Affections of the Reproductorium

the hygienic system orthopathy chapter 15

AFFECTIONS OF THE MALE

BALANITIS
Definition: This is inflammation of the glans penis and usually of the inner surface of the foreskin (pothitis) often with a purulent discharge.

Symptoms: Simple inflammation may result only in itching and irritation, or but little pain. The irritation may cause handling of the part and lead to masturbation. In the purulent form there is great inflammation, perhaps slight pain, and considerable purulent secretion.

Etiology: A few cases are attributed to gonorrhea. Perhaps most cases are due to lack of ordinary cleanliness. The normal secretions of the corona of the glans and also the cervix call for daily attention, else the retained secretions decompose and produce irritation and inflammation. It is most frequently found in those with a long and tight prepuce, or in cases of phimosis. If the discharge is neglected it may be followed by swelling and contraction of the foreskin and inflammation of the nearest lymphatic glands.

Care of the Patient: Cleanliness is the only requirement. The foreskin should be retracted and the parts thoroughly washed with warm water at least twice a day so long as there is inflammation. Daily cleansing, after healing is complete, will prevent recurrence.
Hygienic System Orthopathy

BUBO

Definition: This is inflammation of the inguinal lymph glands and is commonly called "blubore." It is lymphangitis, which see.

Symptoms: Pain and a hard swelling in the groin, with extreme tenderness to touch, inability to move the part without severe suffering, and the usual heat and discoloration of inflammation announce the presence of bubo. If there is severe inflammation the pain is continuous for from one to three days before suppuration occurs, when the pain may cease and a soft movable lump is felt in the groin. The bubo now becomes dark and livid and, finally, breaks. Drainage is followed by healing and the end of the trouble.
If drainage is faulty the pus may penetrate the surrounding tissues and give rise to other abscesses. Fistulous ulcers may form which heal with difficulty. More or less ulceration and sloughing involving destruction of considerable tissue may result. If ulceration opens a blood-vessel, profuse hemorrhage will result. In rare cases the condition becomes chronic and may finally give rise to septicemia (blood-poisoning) with even fatal results.
Rarely the bubo becomes a tumor that slowly enlarges to the size of a hen's egg. In other cases there is no tendency to abscess formation and there is a lingering affection of the cords and glands, extending into the scrotum with a dull, persistent pain in the testicles.

Etiology: Bubo is due to infection, usually venereal. It is seen in gonorrhea and in hard and soft chancre. It may also result from intestinal sepsis, a sore toe or even an ant bite on the toe. It can come from suppurating inflammation of any part of the penis. It develops in profoundly enervated and toxemic subjects.

Prognosis: This is good.

Care of the Patient: Tilden says: "A suppuration of these glands never occurs in properly treated cases." The first requisite is to clear out the source of infection. Drainage of any suppurating part of the penis, or of a sore toe, etc., must be established. Ulceration of the foreskin brought on from neglect of cleanliness often brings on bubo. Cleanliness is essential.
Other than local cleanliness and drainage, fasting, rest, and the other measures described under lymphangitis are essential.

CHANCRE (Hard Chancre)

Definition: This is defined as the "primary lesion of syphilis" or "venereal chancre followed by constitutional symptoms."

Symptoms: The hard chancre, as the name indicates, is hard, the sore being indurate and hardened. It first appears as a small, red pimple, and may easily be mistaken for such. It is usually smooth, glazed, red, dry and painless. It "secretes" little or none at all. It often disappears in a short time, or it may slowly develop into an ugly ulcer. The ulcer is shallow, more or less circular or oval, and is bounded by a hardened edge. It is accompanied or followed by various constitutional symptoms — headache, fever, loss of appetite, languor, malaise, etc.

