SPECIAL REVIEWS: AN HISTORICAL ACCOUNT OF ENURESIS LUCILLE BARASH GLICKLICH Pediatrics 1951;8;859

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 1951 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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SPECIAL
JOSEPH STOKES,

REVIEWS
JR.,

M.D.,

Editor

AN

HISTORICAL By
LUCILLE

ACCOUNT
BARASH Milwaukee GLICKLICH,

OF

ENURESIS

M.D.

E
review with of as

NURESIS

is

still live

far to

from a certain

being extent with

fully still the

understood through problem its

in

its early

causation. history, for

Scientifically and those a short wrestling

speaking of previous it today. successive It is not a Papyrus volume

we

endeavors toward

to cope

seems

useful

Attitudes ages. known of which tiny, when

enuresis
became necessitating 1550 it contains B.C.

mirror

the

basic
problem,

medical
but

opinions
it has since section been the of

and

fashions

enuresis is dated yet

a medical medical Although therein

recognized time this of the ancient

disturbance Ebers is, at best,

childhood

treatment the pediatric

A remedy

for

incontinence
berries

of urine.
1 1 1 hennu measure. to gain mention in one of

Juniper Cyprus

Beer
Thus, the few enuresis medical was texts have in an at least the considered of paid the of day. scant attention survey of to enuresis. great enough

importance

Ethnographers able to collect

But

the literature

few

data show

we

have that it

been con-

extensive in several impression

ethnographic tribes is not

stitutes
areas

a problem
and confirm

primitive that it

in geographically specifically related

widely to

separated of

conditions

modern

civilization.
THE
LITERATURE

Herskovits2

studied

the

West

African

Kingdom

of its

Dahomey

and functions, process at the If the

wrote

as

follows:

child,
and the does the so not ground.

trained
that respond on put Thus,

by
every

the
time in time, to this which

mother,
it must usually training, it sleeps, and the Adida Urine the

who,
perform two and then,

as she
years, manifests at first the

carries
excretory training enuresis

it about,

senses
the age this head clap of does of the their

when
mother four not

it is
puts If a or five, correct

restless
it on

is completed.

child soiling the boy run

mattress ashes are child

it is beaten. over children

habit, or after girl,

on

water into

mixture where ga ga lagoon

then

is poured all ga and stopped, the

offending hands and

who the

is driven singing

street, ga to the
is

everywhere. washed, this being frog repeated is attached School,

Madison,

In second From Wis.

Whydah time
if

the

child

is If

taken
the habit

a to

necessary.

not

a large

the Department
for publication

of History
July 22,

of Medicine,
1950.)

University

of Wisconsin

Medical

(Received

859

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860 the childs waist, however, which beating

LUCILLE so frightens is the

BARASH the offender

GLICKLICH that

a cure

is usually

effected.

In

Abomey,

customary

punishment.

Among
There and are, walking

the
or

Navaho
talking

Indians3
three during it that he things

behavior
which sleep.

problems
evoke

do
concern

not
; left

generally
handedness,

concern

parents.

however,

bed-wetting

If
family

a child
have

past
seen

4 or
to

5 continues stands builds naked

This

to wet
urinated just

his his

bedding
before

very
going to

frequently
sleep,

even
a magical

when
rite

the
is

resorted phoebe
night persists this, the

to. which
hawk past

The
may the

child
also age or his be of

with
helps

legs

spread The
dont is the

over nest
wet remedy. person

a burning
their If who nests. you makes

nest
If

of
enuresis

the

commonly

its nests
then will die

in the
because

hogan.
birds Way

of a swallow
dont

or of a
have all

used. puberty, brother

Blessing because

person

it is a dead

water

the 16th 19th

time.
Enuresis is a pediatric problem, not recognized but pediatrics as quotation had no place branch of Aegina4 in medicine of medicine the last prior until of the to the the

century, century.

and

was
to the

a specialized

It is therefore
reduced

not
following

surprising

that

our
from

knowledge
Paul

of enuresis

in antiquity
great

is

practically

Byzantine

compilers;

ON

INCONTINENCE

OF

URINE

Relaxation
of are produces

of
tonics

the

muscles
most such as hot

at the
wine and to paralysis.

neck
and rather,

of
oil,

the
Our and

bladder
general the like

occasions
treatment abstaining using are

this

affection
from all

and
things

therefore especially which cold

it happens powerfully

frequently

to children.

ought calefacients

to consist

refrigerant

as much The following

as possible, things in like

; for fasting
down the in a day.

a resemblance

naturally

efficacious.

Burn
or the testicleof

the crop
flowers

of a cock,
of the into white

and

give
wine, the

it to the
and toasted give

patient

to drink

in tepid
manner calamint

water
; or,

when
shave and every myrrh third

oxeye

(chrysanthemums) to drink; of the seed

a hare

fragrant ; or give

or give wild

draught Let the

before privy
.

supper be anointed
the Middle

rue to drink the juice

with
Ages Ages were was was

cimolian
were also believed implored also

earth
content a time for of

mixed
to follow

with

of perdicas
the on

(pellitory
traditions of

of the wall ?)
Medically antiquity. St. Catharine November appealed and at The

rather

slavishly and prayer. and Germany from the

Middle of was relief.

of supplication help. those In southern

In Transylvania, her St. dancing nameday, Vitus was mania

Alexandria particularly He

to be helpful

in enuresis suffering

25, to for

a patron

constipation.5

Astride
Padua. combined

the
In

Middle
1472,

Ages
he published of totally Middle the

and
old in

the
the and

Renaissance
first printed commentary

stands
book

Paulus
on diseases

Bagellardus6
of children. and observations

who
His

studied
was a

compilation

on his own

treatments.

He
times, the

said,
dictates

But
of

because
not the urine

in our

times
opposition were

the

doctor
to de the mingling

must
rules, with

act,
the

not
and

according
in so saying, of

to rules,
indicated the bore

but

at
that On

however,

Ages

progress Infantum,

Renaissance.

The

20th Parents

chapter
of

of his
and

work, saddened years

Libellus

Egritudinibus

the boys

title,

incontinence

bed-wetting.

are especially the age of three

as a result pass

of bed-wetting water in the

when bed,

either and this

or infants not

beyond

continually

sometimes

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AN only
only said

HISTORICAL of a single
or six in

ACCOUNT day or two

but measure

OF but

ENURESIS continually,
the for time the

861 and
This

within
up to be

the
very

space
age base

days,

every
boys

night,
thus

not
is And

to the

of five and

years,

sometimes

beyond

of puberty. born.

a certain

unfortunate

although conscious remedies

preceded a probable

there of it, which

by cause

may

be many of been
of the the

causes the

for their of

passing this by
be vesical

water, we
who

while shall
can

they bring and are

themselves forward true, only yet

are not those always

because have
of

brevity
body,

work the
infants

recommended
if they of the then

authorities
muscles.

a purging

be purged

of humidities,

relaxation

We
matters

shall
not

begin
natural.

the
Let

cure,
them

therefore,
beware,

by
of

premissing
coldness of

the

due

administration
and all food

of

six
and

temperature

drink venient

tending to aggravate slumber ; let them

such as crying,

the stomach and corrupt digestion ; let them sleep in a conmake use of moderated exercise ; let them avoid the accidents
immoderate exercise from anger. Now of

of
of

mind,

the

things

recom-

mended urine. kidneys

according

by the Fidelis and humidity of urine

mixed

authorities, asserts
method

Avicenna that
of

says

that

medlar urine and straw,

and used too, and

many

sorb for
for

are beneficial caused stopping

inability

for

excess of the also,

urine,

galanga (a wisp
its

checks of twisted causes.

therein

its flow

by cold a drain)
to check

bladder.

