1113/ form of punishment is reprehensible; even the threatening of punishment may seriously aggravate the condition in hypersensitive children. Suggestion may be legitimately tried in patients old enough to be impressed strongly by the physician's confident assertion that they will certainly get over the habit of bed-wetting.
Belladonna, pushed till its physiological action is obtained in a mild form, is the most reliable drug. It can only be of use in doses capable of partially paralysing the bladder. Children bear belladonna well, and some show remarkable tolerance of the drug, but there is difficulty in proportioning the proper dose, and no rule can be given to fix the quan tity exactly for any given age. A child 3 or 4 years old may get 3 mins. of the B.P. tincture in the afternoon, and again in the evening before bed-time. This may be gradually increased till io mins. are reached, if dryness of the throat and dilatation of the pupils are not observed . It is this great difficulty in arranging the dose of the drug which has led to failure. The physician must be careful not to leave the increasing of the medicine in the hands of inexperienced nurses. There is practically no danger in keeping up the action of the drug for two or three weeks, after which it may be gradually diminished, as the bladder soon recovers its normal rhythm when the micturating habit has been thoroughly broken for a short time. Atropine as a rule should be avoided, since the tincture of belladonna has been standardised, but some physicians recommend the hypodermic injection of r min. of the liquor in the case of a 4-year-old child before bed-time, the quantity being doubled for a child 15 years old, but these doses sometimes produce delirium, Hyoscyarnus may he substituted for the belladonna tincture, and it is especially indicated where the bladder is irritable during the day-time. As a rule the belladonna should not be administered in the forenoon hours. Bromide of Potassium has now and then given good results, but is very much inferior to belladonna. It may, however, be combined with it advantageously. The following mixture may be prescribed for a child 7 years old: R Tinctura Belladonna 5iij.
Potassii &midi 5v.
Syrupi Si/up/kis 5j.
A pee Floris A urantii ad 5iv. ]Iisce.
Fiat mistura. Cujus capiat cochleare :mum minimum, mensurd, vespers et Nora somni.
The combination of Strychnine with belladonna has given excellent results in atonic cases; 2 mins. liquor strychnine; may be combined with each dose.
Chloral Hydrate has been highly recommended—the writer has found it to increase the mischief; like Cannabis Indica, Opium, Codeine, and other narcotics, it would appear as if the dreaming which follows the administration of narcotics is very liable to excite the bladder, and often an intelligent child will state that he always dreams that Ile is micturating before he wets the bed.
Sumach (Nuts aromatica) has given excellent results. linna states that it acts upon the muscular fibre of the bladder. The writer has used it in the case of a young adult with considerable amelioration of the symptoms. The fluid extract (r in r) may be given 3 times a day in doses of 5 mins. to children under 2 years, and io mins. to children of 8 years old. Rhus Toxicodendron (Poison Ivy) in small doses has been found to check incontinence of urine. but in no way is it superior to the Rims iuroncrtica. and it may cause irritation of the stomach and bowels. \iitipYrine has heel) proved effectual by Phillips, who gives S to so grs. to children 7 Years old and increases the dose, continuing the drug for 3 or .1 months without injury. Lycopodium and Ergot have also occa sionally proved useful in atonic cases, and Cantharidin in minute doses has sometimes given good results.
Some physicians advise blistering the sacral region, and Ilarkin re ported good results from painting the upper cervical spines with Liquor Epispasticus. It is just possible that these methods act by preventing the child sleeping upon the back.
Painting the orifice of the urethra over with Collodion, or encircling the penis with plaster or an elastic band, are generally futile procedures.
Electricity when there is an atonic condition of the sphincter has proved useful in some cases, but its effects are transient. Picard applies one pole to the membranous part of the urethra in boys, and to the entire urethra in girls, and places the other pole above the pubes.