If there is incurable paralysis of the sphincter vesicie C. Rutenberg has recommended the opening of the bladder above the symphysis, the keeping open of the fistula, and the subsequent operative closure of the urethra. The urine can then only be voided by bending forward or using a soft catheter. A suitable retaining bandage and pad may be used.
Finally, to restore continence when the urethra is weak and relaxed, the operation described on page 36 may be had recourse to.
As Barclay has so excellently expounded to us, the treatment of enure sis nocturna must be constitutional, moral, mechanical and specific. Constitutional means are nourishing solid and soluble food, little fluid to be taken towards the close of the day. For medicines we may use qui nine and iron. Barclay and Brfigelmann join with me in praising syrup ferri iodat. in doses of D i. to 3 i. taken several times a day for months together. Briigelmann cured a girl in this way (S. f. iod. 7; aq. dest. syr. simpl. 50. 3 iq. 2 hours) in fourteen days.
Moral plasters (i.e., beatings) after every wetting, and regular awakening for urination in the very young. For older chil dren and adults, the avoidance of pleasures, balls, concerts, theatres, and society. They should be awakened two to three times every night. Some authors do not believe in punishing the children.
Mechanical means are: Washing out the bladder to diminish its torpor. If the bladder is very small it should be mechanically dilated with injec tions of warm water. Braxton-Hicks claims to have cured incontinence,
which persisted after putierty, in a girl in this way. In a similar case the same surgeon cured a relapse which set in after three months, with first injections of a nitrate of silver solution followed by injections of a solution of morphine.
As specific remedies we may mention chloral-hydrate and belladonna. I have used them both for long periods of time in large and constantly increasing doses in girls from twelve to fifteen years (chloral gr. fifteen to twenty every night.) But I have uot seen the permanent good effect which has been claimed to result from their use by Thomson, Bradbury, and Leonardi. We may use extr. belladonna, or the tincture in five to twenty drop doses several times daily, or grain as rectal suppositories. Campbell Black praises narcotics with chloride of iron in cases of atony of the sphincter. Great improvement is sometimes effected by giving girls of ten to fourteen years of age four to five drops of tincture of the biaca before going to bed.
Baths and cold effusions to the back and loins at night have sometimes succeeded when every other method has failed. (Savage.) In one of my cases the malady always got much better in summer; so that I sent her to live in the South. So the warm thernue of Gastein, mud baths, and even iron-baths may do good in certain cases. Sea bathing is always useful after a cure has been effected.