: SHBARMAN PETERKIN, M.D., F. A.C. S.

| SEATTLE, WASHINGTON

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INSTRUCTIONS

FOR
RECUMBENT OR HOSPITAL TREATMENT

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

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CONTENTS

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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

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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-

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

«*

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.

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.

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.

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.

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.

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.)

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)

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.

‘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.

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:

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:

)

ade

“I

10.

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.

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.

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

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.

————

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

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

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.

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

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

eee aes

QQ, additional copies of this pamph-
aid. When ordered in quantities

eceipt of $

ed postpaid. When it
onately. Address all orders:

IRS

educed proporti
‘Tun Aurion, ea
Seattle, Washington.

: ri