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Enuresis Wetting the

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ENURESIS (WETTING THE BED).—At about the end of the first rear, or at least during the second, children should be taught how to keep them selves dry during both day and night. When normal and mentally sound children wet the bed after they are three years of age, this is due to a dis turbance which has been termed nocturnal enuresis. This condition occurs not only in weak and sickly children, but also in those who are apparently in the best of health. It may be due to a variety of causes, as worms, stone in the bladder, a contracted prepuce, masturbation, epilepsy, or to enlargement of the nasal or pharyngeal tonsil. During waking hours the child is able to voluntarily retain the urine until a suitable time arrives for evacuating the same, but during sleep this control is often lost. Involuntary urination occurs, therefore, usually while the child is sleeping, and only rarely while it is awake. The urine is freely voided during the first few hours after the child falls alseep and less often during the early morning hours. The act may or may not be followed by the awakening of the child ; it imy be repeated night after night, or at least several times a week. There may be longer or shorter intervals of freedom from the symptom, but it is very apt to return. If the condition remains uncared for, it may persist for many years, even up to the time of puberty, when it generally disappears of itself, although it has been noted up to the twentieth year.

The treatment demands some experience and a great deal of patience. It must be borne in mind that the condition is rarely due to naughtiness or laziness, but that it is much more apt to be due to an inherent weakness in the child. Bodily weakness cannot be corrected by scolding, ridicule, or punishment. On the contrary, this only intensifies the evil by frightening the little patient ; and later medical treatment is rendered much more difficult. The following remedies may first be tried. Supper should consist of solid food only, without any fluids, unless it be some gruel. For two or three hours before bedtime, no fluids of any kind should be given to the child. Carbonated waters, tea, and coffee may exert a very dekterious influence. The child should go to the toilet immediately before

retiring. The most suitable thing for the child to lie upon is a hair mattress covered with some impervious material, as a rubber-sheet, or a piece of oilcloth. In many cases a cure may be effected by elevating the legs and pelvis by placing pillows under them, or, better still, by raising the foot of the bed about fifteen inches. This procedure favours the collection of the urine in the upper portion of the bladder, so that a greater amount must necessarily accumulate before the opening of the urethra is reached, thus rendering more prolonged retention possible. This method, however, can be practised only with older children.

During the day the child should be instructed to hold the urine for intervals of time gradually increasing from two-three-four-five hours, etc. In obstinate cases the child may be awakened several times during the first few hours of the night, and urged to urinate. If a child going to school suffers from this complaint, he should he permitted to empty the bladder frequently, and it is advisable to arrange short recesses between the individual lessons. If these measures prove insufficient to correct the trouble, it may be necessary for the physician to resort to medicine, hypnosis, or electricity. Massage of the bladder has been attended with excellent results in some cases. In weakly children various tonic measures, such as baths, exercises, etc., must also be considered. Punishment is only to be thought of where laziness can be traced as the cause of the evil, hut it is advisable to omit even this, as well as all other methods of torture the application of which is intended to prevent a sound sleep. The observation that a lateral posture seems less frequently attended with enuresis, has led to the practice of tying rough brushes and knotted towels to the child's body in such a manner that the child is made uncomfortable when it attempts to lie on its back. This procedure is cruel and unnecessary. Warning must be given in regard to the many secret remedies which are claimed to cure the condition, without fail, hut which in reality are entirely inefficacious.

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