A scud

to every

administration,

is beneficial

when flow
of iron

or cold due
with wine

or both and
or infused

are

Likewise, Serapio
or diluted

the
times

use

of
therein,

enula too,
when

aids that

excess scoria
imbibed

to cold

humidity.

says,

Alcafabrius

dries

up the humidity Dioscorides said And pulverized and dry

he

which relaxes the muscle and that the cerebrum of a hare, said
of

strengthens it. ground and imbibed, when

the bladder

corrects into
breeding

bedplaster
sow,

wetters.
restrains

Fidelis and it and

is cured.

that
urine.

the
He

lung
also

of
said

a kid
that

eaten
of

and

made

incontinence

a young

when cock rough,

imbibed, triturate of

checks it and

urine. scatter
from

Rasis on of
experience

said the

that bed
that

if you of the
if the

remove bed-wetter passed

the comb without is thick and checks

of a his and

knowledge,

It is known

urine

if a syrup
that

be made
urine

a decoction
and

the

flowers

of nenuphar hedge-hog the Avicenna ; so, too

; the

is quaffed, the of Yet that flow urine, the if one

is true

immediately

is checked

clarified.

.I myself

know so that in this

from if matter

experience it be there softens frequently seems the

understand

that

the flesh administered,

of a ground it prevents because urine

is said

of urine,
although flesh
considers

passing asserts Rasis.

experiment

to be controversy, bowels and

that

of has

a hedge-hog
their dicta,

provokes
what

he

will

is true

and
and

been Maxillae

proved lucii,
they

by me. non salitae,

nocturnal

Rx A

pulversatae
wetting.

subtiliter. skin of the

Administered stomach or cooks, in which dried and not of hens when food only

in the which

morning in our the or for

evening

removed

second

experiment

is that

the

inside

idiom is called requesta and is the one wherein women stomach of hens in twain, raise up a certain little skin digested and is cast forth from it. Now such a skin morning and evening adults of either sex, Thus problem other bladder. the hand This Middle light concept that in the removes and aids ages of the felt held was gave Galenic that in the

they cleave is contained for saw boys, the neck but

pulverized,

imbibed

nocturnal wetting marvelously, the stomach wonderfully. way to the Renaissance. of humors. resulted century from and doctrine enuresis 19th

Bagellardus It is interesting weakness even today. of

whole on the of the

in

to note the

it. was

Organ

therapy

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862 the
in

LUCILLE
of pulverized (1540) (1450-58). animal published whose a bladder work,

BARASH
is also in turn,

GLICKLICH
upheld of is the a by Nicolaus entire reproduction text of of Fontanus Sebastian that of who wrote Austrius Cornelius

form
1642.

Fontanus

reproduction

Rubeaquinal Roelants

In England in 1544, Thomas Phaer Because of his recognition of diseases

publication
Father

published

the written his

IN

first in

edition English, a paragraph

of his

Boke

of Children.

of children
is in

as a separate
Boke,
THE

entity
he

and
entitled

because
as

of his
The

of of English

the

first

book

on

pediatrics

is known

Pediatrics.

There OF of

PYSSYING

BEDDE

Many children waking they

times are against will and be to

for

debility theyr

vertus having they in

retentive whan no must their their power avoid meates

of

the urine to

reines issueth reteine meates, drynkes.

or

blader, out either ye

as wel in it cometh, vertue be

olde

men slepe

as or yf

oftentimes holpen, use this

annoyed, wylles, fyrst pouder

theyre

it whan til

therfore restored

al and

fat

againe,

Take
use of Item the lette The 17th and and assume did not

the
it twise the them humoral

wesande
or clawes lye and authors Blankaart. thryes of be of often

(trachea)
a daye. a goate, age, to the therapy Daniel

of a cocke,
The made it is good naked approach Sennert, stones in

and
of

plucke
an

it, than

brenne
poudred

it in pouder,
is of pottage. with holes the

and
same

hedge-hogge or of is also James eaten

vertue.

pouder

dronken, fyne

in

If and

patient

to make

plates

leade, found

in them, of such

organ as

to enuresis Robert Pemmell,

in works

century Stephan

Primrose,

J.
more
as

Starsmare in number
diseases we of may

As the
more children,

17th
we that lessen,

century
With find the little century practice,

gave
the

rise to the
recognition assuming and importance of which

18th,
and a position

the pediatric
discussion of enuresis and from

works
of new any importance. in

became
disorders given continued changes.

detailed.

enuresis incidence was of

less

Although group of

of

children

discovered the day elements problem. in nerves Dickson8 of the

its causation, was The the undergoing anatomical of the go this four (aromatic acid were blister utilized was was of of disappear form states that for

its cure regular

to be relegated The more humors and of the cites valerian nervous condition by which with this are more blisters foramina a case with of She the stimuwas her lower a

to the no daily Thus to the of had volatile lant) not enuresis extremity A Surgery9 just the

pharmacopeia 18th dominating in sacrum. os been pulp without idle was palsy mechanical of 1751. sacrum, old girl treated (plant success. habit, promptly of 1762,

In the
longer

magic every

the

pharmacopeias. idea

influences of pass

medical

especially most

nerve

pathology. application through He and bladder be both sulfuric of

Thomas As I thought who with from and blisters and had

first

effectiveness might years,

which

to the

it probable had elixer which enuresis of threats a large in the

24

use. diurnal acid), that

1 3 year

nocturnal.

vitriol valeric

is obtained-used to applied special urine, of made ascertain to her use said urine with

as a mild os sacrurn in individuals Dickson. is iron, mentioned but for

Severe finally cured to concomitant of

hours. incontinence

Application

os sacrum

method This

appeasing

incontinence described as

in use

Sharps must be

is a yoke

covered

with

velvet.

It moves

upon

a joint

at one

end,

and

is fastened

at the

other

by

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AN catches the penis, instrument the part With specialty, at different and taken

HISTORICAL placed whenever useful on the because

ACCOUNT a spring. patient it always

OF It must finds an answers

ENURESIS be accommodated inclination the purpose to make and to the water. seldom size

863 of

distances off

This galls

is exceedingly after the the a few advent literature of days the of

wearing. 19th the century, day becomes and the replete establishment with articles of pediatrics on enuresis as a separate in children;

the greatest both

to the impossible which were deemed wet of her led rendered patient

bulk
and in to

of such
and family. station of to It was

literature
social To of to schools hazard, the

appearing
not and ill of the for the of the back day, to poor life, and children,

after
mention

the midcentury.
the unnatural ; while girls boys engage discomfort it necessitated

Enuresis
and of were frequent irritation of as that a higher a domestic enuresis

is considered
inconvenience of linen station who the social a girl again relatives necessarily

an economic
their lack

changes

produced treatment who door, having day.#{176} The would

sympathy work thus medical as

ineligible

of a household

ineligible

maids,

bed

through men

so to speak, been and forced

became pressures.

importance

to the

there

by social

Then,
fested literature. by

as today,
the Let

lack

of

any
and first

definite
varied theories the

knowledge
theories propounded
iN THE

concerning
therapies concerning
19TH CENTURY

this
that

problem
came the cause

was
forth of

maniin the

multitudinous us consider

enuresis.