The chancre may develop into a chancre of greater or less size; it may be attended by much inflammation and sloughing; it may be attended by falling off of parts of the flesh; or may be accompanied by gangrene marked by a tendency to mortification; or there may be "eating" away of the flesh, a so-called phagedenic chancre.
Enlargement of the glands in the groins adjacent to the genitals follows. These are not painful, being hard, movable and entirely insensitive. Chancre may develop on the jaw, lip, tongue, neck, or elsewhere, in which cases the glands nearest the chancre will enlarge.

Complications: Chancre is a skin infection, but if not properly, cared for the blood will become infected producing skin eruptions and various other affections.

Etiology: Tilden says: "The hard chancre is aristocratic; it has class to it; it means the victim of it has lived a life filled with luxury, and has a mind satiated with sexuality in all its aesthetic belongings, up to nerve degeneration." "Those with hard chancres have gone the pace that kills, until their nerve energy is used up and they have lost all resistance, and are just about to develop diseases that come from degeneration of the nerve centers."
The poison of decomposition — sepsis — is at the bottom of all infections. External infection soon spends its force if it is not added to by toxemia and the autoinfection coming from poisons generated in the digestive tract. The more decomposition there is going on in the intestine, as an established habit, the more degenerate the type of skin affection that develops from skin infections.
Infection takes place by contact of an abraded surface with septic matter. The process of infection is identical with that of small-pox vaccination and the ulcer formed in each base is identical.

Prognosis: Chancre lasts from two to five weeks and heals. This should be the end in all cases. However, if there is much intestinal sepsis, or if blood infection has been forced by treatment, secondary skin eruptions will develop just as they often follow vaccination.

Care of the Patient: The first essential is to stop the expenditure of nerve energy and secure rest. Stop all nerve leaks of which fear is the greatest. Cultivate mental poise. Cases we have handled with fasting have not been followed by subsequent eruptions. Fasting corrects auto-infection and allows rapid healing.
The most effective care is to secure rest for the nervous system, fast when in pain or discomfort, stop all stimulants, give a diet of fruits and green vegetables, and put the mind at rest by assuring the patient that complete recovery will not be long in coming. Scrupulous cleanliness of the chancre is essential.
Cut out all tobacco, alcohol, tea, coffee, etc., secure exercise in the fresh air, give daily sunbaths and enjoin strict sexual abstinence; even insist that the patient keep his mind off of sexual matters.
CHANCROID (Soft Chancre)
Definition: This is defined as a soft "non-syphilitic" venereal sore. It is an ulcer of the genitals and is the most common venereal infection.

Symptoms: It is an ulcer, round or oval in form, which usually develops on the head of the penis, and which freely discharges a purulent pus. The secretion is highly infectious and if strict cleanliness is not observed, reinfection will take place producing other ulcers of the same kind. The chancroid is soft and very quickly forms pus; it is grayish with an uneven surface and rough edges; is surrounded with a red, inflamed area, is painful and very rapidly enlarges and grows deeper. It may result in the destruction of a large amount of tissue in a short time. It is rarely attended with any constitutional symptoms.

Complications: Chancroid is commonly accompanied by enlargement and tenderness of the lymphatic glands of the groin (bubo). The glands become swollen, tender, hot and painful, often suppurating. If re-infection takes place often enough, due to lack of cleanliness, septic lymphangitis will develop. The chancroid will spread destroying the prepuce or glans, or even the entire genitals, or it may reach the blood vessels resulting in general septic infection and death through blood-poisoning.

