Cystoscopic examination of the bladder is seldom quite negative in these cases, and it should therefore i.lways precede local treatment. The writer has found tuberculous disease more than once labelled incon tinence. At other times, especially in women, a-dematons patches are found around the internal meatus. They are often associated with sonic uterine to which treatment must be directed.
\\ lien conscientious nursing in combination with belladonna, hyoscy amus or rhos fails, a trial may be made of passing a graduated Bougie or sound into the bladder in order to stretch the posterior urethra. If no result follows, a few drops of Nitrate of Silver solution may he lodged in the prostatic portion of the canal by means of a suitable syringe attached to it rubber catheter. In girls the solid nitrate may be applied to the entire urethral passage.
Obstinate enuresis in young women may be treated by injecting 3 to grs. Nitrate of Silver dissolved in 2 drs. water into the empty bladder at intervals of a week or so clays, and Simms recommended dilatation of the organ by forcible injections of warm water up to the extent of 20 OZ.
method of treatment consisted in placing the patient in the knee-chest position and applying massage to the yesical neck through the rectum for two or three minutes at a time.
The most obstinate and long-continued cases are to be met with in female patients, when the incontinence may become complete both in night and day time. Cersunv's operation may then be tried; he dissects the urethra from its surroundings for r inch, seizes its outer freed border with forceps, and on a twist of half a circle, fixing it in this position with sutures; immediate continence results. Frisch, in a case which relapsed, dissected the urethra. again, and made a further twist of half a circle, and he holds that this is the best of all operations for incon tinence. Before resorting to this heroic procedure the urethra may he gradually dilated by the passage of a series of large sounds till the finger can be finally introduced into the bladder; this method, though not likely to effect a cure, can do no harm, since the incontinence is already complete: it has been followed sometimes by good results.
The after-treatment of nocturnal incontinence will consist in the administration of tonics like Strychnine, Iron, Quinine, and Arsenic, with sea-bathing, open-air exercises and attention to the dietary, strong tea or coffee never being indulged in after the early evening hours.