CAUSAL

THEORIES

Generally toward toward plaint. the this With

12

speaking, development disorder, the who same were

there of and thought heavy

are members

a number There of mind, were eventually vesical the

of same this

factors was, tendency it family

which was was to have were

were thought, often labelled enuresis Deep loss

believed a familial subject by more sleep, voluntary some,

to to

contribute tendency this comcongenital than

enuresis. in sleepers

Children

believed

frequently

those
discomfort thought

who

were
of

not.
a full

Likewise
bladder atony of the

children
which

fatigued
sphincter

by a holiday
empties because itself.12 of irritable atony in turn cord.

are not
of

easily

aroused
further, control.13

by
was

to produce

The
enuresis
a

mechanism
on for imbalance sphincter. incompetence temperament, state

most

widely
and the

accepted
in the general

and

variously
; i.e., This the lumbar

explained
was was

was
detrussor felt the of

that
to result be

which
acting the of

based
against greatest

of musculature Debility of an of vesical centers

bladder musculature

relaxed

cause lymphatic an again gerated irritability

sphincter. of in the

a general or

imperfection

primary

process
10

sanguification

enfeebled

nervous

Acting
was

against
attributed contractile of the

the

weakened
to various of with the

sphincter
causes. muscular of

was

the

overactive
of was vesical one

detrussor.
musculature suggestion was

This
while

condition
and exagprimary

Hypertrophy coat5 propulsive

power bladder

excess

powers

another.#{176}

There
it

are various
enuresis sebaceous extends by the

irritations
was attributed. secretion accumulation

which
between to the of

arise
Phimosis the

either
glans and

in the
of and renders the

urinary
these, that prepuce organ

system
particularly more

itself
where easily

or outside
there irritation excited to is

to which

is one

associated which contraction

producing

by sympathy

bladder urine.13

Food

or drink involuntary
parasites, also

causing
especially overloaded

acid

urine
ascarides, stomach

was thought of the bladder

are listed

to be a factor of irritation which might produce secondary to irritation of the mucosa. Intestinal
among the factbrs causing bladder irritation15

contraction

as are

or bowel,16

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864

LUCILLE

BARASH

GLICKLICH

mucous
pathology0

secretion
and

from
hip

Cowpers that

glands, experimental

contracted work
he noted

meatus, at this
when

bladder time
the

stone,

uterine indirectly Goltz was

distouched this

disease.16

It is interesting showed
cleansing the anal

to note might
divided with

done micturition.
that

by Goltz while
sponge on wet

how
dogs area,

irritation
involuntary

induce
spinal micturition

involuntary
cords, occurred.

One

day,

Powers,#{176} on

commenting

covery,
spontaneous The since stretched

believed
voiding overdistended Civiale18

that

irritation
when bladder that

here higher

in mental

area
of

of
irritation

the

sacral were
was from

innervation suspended,
a somewhat a distended

would
as during disputed bladder

produce
sleep. subject, which denied

influences
was reflex overflow

as a cause incontinence

contended

ordinarily that
viduals morning

was
the

sluggish
vesical were

and
musculature,

filled with
to of

beyond
causing

its capacity, was a distended

still bladder.

others one.
wet

stated
while

that

overdistention that
time

contraction,12

Trousseau13

the

bladder
who despite

of children
awakened the quantity This

enuresis
empty fluid their

He
at their

contended
usual

mditoward

bladder

in the

Mere
enuresis

desire
in the

perpetuated nurses
and often fail

by habit
vicious

was
circle

considered
was believed

by some
by bedtime. of enuresis.

to be a primary
Morris20 to be the

factor
fault

in
of

children.19 day, were

mothers
during Dreams

and/or

who,
to see mentioned

early,
that

feed

the
inciting

child
before cause

improper

food,

neglect

the

bladder
dreams

it is emptied as the

These

included

of were

wetting

the
dreams

bed,13
which

dreams
in later in

of urinating
life the give

in a convenient
rise to nocturnal

receptacle2
emissions.

and
The

amorous
latter dreams

or of were hours that

lascivious nature to

described
relieve

as producing
irritation

enuresis

and
child.16

thereby that
the

acting many
spasm

as a conservative felt penile occurred theory

the

process erections in early contended

or

In this of import
as did

connection in enuresis.
This

it is interesting They
was

to note that
likened

authors often
of

noted
also

erection
to

of the penis neurogenic

or

enuresis.18

nocturnal

ejaculations.22

Another
there was

explanation
either excessive

for thus

enuresis
or deficient

was

the
irritation

one. enuresis

This
of

irritability

efferent

afferent

nerves central excessive

centers.22

to or

the

bladder,

connoting

the

idea

that

could

be

either

due

to

to peripheral or deficient
Diminished

irritation irritability
activity of

or lack of nerves
vesico-spinal

thereof. between
centers

Centrally, there might the spinal cord and

or partial anesthesia

further be encephalic
of sensory

nerves the considered removal

tween inhibitory

to the bladder bladder to the an indirect of inhibition

and centers in

produces cerebrum.23 factor by the the

brain,

delay

in conveyance

of information centers

regarding in the cord

the state might

ol be

Exhaustion

of neighboring

in weakening nervous control over the bladder, as might encephalon such as in sleep. A broken communication be.
would certainly however, produce Powers incontinence workbo contended of urine.22 that this Speaking center of was

cord

encephalon

in the vicinity of the excito-motor Eczema was spoken of as one

of importance in enuresis.

center of the

at L.5 and denied its existence in the brain. nervine lesions producing peripheral irritation

Aggravation

of such

a lesion observed

was lesion

noted which that

to increase brought the concentration maladies with of minor

the with progression

severity it an of of to the cure

of

enuresis.
more on

Chorea
enuresis. bladder higher

was

another
was of

so-called
enough, regained ganglionic

nervine it was influence, probably

associated chorea, disease themselves.0

Interestingly control spheres

because permitting

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1
AN Stein2 turbance a neurosis actually form of spoke of the resulting clarifying a mental or of HISTORICAL or the cord Other neurosis, as insanity cerebral presiding men, yet ACCOUNT stimuli over too, leaving OF producing micturition, spoke the of impression It is clear, ENURESIS temporary calling enuresis as that however, this molecular phenomenon never a lesser neuroses it was that a neurosis, 865 dis-

peripheral of defining in enuresis.

segment

disturbance,

or epilepsy.

were
drawn

thought
between

of enuresis
epilepsy

as organic
such disturbances

rather
and

than were
of

functional
that

disturbances.
are very

Certain and
from enuresis.

parallels
Trousseau3

were
sug-

enuresis

interesting.

gested
may noted larity be

that
that in the

and
in the

epilepsy
family early with

both
an occurs

hereditary
individual at night

or familial
suffering as does

that
the He

one
other.

condition
AlibuttIl simi-

present

in the

history stages
the

found

epileptic

facies

with
spasms

complaints
of epileptic

of

enuresis,
patients

then
with

downcast concluded
giving

look and the appearance his discussion by comparing

rise to incontinence of urine

of

individuals the sudden

or nocturnal

spasms

ejaculations.