Etiology: The condition develops largely in young men, largely in the full-blooded, or plethoric, with an acid state of the alimentary canal; in young men who have gone the pace, but whose sexual excesses have not yet begun to produce symptoms of nerve degeneration. The infection, which is septic infection, is caused by lack of cleanliness. A man with a long and rather close prepuce who does not wash it frequently, just as he does his face, is liable to have decomposition of the secretions that accumulate under the foreskin. Irritation and inflammation caused by the acidity of the retained secretions result in excoriation and, if cleanliness is not begun at once, ulceration will take place at once.
"Chancroid is invariably the result of contact with an infected woman, and usually with one of the lowest and most unclean type." This is the medical theory. If a plethoric individual, whose resistance is low, has intercourse with a woman who has an ulcer of the uterus or an accumulation of secretions that are undergoing decomposition, and there is an abrasion on his penis he is liable to be infected. It will be septic infection and will produce chancroid.
"Mixed infection" is a professional subterfuge. Hard chancre is said to be "syphilis" while the soft chancre is said not to be "syphilis." If an individual with a soft chancre later develops locomotor ataxia, or other central nervous affection, the physician who treated him for chancroid will declare it to have been a case of "mixed infection" and that there was also "syphilitic" infection.

Prognosis: There is no need for this infection to ever become systemic and it cannot do so unless badly treated. If proper care is instituted from the start, speedy recovery will follow.

Care of the Patient: Cleanliness is the one great need. It should be frequently washed with hot water. All attention to the general health will hasten recovery. This attention is especially important if the glands have become involved. Rest and fasting, or a very light diet, and cleanliness are essential in this stage.
CHORDEE
Definition: This is a painful deflection of the penis seen in severe cases of gonorrhea. The penis usually assumes a downward curve.

Symptoms: The condition usually develops at night or while lying down. There is erection, with distress and curving of the penis.

Etiology: This may be due either to spasm of the urethral muscles or to the fact that the inflammation along the urethra prevents the corpus spongiosum from becoming as much distended as the corpora cavernosa. If the inflammation extends into the spongy tissue a certain amount of agglutination takes place, and this interferes with the influx of blood and with normal erections. Under these conditions distention takes place irregularly resulting in a bending of the penis in the direction of the inflamed urethra which does not distend.

Care of the Patient: The first consideration should be to hasten the recovery from gonorrhea. Next, every effort should be made to avoid erections. These often come on during sleep and may be so painful that the sufferer will be up and out of bed before he realizes what is disturbing him. Standing or walking result in speedy detumescence. Attempting to "break" chordee may result in bleeding and the formation of stricture. It should be cared for gently. It is asserted that severe chordee may itself rupture the urethra and produce stricture.
Fasting or a fruit diet will lessen the severity of gonorrhea and reduce the tendency to erections. Indeed there will be very little chordee if gonorrhea is cared for properly from the start.
EPIDIDYMITIS
Definition: This is inflammation of the epididymis, or seminal vesicles.

Symptoms: This complication of gonorrhea starts up suddenly. A heavy feeling with sensitiveness to handling is the first symptom. Often in twenty-four hours the swelling will attain the size of a fist and every increase in the swelling adds intensity to the pain in the testicle and back.

Sequels: It is usual for sterility to follow inflammation of both seminal vesicles. The epididymis is left in a more or less hardened condition, which may persist. The fine convoluted tube which forms the epididymis may be obstructed and permanently closed.

Etiology: It is not uncommon for epididymitis and orchitis to co-exist. The condition is almost always due to badly managed gonorrhea. Injections used in treatment carry the infection deeper into the prostate, seminal vesicles and epididymis. Sexual excitement and indulgence, alcohol and the use of instruments under the same conditions may result in forcing the infection into the seminal vesicles and testicles.

Care of the Patient: Fasting and rest are the great immediate needs. If activity and eating are persisted in, sterility is almost sure to result.
This is a condition that will not develop in gonorrhea cases that receive proper care from the start.
GLEET
Definition: This is a term applied to a chronic catarrhal discharge of the urethra, usually following neglected or improperly treated gonorrhea. It is commonly called chronic clap.

