A y 4 4 \ 4 ‘ = 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 Reet Ae TOT) MOL PCE CIT) Se eet ee ee eM eet cn gt Byars etn, os 1 ever rime le TuChiOneaee aUMme wOlctiy SOY th Mae ole VE ad 5 i TONE ol of es OEM a, See a a Le ee SRN ae ee Oe a fe (ACO NORSTO YE a UR 4: alate ax J rethe 9 Aeo t ie case eG vlad a NJ) a Paez Lori Lic seers Waa Pere eee cel thie thie halen yore eet de Ss eo 8 ere eatin Cae tate ee i ee, ee) ak 9 TSP aM URS OTE SIE SEI Tage 1 ae ey do ee Re Ra 9 TU eer erly Sree) ay Ui Tees ATIC ly CGO Gta 8 ye ice 88 sap desec lap vanes oee eames 10 aot eiearOlsnlOm ALE LOT NAKING LM JeCtLONS 0c..5 2c -0-s. tints ee coos don stdeenste se Lt 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).