Epilepsy and reflex irritation.25 produce

unstriped use tiOns. Trousseau3 In such

enuresis Both in
fibers

were further associated by considering both as being caused by affections were said to be influenced by sympathetic nerves which fibers
of cases a patient insanity. the where might In was such

spasm
muscular

muscular

of

small

arteries

of
and first enuresis

the
both

brain
were

and
said

likewise
to be

in
abated

the
by

detrussor enuresis suffer

vesiculae, was the

of belladonna.26 reported cases, finally, each in a chain as of neurotic and in transmutalater it writing life is not of from of be a child

develop
epilepsy surprising

hysteria
and, that

or epilepsy
entity

; or the chain
considered

of events
a series to

might
a type

include
of

enuresis,
manifestations,

spermatorrhea,
Rex,27

succeeding

neurosis.

night showed

terrors, lack

referred of were

to them force to

as closely evidenced marked form period,

allied

to enuresis of made

in which indigestion the

the child and

so plagued, These and if

nerve said articles

tract

by constipation, disturbances of insanity. mention

factor

anemia. system

conditions neglected In most

of the

show to some of this such

nervous

thought of the discussion

or genitourinary

to lead

was
in the

of the relation
of enuresis,

of pathology
but for the

as a causative

production

most were
vagina,

part,

of
kidney,

factors and

stopped
and

with stricture

merely
ureteral

their

mention.

Among

these
about

malformation
uterus

of bladder or scrotum.28 incontinence

appendages, noted Taylor29

of the urethra,
orifices

diseases
terminating

of rectum, eruptive found in

diabetes2

anomalous

the fevers

vestibule suspended

Trousseau13 while

that found

intercurrent that

diseases

with states

preparalytic

poliomyelitis that uricemia enuresis. Laziness, development to

use

or diphtheria was common

were instigating causes in little children and

of incontinence. He further discovered he felt this to be a diathetic cause of as possible contributing Adams16 had an apt and to be a pathologic
itself after having wet

cowardice and fright were mentioned of enuresis in childrenl3 but Samuel Inasmuch
that a child

factors potent state,

been

to the answer he
taught

that

suggestion.
to admit

as he
ever

believed
deliberately

enuresis will

was
to

unwilling a vessel.

None why
are not

of the
able,

brute
by the

creation this
a careless helpless

lie in their in the rational

superficial

urine
examination

if they being
to

are not
find the

tied
Simply cause,

or

penned; because

then some

do we attribute that their

practice
and

to laziness? account

and
act,

well
they

knowing
too often

reputations

will
child

be at stake
to daily

if they

do not

for

the

condemn

floggings.

Unfortunately,

Adams

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866 was century diagnosis correct drew by in his to its

LUCILLE condemnation close, we We find can he clarify of

BARASH many more well of and see the more where turn problem

GLICKLICH physicians emphasis the of the day, to of of the the but as the 19th of be

given

importance day could

examination.

practitioner

confused
enuresis investigation

upon
; and in

being
how an

confronted
in desperation attempt to

by the
would this

quantity

and
to his for

variety
own himself.

explanations

offered
observation

for
and

faculties

TREATMENT

If, however,
only by the specific anything to turn magnitude treatments methods.

the
to the of

problem
variety confusion specific were for Cures of

of etiology
proposed which causes, pronounced, inclined disorder to just

of enuresis
treatments this disorder either believe

does
for this created.

not

appear
disorder There shotgun

overbearing,
to be duly were general therapies of all the

one
impressed measures, and treatment.

has

homeopathic

therapies, because that when of or

tryin a

in spite

When
the specific

one
name case

reads
of of

of the
he enuresis,

number
is the

of medicaments, upped intake

possibly to
on

implements and of
on
back.

and
these

methods,
were it was

all
turned

used
on

science,

died the
a hard
Deep

because

outnumbered.

General
bedtime, with
assuming

measures
emptying the if
position

included
bladder necessary.3
but that

limiting
He
of

fluid
was

child

for

three
with

hours
the few

before
bowel covers,

at bedtimebo

accompanied

by emptying mattress
sleep was

an

enema
any

sleep
his

lying

to be avoided
should further

by
be

awakening

the

child

during

the

second

hour

of

sleep.15

The

child

awakened or
the

just alarm
advised

prior clock.9
warm or

to the In
ones douches

time
to be to the

he usually to this,
taken lower at bed spine

wet. some

This writers

was
Still

to be done advised
others

either sitz
that cold

by a parent baths3 while

to dashes

an

addition

cold
felt

others

time.15 were

perineum2

to be highly

recommended.22

During and ablation

patients the general

the
and

day, with

good cold

diet water
in

and
those

general
with

maintenance8 drying
good debility,

together with
food, free

with

open were

air exercises advised.

cod liver

followed drugs

by brisk such

a towel5 were regulation

might

In all
oil,

particularly

bowels,

hypophosphates
physical

and

other

tonic

as iron proposed him.16

of food,

compounds that such

who

suggested

to improve out
patient

Food
a hospital,

was

also

tone. 22 to be regulated.
away from sour

It was

be carried
consider the tea and

in

if possible,

sympathetic articles

relatives

unduly
avoidance

restrained
of with salt,

and
sharp

tend
or

to overindulge be
intake

The
malt, It was

diet

was

to be nourishing
spirits,

with
coffee.

liquors, felt,

The
merely

amount and

of

meat anemia

should
of meat

moderate,
in the

some
diet.2

asserted,15 in the diet.

while
however,

others
that

cited
in cases

cures
due

reduction

to debility

meat

was

an essential

item

If a child

was

rheumatic,

or if his urine was turbid or acid, milk The pharmacopeia was then thrown which
sumac)

should replace nitrogenous food wide open. Leaves of uva ursi

of the was urinary system. Oleum

in his diet. was an astringent glabrum aromatica32

or

had
was

peculiar another are drugs debility, of

operation astringent

on

diseases which

Rhus Rhus
alone quinine For

(smooth
equal

recommended.

terabinthinae,10

parts
Rhus tion

of tincture
radicans33 with other

of cantharides
a few were and drugs found

and

muriated
effective neuroses

tincture
in passing cures were and

of
which for treated

iron,28 either enuresis. with

and

mentioned to be and

in combinamild

Weakness, preparations

nervousness

sulfate, gastrointestinal

arsenic

steel,2#{176}zinc

sulfate8

bromides.

