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). <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 Upo Ss eee aes QQ, additional copies of this pamph- aid. When ordered in quantities eceipt of $ a ed postpaid. When it onately. Address all orders: IRS educed proporti ‘Tun Aurion, ea Seattle, Washington. : ri