Symptoms: There is a discharge from the urethral canal which varies from a thin, colorless fluid of a mucus or albuminous character, to an opaque pus. There is usually no pain, redness or swelling. In some cases the urine contains threads of epithelium. Sometimes the lips of the opening are found glued together upon arising. Rarely the orifice may be so tightly sealed that it temporarily checks the flow of urine, causing a distention of the urethra and a sharp pain. In some cases there is a sense of itching and uneasiness in the deeper structures.
Where there is a yellow or brownish tinge to the discharge, it indicates that there is enough inflammation to cause necrosis of the mucous membrane and that the condition is dangerously near the point where septic infection can occur. All that is needed is that drainage be prevented by dressings or the plugged-up urethra.
Sometimes the discharge is noticeable only in the morning, in other cases it is continuous. It sometimes ceases for weeks or even months and then returns. Dissipation, excess or overwork may cause a return. Sometimes the discharge actually comes from Cowper's gland, the prostate gland, or the seminal vesicles.

Etiology: Although considered to be always an aftermath of gonorrhea, we have seen cases that gave no history of gonorrhea. It is our opinion that chronic inflammation of the urethra, prostate, Cowper's gland or seminal vesicles will produce the symptoms labeled gleet. Even in those cases following gonorrhea the real cause is the enervation and toxemia that perpetuate the inflammation. We do not believe the medical theory that a man suffering from gleet can infect a woman with gonorrhea.

Care of the Patient: The usual procedure to relieve the body of toxins and restore nerve energy — physical, physiological and mental rest — is essential for speedy and satisfactory results. Locally, cleanliness is most important. If there are sensitive spots, along the urethral channel, these may be gently rubbed or squeezed by rolling the penis between the fingers to force pent-up secretions into the urethra so that they can drain and wash away.
Alcohol, sexual indulgence and all forms of dissipation will keep up the inflammation and prevent healing. The man who mixes freely with women and allows himself to be repeatedly sexually excited, even though abstaining from intercourse, will not recover. Indeed abstaining from intercourse under these conditions is worse than if be indulged.
Men who spend two, three or more evenings a week with their sweethearts or fiancees and who keep themselves in a state of sexual excitement and the sex organs in a high state of engorgement will prevent recovery. Indeed this kind of life will often produce symptoms of gleet, with not only an albuminous discharge, but with also a loss of semen.
NOCTURNAL EMISSIONS
Definition: A nocturnal emission is a loss or discharge of semen while asleep.

Symptoms: Emissions commonly occur during an erotic dream — "wet dreams." The subject usually awakes immediately thereafter and finds the discharged semen upon his body, clothes and the sheet.

Etiology: They are caused by an excessive accumulation of semen. Erotic thinking, whether caused by day dreaming or by stimulating situations, increases the frequency of this overflowing, when the semen is not discharged by normal intercourse. Women may also have erotic dreams accompanied with orgasm.
Nocturnal emissions are not, except in rare cases, a sign of weakness. They represent a perfectly normal method of getting rid of excess material, for which the body has no immediate use. It is possible for emissions to become excessive, due, not to any defect in the process itself, but to overstimulation of the sex glands. What are called physiological seminal losses occur at long intervals and leave no disadvantageous after-effects. A few men seem to have no emissions. Excessive emissions tend to weaken. Worry about them often causes more trouble than the emissions.
When the habitual masturbator abandons his practices he is likely to experience frequent emissions for some time thereafter. The sex glands having formed the habit of producing a certain amount of semen and of discharging it at regular intervals, will not cease this habit at once; but will discharge in nocturnal emissions what was formerly discharged by masturbation. However, these emissions tend to occur less and less frequently as the habit is abstained from.
One of the greatest, if not the greatest causes of nocturnal emissions is nutritive redundancy. Protein excess is especially bad in this particular. Milk, cheese, cereals, meats, eggs, chocolate, and cocoa are among the foods that tend to overstimulate the sex organs.

Care of the Patient: General health-building is the chief need. It is essential to avoid overeating, overstimulation and lascivious thinking.
PARAPHIMOSIS
Definition: This is a retraction of the foreskin behind the glans penis with strangulation back of the corona and results when the glans has been forced through a very narrow orifice of the prepuce. The orifice of the foreskin now forms a tight ring or band around the penis, shutting off circulation in the extremity of the organ much as a ligature would do.