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AN disturbances, fermentation.18 turbances. cases, and syrup of

HISTORICAL iodide of iron was and

ACCOUNT to be considered camomilla purgation placed in

OF

ENURESIS since iron supposedly for and prevented such by surrounding

867

Sodium

phosphate27

were

also Worms

recommended

discina

To
enuresis

restore
was and

chylopoietic
cured by extensive were anodynes

derangement,
the

purgatives
alone. rectum

were
to

advisedl2

in some

were soothe

eliminated the

calecarb13

structures.34 To render
potash was

urine
popularized5

more liquor into

To taken,

irritating
while

and
to decrease

thus

more
acidity

stimulating
and other

to the
irritable

bladder,
properties

nitrate
of urine,

of

benzoate Ergot
bladder

of soda,8 was injected

were sphincters.T

potassii#{176}and the
give while

bicarbonate fossa
bladder strychnine

of potash to promote
muscles, was

and direct
for

soda6 effect
opium,36 excitation

were

advised. weak
and spinal ergot of

ischio-rectal
tone by to others

upon

camphor, taken

strychnine2#{176} nerves.12

Of
included oral while strengthen excitement success obtained of
it

the

drugs
strychnine

there
for or there used it of the as

were
atonic

four

utilized
sphincters and who of tonic while At any operandi. 1870s. to impairment

more
and sacral it bladder

extensively
bladders plasters2 to restore spasm.4 group

than
; belladonna, was muscle

any
used

of the others.
in various for, tone used well, of it in the let primarily

Those
forms us of say, to

medication since others efforts of regardless generalized bladder.37 not resorted the ointment used when produce to,

suppositories20 were in the those cases sphincter38 arc.39 modus in the preferred or not and urine medication. urine was used

enuresis,

used

bladder3T

Some felt was

another rate It was belladonna Chloral felt

it acted used is the was drugs. would It was day with

preternatural overwhelming drug rapid, cantharides to stimuact to as it to in turn used advised

15

reflex of It was diarrhea its usage

hydrate to act because its When other three

third in reducing more failed,

which irritation and

primarily action others which

the did

belladonna of increased on There the was with

vision.26 as the contraction urethral one heat, doctor pain

was late awaken an be

but

was

as routinely

It acted

urethral the patient or

surfaces when an reddish oral

produce pressed

sphincter.38 of and the

either

who

passed

Then
the earlier

there
it had

were
The been

those
18th used

individuals
centurys to stimulate

who
blister sacral to

preferred
the nerves,

to use
sacrum it was

a more
lost used now

physical
popularity. to prevent

approach
Whereas children

to

problem.

never

from believed An
on upon a reel

lying

on

their
problem

backs of devised
thus For the

and the
of

thereby supine
lying

from position
on

heating prevented
their a most refinement to prevent

those
backs

same urine
was met

sacral from
by

nerves. gravitating
other means, his merely

Others to the
too.

prohibition was
back, to cotton lie.9 over

trigone.3#{176} This

children

instrument
the or childs which

with
making those spine

a steel
the to whom was

spike
back such

projecting

from
was the

it which
portion not supine available,

was
of

to be placed
anatomy tying men

undesirable

sufficient

position.4#{176} For

who
orifice, body again, of

were
at

interested
a 45#{176} angle there were who were

in preventing
frame and did available. for parents not elevation prevented who respond The

the
of

offending
the pelvis from to

urine
was entering these treatment.

from
the abnormal All could

approximating
This sleeping was be not lost! placed urethra. posterior

the external
the conditions Other with forms silver childs or

a wooden

in order.

urine objected

Perhaps

children

to such orifice of

treatment

the

urethra

cauterized

nitrate

to render

this

portion

more

tender

to the

passage

of

urine

over

it.#{176} Especially

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868
designed nitrate or for girls was of

LUCILLE
treatment chromic for of

BARASH
the anterior while the

GLICKLICH
1/2

to 34 inch
heirs

of the

urethra
blisters

with
to the

silver
penis

a solution measure

acid,24

male

received

as a curative

enuresis.27

Reasoning gested
period

that
time until

decreased Sims
it held

bladder that
up

capacity bladder urine within

was

might
Along the

be a factor with
line same

in enuresis, water,
of logic is the

it was
suggestion

suga

by H.
of

Marion be taught

the their held

be distended longer
one

gradually therefore
received

over increase
good

to a pint.42

that

children
Dilatation

to retain to urine
with urethra

during
method

the day and

which often

tolerance results thought Either

girls.

of the
of

bladder
the

its confines.13 Mechanical and girls,

hymen

sounds

in cases

of irritable

or spastic

urethra.43

dilatation

and

irritation

was

to stimulate due to the orifice

rubber

the sphincter lower incidence there

bags

to greater contraction of enuresis in little a few references

beyond the

increased power.44 or to the lesser accessibility treatment

the vagina

of the urethral
India

are only
were

to the specific
in

of enuresis
and inflated

in same

introduced

with author

air ; these recommended of

acted its reflex

by compressing flagellation power.18 and

the stinging

lower with

bladder nettles

neck

and

urethra. of

The

as a means the subject at preventing reason

the of

intimidation of numerous urine from

is to the

or because

The unfortunate manipulations and leaving

desperate

male gadgets.
to stop it.

child with his exposed penis was Certain mechanical devices directed were
up This

the

male urethra
gesture

utilized
the was dike,

apparently
so to

without
speak. Of

true
these,

but
most

in a seemingly
outstanding

the lower

practice surface

of

Dominick penis

Corrigan16 by adhesive

whereby
doubtlessly

he
effective

poured
! Bits

collodion
bougie

into

the the

prepuce, walls of

hermetically

sealing

attached

of the

plaster

was

utilized

to approximate ranging of tape

mechanism

the urethra.18 Various forms of penile bandages came into vogue, of eight bandage fastened with a hook and eye45 to a mere piece
penis.46 Trousseau,13 for however, was the the man of the day, for his

from a figure encircling the

for enuresis

and

spermatorrhea An apparatus fixed

by

was
compressing

referred consists
to which

to time
prostate.

and

again. of small

In his own cone made

words, of

he describes ivory or vulcanized

this

apparatus
.

which
a cincture

of a sort which
are attached

caoutchouc
in its place

by a T bandage, of my apparatus hemorrhoids

situation of the

bandage and

The for does form egg.

which

stem-pessary compressing
the

is longer
vesiculae

is applied around the loins and kept ir front, bands passing under the thighs. more bulky than that of the bandage used higher
a simpler

as it is requisite
seminalis.

to be introduced
I now use

up in the rectum
apparatus in that

so
it

as to reach

not

require

a bandage.

an

apparatus

consisting

of a sort

of metallic

bung

of

the

of a very elongated olive varying This bung diminishes downwards,

does not exceed 5 mm. so that

in size between a pigeons egg and a small hens taking the form of a neck, the diameter of
once introduced into the rectum, it is retained

there
breadth;

by the
the

natural
upon anterior

constriction
a flat stem one-half of

of the
the of same the

sphincter
metal stem

of the
about

anus.
3-4 to cm. be

The
in

bung-like
length to and the

compressor
1/2 cm. perineum in

is soldered

is intended

applied

and manner
toward

the other of
the

one-half tolerance.
side and and coccyx

to the coccygeal The

an the

region. of the
of

Size

varies and
the pubis

with stem
other. with

the The
the

individuals forms obtuse

superior

age and acute

part

junction
obtuse acute

compressor
125#{176} on the

an

angle looking
of the

of 75#{176} on one bulge resting

angle angle

angle

toward

on

the

prostate.

