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Background:Ramon Guiteras is heralded as the founder of the AUA, and he authored one of the earliest American comprehensive texts on urology in 1912. His contributions to the field of surgical sciences, as well as diplomacy and athletics are well known. However, his 1912 published delineation of the urologist’s role in “clearing” both men and women for marriage is a fascinating view of both medicine and society in pre-WW1, pre-antibiotic, turn of the century American society.
Materials and Methods: We reviewed the published works of Ramon Guiteras regarding premarital clearance for STDs.
Results: In his chapter titled Inflammation of the Urethra from 1912’s Urology, Guiteras outlined the urologist’s role in management of gonorrheal urethritis as it pertained to those engaged to be married. After outlining the potential consequences of gonococcal infection including female sterility and blindness in the newborn, he made clear the sense of personal responsibility he felt for the welfare of his patients and for society as a whole. In a patient presenting with symptoms of urethritis, examination of the urine and urethroscopy were performed. Acute treatment included use of urethral instillations of silver nitrate, boric acid, and carbonic acid, followed by instillation of “astringents” such as zinc sulfate and alum until the discharge fully resolved. On occasion urethral dilation or prostatic massage was indicated. For those patients anticipating marriage, the practitioner was to ensure the urine was clear of pus cells, “shreds” and gonococci, and that the urethra was without visible lesions prior to giving permission for the patient to marry. If a patient were to have persistent symptoms, or findings on examination of the urethra or the urine to indicate persistent urethritis, the urologist was to forbid the marriage. As he describes various clinical scenarios he had encountered in his own practice, it is clear that Dr. Guiteras felt the urologist played an integral role in assuring the safety of his patients and their future spouses and children.
Conclusion: Over one hundred years after its publication, Ramon Guiteras’ treatise on premarital clearance in those afflicted with STDs demonstrates his perceived role for the urologist as purveyor of societal ethos. His texts underscore that the urologist -- even at the very dawn of urology in the US - must play a role far greater than simply surgeon of the urinary tract.