(c) Educative.—­(i) Curtailing the fluid drunk. (ii) Waking the child at intervals during the night by an alarm clock or otherwise. (iii) Rewards and punishments.

(d) Medicinal.—­(i) Belladonna. (ii) Thyroid extract.

(e) By Suggestion.—­(i) By simple suggestion. (ii) By hypnotic suggestion.

I do not think that any single one of these various forms of treatment outlined under the first four heads has any effect other than to aid the suggestion of cure which we proffer in adopting it.  Removal of tonsils and adenoid vegetations might conceivably cure an enuresis which is nocturnal, it cannot account for an incontinence which spreads to the day.  We might believe that to distend the bladder by hydrostatic pressure was a cure for incontinence of urine, and that it acted by removing the local cause,—­the smallness and contraction of the bladder,—­were it not that the loss of control is so apt to spread to the rectum as well.  There is no evidence that the urine is peculiarly irritating.  Indeed, such evidence as we have goes to show that, as in some other neuroses, the urine in enuresis is unduly copious, and of very low specific gravity.  Incidentally, we have in this polyuria a further argument against the view recently advanced that a small and contracted irritable bladder is the cause of enuresis.  We do, of course, meet with cases of irritable bladder often enough, but the complaint is then not of incontinence, but always of the discomfort of having to rise so frequently for micturition.

To deprive the child of fluid, to wake her many times at night, to tilt the foot of the bed, are devices which may help in the hands of some one who is confident of his ability to cure the condition and can communicate the confidence to the child.  Carried out hopelessly and pessimistically by a tired and exasperated mother, they are well calculated to strengthen the hold which the obsession has on the child, so that often we meet with a mother who rightly enough maintains that the more she wakes the child, the oftener the bed is wet, till she wonders where it all comes from.

The treatment of enuresis to be successful must be conducted through and by means of the grown-up persons who have the control of the children.  To stop the development of enuresis in early infancy we must intervene to prevent the concentration of the child’s mind on the difficulty.  During the time when control is ordinarily developed, in the second and third year, judicious management of the child is essential.  The emphasis should be laid upon successes, not upon failures.  For every child his reputation will sway in the balance for a time.  He must be helped and encouraged to self-confidence, not rendered diffident or self-conscious.