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AN But as the comments stated

this

HISTORICAL

ACCOUNT

OF

ENURESIS

869

the

literature of the such that

organ.47

printed objectors, mechanisms seen

the contributions and they were could two of cases

of these enthusiasts, so it also contained many. Some merely disagreed, some failed act the penis took them to control had been enuresis, cut away interest as methods
pathology

to see where
author
ties about

physiologically in which

while

one

he had further, with which congenital

by use of in their of the some-

There problem
day would

were, children
permit.

men enuresis produced

medicine who and investigated

advised to

a conscientious as thoroughly
if there was

Urinalysis

was

determine

arising

from times Other when

the

organs

urine.48 which

Examination in some discovered of removal enuresis,

of cases

the

external were

genitalia

revealed

anomalies,

corrected

surgically.

men cleaned away smegma and broken, allayed symptoms because were often performed for in a Jewish only 1 % 1 2 circumcised, perhaps,
latter, may

glandulo-preputial of an external with reported

adhesions which, source of irritation.49 good results. inmates Juvenile It is interhad been Asylum, such
there

Circumcisions esting that circumcised, however, Is this,

as the

orphan asylum of the 540 boys 1 1 of whom that

been 19th

in New York, where all of the had enuresis. In the New York are Jewish, among
in the

had Jews
production

a 20%

incidence

of enuresis.38 institution
? Although

an indication
truly have

anxiety
a factor

in a non-Jewish
of enuresis

were general view. sanitary their

some

physicians

of the

century enuresis, may may of thought wetting

who there object

sacrificed were to others

prepuces who this in an adult Jewish

indiscriminately held another and rite point circumcision practiced

as a of a on

measure Though precaution, boys simply was

of therapy a redundant some for

for parents school

prepuce

be a nuisance having bed.49 treatment of the in the

an occasional

There essentially relay such that retentive.21

pregnancy3

yet another

of enuresis

which

preached

the omission of treatment. a shock on the genitourinary of special of enuresis were organs was Cessation of or the
the

This flourished on organs that enuresis would likewise that or

to patient be

the theory that puberty would would cease.1#{176} Others believed bladder less irritable marriage merely were
contribute problem to

development

render expected unless

and an

the

and and

more first of they

of the

with enuresis punishment

did not

dentition, was

Most idleness
aggravated

men
mental Likewise,

in agreement or
was jt was

a symptom since
relief and

habit,4#{176} threats
distress it

ridicule
of the believed

physical

useless

disturbance.#{176}

individualized

if found

in the

bright

active

child,

suggested

that

thought

be turned

from

marks

and

prizes,

that books individual, to secure

treatment fact even

be pushed aside and muscular activity be adopted. It was said the slow dull on the other hand, should be treated with general medication.5#{176} Some felt that peace for should
of enuresis in the last

the

child evoke
today,

and
and In

to give
we that can

him The
see

loving allaying
the has from there

care

in addition of anxiety
that progress

to medication is the
it was from

such of the
as a when

as belladonna

a recovery.27
respect

keynote
accepted the days

preceding been

century.

Adida
Progress,

ga ga ga ga
however,

was light

shouted bulb

in the
thing.

streets.
Thus everyone will agree that when Thomas

is a relative

Edison electric

invented stimulation

the

progress use

was

being could

made.

Also

enuresis be considered

was

treated

with

but

such

of electricity

hardly

as progress.

Galvanic and faradic stimulation of the 19th century. Reports from ods of use varied, with some

to the pelvis became widely all over the world indicated advising that electrodes

used toward the last part widespread success. Methbe placed on the pubis

individuals

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870

LUCILLE

BARASH

GLICKLICH

and sedative bladder cord.52 Another by

sacrum the and and It

; others labia a also was method

used and

the against and with out for

perineum the was debility several electric urethral thus

and

still f152

others in

inserted This cases of

it treatment

into

the acted

urethra as both of

or a the

between

stimulant in cases carried of utilizing

successful bladder every

over-excitability in the were

of the minutes stimulation

sphincter day treatment

or its center until results of enuresis

lumbar

obtained. is described

in the

Nye.53 Attach the one pole shoulders of an of electric the battery patient and to a moist the other sponge to or a dry a metallic sponge plate placed fastened over the

between

meatus let him

will soon

urinarius. be put
lull the

When to bed
patient

this and

has the

been circuit
While

done
the

and

arranged bed completed.

is dry,

so as not The
no

to annoy sound

the patient, of the battery

through

of the

to sleep.

sponge

electricity

passed

the body of the patient to urinate, the sponge completed

and as like by caught the experience

and his slumber is undisturbed, but the moment the patient begins is moistened and becomes a conductor of electricity. The circuit is body
act

through
in the for ; but for and since electricity

the
very

of the
and thus number further suggestion

patient
caveat proceeding of has

and

he or she
by least ought, to me at for

is at once
the will this of time. inclined not

aroused,
the A to had patient

awakened
as well of to cure a

is entered times occurred

against a sufficient this

repetition think, an opportunity

I am I have

the

patient

of putting
profession

it to the
what

test

of practical age

experiment something
by Stevenson

and better

submit has
Smith,

it to the consideration been

Ph.D.,

of the

it is worth.

Perhaps
Origin

in this
Treatment

enlightened
of

found.
was

The published

Psychological in 1948.

Enuresis54

In Chapter When about

untolerated and tioned the act going signal and beginning

V, the

The parents

Method get
pressure

of Direct child
would be first urinary

Conditioning, up at night they

become if of his they urine and behavior,

he says: seldom
the could would for he will

their

catch then
cue

him the
the

when
childs just

he is just of almost
waking as the his he condiin bedis

to urinate.
bladder to the for then

It would
toilet. for there contracting and

be well
It might then the caused the

if they
gradually still

could
better

do so, for

stimulus
him become If he break

for arouse soon

to urinate,

dribbling sphincters

awakening. usually

is caught

to reverse

wetting habit. What we need then wet the bed. A number

is some device of contrivances

show to Harvard of direct several cure,

that will waken a child the moment have been devised for this purpose.
impractical or at least and gadgets control Mrs. was given Mowrer and enuresis. made a scientific one or two It was their tryout.

he starts to The United

cumbersome not, very however, practical

States but until

Patent usable Professor that

Office machines Mowrer the

records intended of method

University conditioning

apparatus

The on which starts

urine

Mowrer to urinate
as a result

apparatus When then and

rings thus goes

stimuli

a bell awakened,

when

the child he cuts In time

wets

the specially flow of urine comes

to urinate.

constructed shortly
When this

pad after he of

he sleeps.

off the he usually

to the toilet.
he gives

to cut off the flow

occurs

of the

himself

in starting

before stimuli
the pad

the bell rings, and when the response of being about to urinate in bed,
is discontinued.

of stopping becomes the childs bed-wetting Wetting

closes

firmly conditioned ceases, and the completes

circuit

to the use of from

the pad

The
a B-battery

Mowrer
and

apparatus
actuates

is beautifully
a relay. The relay,

simple.
in turn,

the pad
the

a circuit
and rings The

dry-cell

bell.

Thus

the current

used

is too weak

to be dangerous

or even

to be perceptible.

