(b) In the second place, the influence of suggestion is shown by the behaviour of the child when removed to a hospital for observation.  It is the invariable experience that the enuresis then promptly stops.  In hospital the attitude of those around the child is entirely different.  She has the comfortable and consoling feeling that in wetting the bed she is doing exactly what is expected of her.  There is even a feeling that otherwise she is showing herself to be something of a fraud, and that she has then been admitted to the hospital on false pretences.  Hence, perhaps for the first time in many years, the child is free from the obsession, and the bed is not wetted.

(c) In the third place, it is easy to recognise in the history of many of the cases, the ill-effects of circumstances which add new force to the fear of failure or shake the confidence in the control which had been regained.  Thus a boy, an only child, who had suffered from enuresis till his seventh year, had regained complete control till his eleventh year, when he went to school.  In his dormitory at school was a boy who had enuresis, and who was being fined and punished by the schoolmaster.  The enuresis at once reappeared and continued unchecked so long as he was at school.  As might be expected, school life is very inimical to cure, unless the trouble can be kept from the knowledge of the other boys.  Anything which directly increases the nervousness of the child—­an illness, for example, with loss of weight and failure of nutrition, or some mental stress, such as the approach of an examination—­is apt to accentuate the enuresis.

(d) In the fourth place, the incontinence sometimes spreads to the daytime, and the child is wet both by day and night.  Further, in bad cases it is not uncommon to find incontinence of faeces making its appearance also.  These extensions of the fault only take place when the management continues to be very faulty, when the grown-up people around them are more than usually distressed and pessimistic, and have redoubled their expostulations and appeals.

Now these peculiarities of enuresis seem to me only explicable if we assume that the want of control is due to auto-suggestion, dependent at the beginning on the unwise attitude adopted towards the fault by the nurses and parents, and later kept up by the sense of shame and the mental distress involved.

The forms of treatment which have been recommended from time to time are, as might be expected, very numerous.

(a) Operative.—­(i) Removal of tonsils and adenoids, (ii) Circumcision.

(b) Manipulative.—­(i) Injection of saline solution under the skin in the perineal and pubic regions, with object of lowering the excitability of the bladder by counter-irritation. (ii) Gradual distension of the bladder by hydrostatic pressure, (iii) Tilting the foot of the bed so as to throw the urine to the fundus of the bladder, in order to protect the sensitive trigone from irritation.