Eneuresis, or bed-wetting, is a fairly common disorder of childhood which sometimes persists into adult life. It is in many cases the result of a dream, and since it is accomplished by activity of the bladder is a form of somnambulism. The dream of passing water may arise from stimulation of the bladder-neck by the accumulated urine, and since the inhibitory powers of the waking state are absent the act is carried out. Or in a dream a child may see running water or in other ways have the act of voiding suggested. In most cases the dream results from stimulation of the bladder. Usually children who are bed-wetters are sound sleepers. However, their general health is apt to be poor.

The majority are very restless, fidgety, nervous, and as a result of their impairment may become much run down.

Eneuresis is a common impairment of the feebleminded. In such it is rarely cured if it has persisted up to puberty. Many reasons tend to maintain it among those of feeble intellect. The disorder being present from an early age, the bladder is rarely allowed to hold more than a few ounces, and thus the organ is not developed by expansion, which occurs when one has the ability to hold water. Again, the feeble-minded often suffer from general nervous and physical weaknesses. They are rarely willing to carry out or co-operate in curative treatment and are not appealed to like normal children. Personal experience with defectives has taught me that many of these children are unable to retain water long; even those who are not eneuretic must void promptly when the desire arises. Few, if any, of them appear to suffer in general health because of the impairment.

The proper method of treating eneuresis is to first remove any discoverable physical error. Often physical impairments are at fault and the trouble ceases when the correction is made. In particular one should look for adenoids, diseased teeth, eyestrain, constipation, digestive ills. In other cases faulty hygienic habits are solely to blame. Among these might be mentioned overeating, insufficient mastication, eating at irregular times, improper food, lack of fresh air. Over-study aggravates or causes the condition not infrequently. Often the children are mentally and physically fatigued and this is a causative factor. Many eneuretics have pin worms or local conditions requiring correction.

In cases which do not appear to be benefited by attention to physical defects or hygienic treatment the following method will be found curative in most cases provided it is followed faithfully. The plan is hardly suitable for children under four years of age since the co-operation of the child is requisite; under this age such co-operation would not be secured owing to the child's not comprehending the necessity for obeying the rules enjoined.

At the outset the child should be tactfully informed that certain things are to be done for it, and the object is to cure bed-wetting. A promise to do what the parent asks should be obtained. For a faithful observance of the rules rewards may be promised. Rewards should not be offered for not wetting the bed as the child is not responsible for this. Punishment is positively out of the question; if given it simply aggravates matters.

Often a child can be so impressed that it is eager to co-operate. For instance a girl may be told that if the disorder persists she will be unable to stay over-night with her friends, that when she grows up she will not have any gentlemen friends, etc. A boy can be told that the habit will, if it persists, prevent him from going to boarding school, or from gratifying his youthful ambition, whatever that may be. At the same time the possibility of cure should be emphasized.

Diet is of great importance. Hasty eating should be forbidden; if the child is forced to stay at the table a certain length of time, whether or not the meal is finished prior to this, it will soon learn to take time in eating. Eating between meals is to be discontinued; this rule has no exceptions. The diet should be selected from milk, meat, fish, eggs, vegetables, stewed fruits, with a little sugar, oranges, bread, cooked cereals, butter, unsweetened desserts. Condiments, highly seasoned foods, fried and greasy foods, baked beans, soups, pickles, cake, candy, ice-cream, syrup, bananas, pies, raw apples, tea, coffee, cocoa, are to be avoided. The evening meal should be light and should contain no meat.

Fluids of any kind are not to be drunk after 4 p. m. This may at first seem a hardship to the child, but if the latter is encouraged and told the reason for the prohibition it is apt to be content.

Best is what most of these children require. In many cases it may be advisable to take the child out of school for a while. If so, the time should be spent out of doors, but quietly. Playing that involves running, jumping, physical exertion, or which causes excitement is inadvisable. Home study is not permitted; this includes piano and other lessons.

Before bedtime the child may amuse itself by playing games that require no exertion, physical or mental, as with blocks, or reading a quiet book. Ghost, Indian, and other exciting stories are tabooed. A nap after dinner is helpful in many cases.

During the day the child should be encouraged to hold the water as long as possible. This strengthens the bladder and enlarges it. These children usually have small bladders since they rarely retain more than a few ounces at any one time. With puberty, or before, many eneuretics are cured spontaneously; this is ascribed to the development of the bladder which occurs at this time and to the better development of the motor-inhibitory nerves. When voiding, the child should be instructed to empty the bladder thoroughly.

Exercises that strengthen the abdomen are useful; these also develop the bladder. Deep breathing exercises are useful in this connection. A proper posture should be encouraged. Constrictions about the abdomen as well as the chest should be removed.

The child should be in bed by 7 p. m. Prior to going to bed the bladder should be emptied. The bed clothing should not be too heavy, nor produce excessive heat. If the foot of the bed is elevated by wooden blocks, or if the child is prevented from lying on its back by means of a belly band, with a knot pressing lightly against the spine, the urine will not be so apt to irritate the bladder-neck and so cause voiding.

At first the child should be awakened to make water at 10 p. m. and at 6 a. m. The hours should be exact; variations of a few minutes may interfere with successful results. If the child is unable to retain water from 10 p. m. to 6 a. m. it should be awakened at 2 a. m. also The child is apt to be sleepy and to only partially empty the bladder; unless the voiding is thorough it may void shortly after returning to bed. To avoid undue disturbance of the child's rest a urinal should be near-by.

After a few weeks of awakening at definite hours the 2 a. m. waking may be discontinued. Or if the 2 a. m. waking has been unnecessary the 10 p. m. waking may be discontinued. If the child voids after the discontinuance the awakening must be reinstituted. Sometimes a few weeks of awakening will suffice; at other times months of strict adherence to the rules must be obeyed. If all goes well, eventually the child will pass the night without wetting.

If a forcible mental impression is made upon the child it may be unnecessary to carry out such a plan as the above. This applies particularly to older children. A child sometimes is a bed-wetter from habit, the cause having been removed. If habit seems at fault the spinal douche at bed time may cure, especially if the child is impressed with its ability to cure. The douche may be given as follows:

The child should stand unclothed, or with a blanket over the shoulders, in a bath tub; a wash tub will do. The room should be warm. From a hose attached to a hot water faucet play a stream of water up and down the child's spine for a few moments. Then abruptly play a stream of cold water up and down the spine from a hose attached to the cold water faucet. Or one may carry out the procedure by pouring the water from pitchers or watering-pots.

Once the child has been cured of the eneuresis there will be a marked betterment in its general health. Disorders, supposedly causes of the impairment, are likely to disappear with the cure. The treatment requires much patience on the part of the mother, but this is necessary and well worth the trouble, considering the benefit accruing to the child.

Adults as a rule do not suffer from eneuresis unless they are of a neurotic disposition. When it is necessary to pass water at night normal adults awaken. Unless one has partaken liberally of water during the day, necessity for voiding at night is abnormal. Usually a physician is able to discover the cause of such. However, in some cases no cause is found. It might be mentioned that in the latter cases attention to eye defects, often unsuspected, occasionally cures. There is a form of irritable bladder occurring in women particularly, characterized by frequent and painful urination, which is due to ulcer of the bladder; this is curable by surgical means.