Symptoms: The glans becomes swollen and congested, the pre-puce overhangs it like a swollen ring. Unless the glans can be forced back through the ring, ulceration and sloughing will follow in a few days. The more swollen the, glans becomes the greater is the difficulty of forcing it back.

Care of the Patient: In the early stages reduction can usually be accomplished by thoroughly oiling the parts with olive oil or vaseline, then drawing the prepuce forward while compressing the glans between the thumb and finger. In a few cases it may be necessary to compress the glans by means of a very small bandage tightly applied. If reduction cannot be accomplished in a day or so it will be necessary to secure surgical aid without further delay.
PHIMOSIS
This is tightness of the foreskin which cannot be drawn back over the glans penis. The foreskin is constricted or narrowed at the extremity, sometimes the opening is as small as a pinhole causing difficulty in urination, with distention of the prepuce with urine at the time. In such a case, adhesion of the prepuce to the glans may even close up the opening requiring immediate and radical attention. In all cases there is a likelihood of adhesions.
The condition is usually congenital, although it may result from injury of the prepuce. It tends greatly to restrict the growth of the penis and, due to the difficulty in cleansing the parts, causes irritation and inflammation even infection from decomposed secretions, and sexual excitement. The excitement may lead to some form of masturbation.

Care of the Patient: The usual method of care is to circumcise the child. This is barbarous and unnecessary. Let us say at this point that circumcission possesses none of the virtues claimed for it. It does often result in much harm.
Proper care involves keeping the parts under the tight pre-puce clean and peeling off the adherent prepuce.
To cleanse the prepuce, cervix, corona and glans a small penile syringe may be inserted into the mouth of the prepuce and warm water forced into the cavity between the glans and the prepuce. Holding the orifice tight over the syringe and forcing the water into the cavity affords one of the best methods of dilating the prepuce and slowly peeling off any adhesion. Plenty of water should be used to insure cleanliness. Daily washing and dilatating in this way should be employed.
Instrumental dilatation of the prepuce will hurt a little, but nothing should be used to deaden sensation. The prepuce should be gradually dilated and the adherent foreskin pulled and pushed with the fingers or peeled off by a probe, small sound or grooved director. It is not necessary to overcome the adhesion or constriction at one time. If necessary, carefully manipulate the prepuce a dozen times or more, making a little progress each time. Extreme cleanliness of the hands and instruments is very essential.
Hygienic System Orthopathy
PROSTATIC ENLARGEMENT
Definition: This is enlargement or hypertrophy of the prostate gland. Two forms are noted (1) enlargement due to infection and (2) enlargement peculiar to advancing age. For the first of these see prostatitis.

Symptoms: Enlargement is definitely established by digital examination by way of the rectum. The enlargement develops so slowly that it may not be noticed until it has progressed to a considerable extent, causing greater frequency in urination. Often there is serious interference with the voiding of urine, even complete obstruction of the urinary tract. There will be considerable pain upon urination if the enlargement is great. One lobe or the entire gland may be enlarged. It may be complicated by inflammation of the bladder in which case there will be mucus or pus in the urine.

Etiology: Hypertrophy of the prostate may follow chronic inflammation, of the gland commencing early in life, or it may be the result of sexual excesses and over eating. Toxemia is marked in all cases.

Care of the Patient: A fast will bring about reduction of the enlargement. We have seen three days of fasting enable patients to urinate freely, who, before, were unable to urinate and were forced to keep a catheter in the urethra. The fast should continue long enough to eliminate toxemia. Sexual rest is as essential as physical rest. After the fast it will be necessary to give up the use of tobacco, coffee, tea, and all root vegetables.
PROSTATITIS
Definition: This is inflammation of the prostate gland. It may he acute or chronic.