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AN

HISTORICAL

ACCOUNT

OF

ENURESIS

871

is constructed cotton cloth

material. relay locked circuit box.

of two sheets of bronze screening separated by two thicknesses and covered on the top side with a single thickness of the same
wires along lead with from the the bell two and pieces batteries, of bronze screening and housed plug which, is conveniently

of heavy absorbent
into the in a small

Insulated

Mowrer
type

and
lulls

Mowrer54
the child conditioning the

report
to sleep.

exceptional
device tablet that are that

success
has great the delivers the moves tube an older of will end

and

their

battery

is not

even

of the
stream by the bag for sheet sleep, tube the on a that as to training

which Another water urine.

direct when These

possibilities of a rubber to the the linen about be child snug stream sheet in his end

releases tube of of and an water the bed over in such tablet. has certain than

a small is dissolved enema may, rubber during the

of cold voided are which

soluble tips

closes that between

soluble available. child, If the childs may the use with of branching by the tube that the lies.

that outlet placed the sewed urine

to be attached

commercially of the of the it most child outlets outlet likely

The be child from be first water the

training

a younger

ordinarily main For voided

number
is likely assured, make

may

distributed whose panties

area

to be wet

voiding.

cooperation

is thoroughly a position In the

to a pair

contact

the

soluble sleep rather

of

children

in congregate
; hence working rooms. of air cools using from the of his to which water an skin bed the subjects were technique his each are small rubber tablets) link that of own cut with end. brought rubber tubing tablets, keeps for fairly the use. and linen. tire

institutions,
children

the
to arouse

ringing
the child large

of

bells
from groups

in a dormitory

can

not

be

permitted as it permits isolated

,

advantages, in individually

in fairly

sick of

Instead

from the The pump were

an inner damp

enema tube.

bag The

the air even

writer which more tube

has than

with the

excellent when water for rubber the does

success the and and and tablet

used is effects aids carries

blast

inflated

is released

dissolved
a great in

clothing tube joined the

saving

inner

is a positive inner

attraction to the

child hose

securing valve

cooperation.

A T-tube

the eight these

is attached.

This
of

method
these children

was tried
cured.

in feeble-minded
boys Perhaps is usually involves edges strip band or and and the

chronic
eight cold were

bed-wetters
girls. of the of with holes. supply then After old

in the state
three were

of Washington;
of training, to these

weeks forerunners

douches when of old a strip inner dusted an oldfashioned the are

modern
Another undertakes eight inch The while be the the cut small gadget

methods.
that training straight This together satisfactory the from held by use an child rubber, talcum clothespin The placed The the small in the clothespin pocket urine voided himself one A hole wholeheartedly and a quarter and similar bands formed twisted. device may by and to the likely by a half is punched or

inches, from ends a very from

tube.

is thoroughly is threaded obtained through from either strip little underpants from assembly side,

powder rubber Two

a dental untwisting.

house.

Lunde loops is removed sewed is most

Trayna

(dissolvable

one rubber This

on

is ready

is placed where

in a loose

outside

of a pair

snug

at a place

to reach weather
rubber instantly. become

the soluble to prevent

untwists The ineffectual.5 with

tablets. The child should be dusted with perspiration dissolving the tablets. When
sufficient force is very to waken brief and, any when child once who has

talcum powder the tablets are

a real inclination by the

in warm wet, the

to rise child, may

stimulation

disregarded

Belladonna

or atropine

are still

being

used

to inhibit

the action

of the detrussor

muscle

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872

LUCILLE bladder.
as nux

BARASH

GLICKLICH to increase tone

have

of the
much

Ephedrine
vomica was

also
used the

is administered
earlier. So was we treated

of the bladder
we hogs but come

sphincter,
so very far?

ask

ourselves,

Our
days

understanding
when deficiency

of
of

enuresis

is not,

today, and

much
with of enuretic

more of the

advanced urinary
children55

than system
we

it was and

in the
we not

bladder

dessicated

bladder.

True, as yet do

know that fully

more urologic

concerning lesions the are

the physiology found mechanism

PSYCHOLOGIC

anatomy enuresis
OF

we realize

in 5 to 10% producing
ASPECTS

understand

in apparently
AND ITS

healthy
ETIOLOGY

children.

MODERN

ENURESIS

Of the modern interpretations disorder and of the

contributions this symptom. implications

to the study Enuresis and

of enuresis, is today

most considered

important

are the psychologic of personality combinations

; or those who

a symptom are numerous.

interpretations

of this

entity

Sweet56 explains psychogenic enuresis of three conditions. A. The child has not as yet matured have acquired lack it do not know of parental how or with sympathy

on the basis with reference have

of one or any possible to bladder been poorly As a result, control trained, the child

to use it. They or understanding.

under has

tension become state age. This

to resolve

bewildered, tense and thus retarded in reference to bladder control. B. Subconsciously, the child wishes to remain in or return to the of
may

irresponsible of his
inability

infancy
such

rather

than
by jealousy

assume
of

the
new among

normal
siblings, parents. parents.

dangers
feelings

or responsibilities
of insecurity and

be aroused

a conflict

as disagreement

C. Subconscious resentment against The first condition may be thought ditions pathology. during
neurotic

of as one is expected The Enuresis

it is found

based to occur
that

purely than on because

there

on unfavorable any listed

are

social

con-

and certain occur

lack In some

of

parental

understanding enuresis
children,

rather two latter

intrinsic above tend

other

personality in siblings to display

symptoms

families,
In such

it was present
several

periods together

of childhood. with enuresis.

conditions found

tendencies.

which found These ments.

and

was seldom

to occur

alone.

Michaels57

that there are five traits which tend to occur more often in combination than alone. are enuresis, nail-biting, thumb-sucking, temper tantrums and speech impediKanner58 writes that it is frequently associated with nail-biting, temper tantrums
eating problems. He feels that enuresis reflects a lack of internal inhibitory agency,

while
integration

Michaels57
of the child

believes
components

it to
of

be the

a reflection
different levels

of
of

an

ill-balanced
.

personality Gerard59 associated

hostile

(faulty found with that food

upon

personality)

enuresis,
refusal

when
if the

it coincided
was not

with
fed,

arrival

of

a new
and,

sibling,
in some

was
cases,

whining,

clinging

attacks

the sibling. the infantile Certain

include

These state personality

traits and

seem at that traits

indicative level were extensive found

of a desire with

on the part the rival

traits children

of the subject enuretic

emotional displayed

to return

to

compete
jealousy,

sibling. among
and who

to be dominant
infantile

children
enuresis

; these and

sensitivity,

aggressiveness,

instability.6

Gerard she has

carried found

out that

a fairly there

analysis

of

72

is a difference

in personality

and

motivation retiring, injury.

of

the

male

as

opposed to the avoids strenuous

female enuretic child. The male is passive, physical activity because of fear of physical and eating, to indulge

self-deprecating He is slow and

and dawof

dling in daily activities as dressing help and assurance. He is found

and demands more than the usual amount in evasive, petty lying and in exhibitionistic

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AN
activities of a non-aggressive

HISTORICAL type a good with such I.Q. the

ACCOUNT a giggling and female is inattentive

OF and

ENURESIS grimacing. and the easily He distracted. displays He

873 low fears

school

achievement

despite

women
whereby

as dangerous
he identifies

persons.
himself

To overcome role.
described

this

fear,

the male

child
role

employs
of a passive

a mechanism
individual

by assuming

who
as

avoids
a passive

the
act.

active
One

male
child

Urination
it as,

is considered
drifting lazily

by this
down

group
stream

of male
in a boat

children
without

paddling.
and

The

thereby parental all

the

the

mothers

were

act of urination
male identifies are

is thought
himself

to be a symbol,
with Although nature, the female. the

perhaps,
In this of

of female
group the this of fathers was

menstruation
male children varied, demonstrated the

attitudes basically

interesting. of of a rejecting

attitudes

although
61

in some

by overindulgence,

a form

overcompensation.59

Beverly62
boys, scary dreams.

also

found

that

the
and in

male

children
They as

with
were

enuresis
nervous, of

were
fearful

usually
and with

small
admitted the

puny
to father

underweight, describes

immature enuresis for may

effeminate. the male

Kanner58

a form

identification

since,
potency.

he states,

urination
of puberty

symbolizes
masturbation. then by the

ejaculation
be due fact that to the

and
onset

fulfills
of

the

subconscious
in some and hence

desire
children removal

for
with

It is a substitute

Cessation

enuresis

commencement

of masturbation

of
was

the

necessity
This stimulation

for
was were

symptom
explained

substitution.59
that

In
the masturbation

Gerards
fantasies was

group,
which a most

however,
children dangerous

masturbation
associated indulgence.59 with

absent.

sexual

so destructive

In the female child, with leadership qualities.

well-behaved, present depreciation a strong the girls competitive

Gerard Their
were

found school
ambitious, attitude

the subject to be active, activities correlated with

honest, toward boys, frank and and the girls

independent their I.Q.s.

fearless. frequently

and efficient Attentive and

There voiced was verbal

generally

of the male.

The
aggressor their males. explained in an feels, the

mechanism
who abilities, Urination could

here
eliminated in this

is described
by them group can the of no the
in that

as fear
activities fantasies

of
and as

the

male
the themselves active,

who

appears
children assumed

as a destructive
denied role men the process. as active One by girl flying Gerard and

injure

his from

; therefore,

female

is expressed burn and is with hurt the

an people. on male but an

destructive use In act. fathers of

the

it as this. airplane the and identification described

61

Urine killing

I could them. sexual the

it in a war female group were all child,

enemy consistent

by urinating pattern, as

the

urination

In this

of females, fond

mothers Kanner58

affectionate.
agreeing with

described
Gerard

female
urine

enuresis
symbolizes

expression
and

the

castration
is an outlet

complex,
for un-

semen

wetting

conscious

desires

for

masculinity.

Both
to had have been
(2)

male
night

and
fears

female
of to the

enuretic
being sex attacked

children
by

in Gerards
fantasied persons,

series voiding.
sexual

were
usually

analyzed
of the

and
opposite

found
sex.

Both tion,
of produced group

groups

admitted

to pleasant
act

bodily
as a result

sensations
of

while
traumatic

A few
experience

of the children
or informa-

exposed

(1)

visual
advances in them

experiences
by either a fear proved of

of sexual
parent harm refractory or

advances
(3) to hands

of either
wishes of

parent

to the other
rival of of the because opposite the

or of rejection
This sex and had this of

such

destructive superficial

toward

parents.

at the

a member therapy

of

children conflict.

repression

emotional

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(74

LUCILLE Kanner58 cites

stages just

BARASH idea that

in and

GLICKLICH enuresis
groups stage and

the
of

psychoanalytic
infancy. as there is an oral

is wish
that

fulfilling
there enuresis then

with

regression
phase

to of

the

early

It is felt

certain an anal

is a urethral

development

is a regression

to urethral
stated by or

erotism.57
Freud.58 destroying

A second
There by are

theory
also passage those

is that

enuresis

represents
who

an emission.
interpret the story

This
of

was
the of

psychoanalysts

Deluge
flooding

as an has feels
integration

enuretic been that

lack of

fantasy.5
the

Melanie in correlating of enuresis

different

Klein57 enuresis indicates

level

describes
of

enuresis
urine.

as

a phantasm

of great

quantities

There Gerard6
faulty

work the
of the

done presence

and

certain

psychopathic and
reflection Enuresis

tendencies. mirrors
demonstrates

a lack
components.

of maturation

the illand is

individuals

the

individuals persons behavior

of the

an type

inhibitory belonging group.

tendency, to the The

weak psychopathic

ego

and

the

of all
individual

balanced psychiatric

personality, psychopathic

delinquent,

problem

persistent

enuretic

dominated

by the

repetition
it

compulsion
is felt that

tendency
there is

and
inherent

reacts

primarily

under

the influence system realizathrough the child

of the pleasure principle. In the Adlerian school in enuretic

tion the of night

inferiority

of the urinary of choice

and It relieves

patients.
a variety and per of

This
goals,

weakness,
particularly attention

therefore,
assurance of parents

furnishes
of from

a symptom
parental a rival affection sibling.

for
care

distracting

of The

certain wetting

responsibilities

and

allows

him

to revert

in part of insecurity

to the and therapy

Broad child

freedom

of infancy. of of

se is interpreted

as an expression origins,
this particular

is a continuation is the treatment

as in this his statement

infancy.58

In cases
the underlying must

of enuresis
causes be treated

with
which

psychogenic
produce

the accepted
symptom.

seems
which

it can be only

thus
as

stated,
it

for
personally

each

individual
affects that

case presents
particular

an individual

problem
individual

environment. Enuresis was

and colorful with if ever, resolved.

born

with

the
for

dawn

of civilization
and more is a symptom,

and
not

is still
a disease,

with
life and

us. Its history

its problems it is only as such

is long
are, with

prognosis Basically,

a longer

exciting

before

enuresis

greater

understanding

of to conquer

the
it.

underlying

pathology,

be

it organic

or psychogenic,

that

we can ever hope

SUMMARY

This
discussion

paper
of

presents
the treatment

a review
of the

of

enuresis

from
problem

an
in

historical
primitive

aspect.
civilizations

It

begins
and

with
carries

a
its

enuretic

colorful
of by the greater

history
modern

through
psychologic

to the close
theories

of the

19th

century.
its

There

follows
In

a short as such
enuresis

discussion
there is re-

concerning individual

etiology.

conclusion

emphasis
successfully

of the statement
understanding treated.

that
of

enuresis
the

is a symptom,
underlying

not a disease,
pathology

and
that

it is only
can be

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1923,

F. 1-I., in Abts
vol. 1, p. 13.

Pediatrics,

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1,

Company,

Herskovits, 3. Leighton, Press,

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M., Dahomey, New York, Augustin, Inc., 1)., and Kluckholm, C., Children of People,
1947, p.

vol. Cambridge,

p.

272.

Mass.,

Harvard

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55.

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4. 5. Adams, Society, Buschan, G. F., G. F., T., Seven 1844, H., History Of use vol. Uber of of Books

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SPECIAL REVIEWS: AN HISTORICAL ACCOUNT OF ENURESIS LUCILLE BARASH GLICKLICH Pediatrics 1951;8;859
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