Symptoms:
Acute. The prostate gland is situated at the base of the bladder and completely surrounds the urethra, consequently when it is inflamed or swollen it seriously interferes with the voiding of urine. There is frequent desire to urinate with a feeling of pressure in the region of the bladder. Urination produces a painful, scalding sensation and this gradually increases in severity as the swelling in-creases. The prostate is swollen and so tender that bowel movements may be very painful. Backache may be present. If the swelling is great there may be retention of urine, especially, as sometimes is the case, if there is suppuration. A catheter may have to be employed to draw out the urine. Abscess formation is serious. Unusual nervous depression, more or less fever and general constitutional symptoms accompany acute prostatitis. All in all acute prostatitis may be a very painful and distressing ailment.

Chronic. The symptoms of chronic prostatitis are similar to those of acute prostatitis, except that they are mild, perhaps without enlargement of the gland, and little pain. There may be slight pain after urinating and a dull pain extending to the back and thighs. A catarrhal discharge from the prostatic urethra may slightly cloud the urine. There is a discharge of viscid fluid varying in quantity, which is called prostatorrhea. The discharge is particularly noticeable after urinating or straining at stool. Fever is absent, but there is much mental depression, the sufferer morbidly dwelling on his condition and magnifying its seriousness. Neurasthenia is a frequent outcome.

Etiology: Acute prostatitis may follow injury, but in nearly all cases it is due to gonorrheal infection, perhaps in all cases the result of maltreatment. Chronic prostatitis may follow acute prostatitis resulting from gonorrheal infection, or it may result from repeated congestion of the gland due to frequent sexual excitement, retention of semen in incompleted coition (coitus reservatus), irritating injections, stricture, stones in the bladder, or other locally exciting and disturbing influence.

Prognosis: While proper care results in rapid recovery, if wrongly cared for, acute prostatitis may leave the prostate gland in an injured state which may lead, later on, to enlargement. Chronic prostatitis recovers readily enough under proper care, but may lead on to enlargement if not properly cared for.

Care of the Patient: "Nothing," says Tilden, "will ameliorate, mitigate, or jugulate this or any other disease as will ac complete fast, continued until all discomforts have disappeared." Again, he says: "Infected prostate is very distressing and should be treated by sending the patient to bed and fasting him for, several days, or until he is comfortable and able to retain urine for three hours."
If there is retention of urine due to swelling of the prostate two measures may be employed to start the urine. Hot baths will usually cause the urine to flow. If these fail, and not until they fail, it will be necessary to introduce a self-retaining, soft-rubber catheter and drain, even irrigate the bladder. Irrigation should be done with warm water only. Drugs, even borax, often produce great evil. The bladder should never be irrigated during the active stage of gonorrhea, unless every other palliation has failed, or unless suffering demands relief that fasting, and hot baths will not give. We do not favor hot water drinking in these cases, as the excess of water adds to the distress.
The catheter should be removed as soon as urination becomes possible. Both in introducing and in withdrawing the catheter great care should be exercised not to injure any part of the passages lest infection take place at the denuded point.
STRICTURE
Definition: This is an abnormal narrowing or constriction of the urethral canal, interfering with or obstructing the flow of urine.

Symptoms: The chief symptoms are difficulty in voiding urine and sharp pains experienced while urinating. There is a small stream of urine due to the narrowing of the lumen.

Complications: Inflammation of the prostate, seminal vesicle, bladder and kidneys, or even rupture of the urethra itself with extravasation of urine or even pus into the submucous tissues, followed perhaps, by abscess or fistula may result. Hemorrhage and general blood infection have been known to occur. When there is much granular thickening of the mucous membrane the urethra loses its self-cleansing power and the canal becomes septic through putrefaction of retained exudates after which auto-infection follows.

Etiology: Three forms of stricture are recognized as follow:
Inflammatory Stricture results from the swelling of the walls of the urethral canal in inflammation and temporarily closes or partially closes the canal. It is caused by anything that produces inflammation of the urethra. Masturbation, rough handling, long retention of the urine, decidedly acid urine such as is seen in those who eat heavily of starch and meat, or anything that irritates or denudes the urethral mucous membrane will cause stricture.

Spasmodic Stricture is largely a nervous phenomenon, it is a constriction of the urethral canal by muscular spasm due to irritation of one kind or another.

Organic Stricture is a narrowing of the urethra from contraction of scar tissue. It is usually the outcome of inflammatory stricture and takes the form of a radical and more or less permanent alteration in the structure of the canal. Or it may be due to pressure from tumors or growths adjacent to the urethra.
Many cases follow injury or are the result of the destructive effects of strong drugs used in injections.
It is claimed that most cases are the aftermath of gonorrhea. Tilden says: "It does not occur except in those cases where the discharge has been held back and forced to take on decomposition — forced to change from a yellow, creamy, non-irritating discharge to a thin, greenish or brownish acrid fluid that is excoriating and highly septic. This discharge is destructive to mucous membrane, especially so when held on it by the usual dressings." Drainage is as essential in inflammation of canals as in wounds and anything that prevents the removal of gonorrheal exudate as rapidly as it is thrown out builds the "perilous" complications the public are so often warned about.

Care of the Patient: Experts tell us strictures are located in the deep urethra. The fact is they may be located anywhere along the urethral canal and patients often present, one, two, and three strictures in the anterior and middle third and none in the posterior third.
Strictures are soft and easily overcome when properly cared for immediately after or just before the inflammation subsides. In caring for the granulations sequent to inflammation, care should begin as early as the case permits. In all cases of gonorrhea there are sensitive points left along the course of the urethral canal after the discharge has ceased. The presence at these points of granular inflammation is made known by itching and there is an almost irresistible desire to rub the urethra. The patient should be instructed to always rub toward the end of the penis and not back toward the bladder and then allowed to rub as much as he desires, merely avoiding too rough treatment. This external rubbing dislodges and squeezes out retained or pent-up secretions and should be followed by urination to flush the canal of exudate.
Better results may often be obtained by employing an olive-tipped sound in conjunction with the rubbing, stopping the head of the sound at the point of sensitiveness and gently rolling the penis between the fingers which are held over the sound, until the sensitiveness vanishes. The sound is essential where there is scar tissue, as in organized stricture, that must be stretched. This may be done as follows:
Thoroughly cleanse a few olive-tipped sounds, as well as the hands. Have the patient urinate and wash his penis with hot water. Lubricate the sound with white vaseline and introduce it into the mouth of the urethra very carefully, as it is very sensitive.
At the first use of the sound, it should not be inserted more than two inches; then at each subsequent repetition of the treatment, the sound may be introduced a little deeper until it is inserted to where the urethra curves under the pubic arch. It is well not to go beyond this point unless malpractice has forced the infection beyond this limit. If it is necessary to go beyond the point of the curve a curved olive-tipped sound may be used.
Upon introducing the sound rub back and forth, especially at the sensitive points and as soon as sensitiveness ends use a larger sound and a still larger sound until one is used that meets slight resistance. The rubbing should be continued until all sensitiveness has vanished and the treatment should be repeated every other day, until the urethra is normal. At the beginning of treatment there may be a discharge of bloody water or even blood. This results from the breaking-up of ulcerating folds and pockets and the breaking-down of granulations and is essential to speedy return to normal.
This procedure should be continued until all soreness is gone and the stricture is sufficiently dilated, after which, if necessary, a little of the same treatment may be repeated every six months or every year to prevent constriction of the canal. Organized stricture, like all scar tissue, cannot be removed and treatment should end when this has been dilated enough that no obstruction exists and irritation, sensitiveness, tumefaction and engorgement are gone. If stricture has not reduced the caliber of the urethra more than 25 per cent the treatment need not be given.