ANAESTHESIA OF THE BLADDER. 81 



enuresis nocturna (nocturnal wetting the bed) to an imperfect anaes- 

 thesia and diminished irritability of the vesical sensory nerves. This 

 extremely distressing affection, for which the patient not unfrequently 

 is subjected to the most abominable treatment, and which often de- 

 stroys the happiness of families whose older children are afflicted by 

 it, is usually classed with palsy of the bladder. Many cases of enu- 

 resis nocturna as I have seen, however, I have never been able to per- 

 ceive that the sphincter vesica failed in its duty during the day, or that 

 the children had any dribbling of urine, nor when the inclination to 

 urinate came upon them were they ever in great haste to reach the 

 urinal. Indeed, there are only two possible ways of accounting for 

 enuresis nocturna. Either the sensation to which a full bladder gives 

 rise is too feeble to awaken the child from his normal sleep, or else 

 the sensation is of its normal intensity, but the sleep is unusually pro- 

 found. In the latter case it would seem as though nocturnal incon- 

 tinence of urine occurred somewhat as do those well-known cases in 

 which children sometimes fall out of bed in their sleep without awak- 

 ening. In the cases which I have seen, especially in adult patients, I 

 have not been able to discover such unnaturally profound sleep. For- 

 tunately, it is rare for enuresis nocturna (which usually affects chil- 

 dren, and often lasts up to the time of puberty) to continue after the 

 twentieth year. Knowledge of this fact is of importance, the best 

 means of comforting the patient and his relatives in their distress be- 

 ing the communication of this intelligence. 



It is customary to deprive children, suffering from this affection, of 

 all drink or liquid food during the evening hours, and to waken them 

 during the night once or twice to make them pass water. There is no 

 objection to be made to these measures, excepting that they scarcely 

 ever do the least good. I must protest most earnestly, however, 

 against the cruelty of whipping or otherwise punishing a patient with 

 nocturnal incontinence, unless the wettings of the bed manifestly be 

 the result of laziness. In families, but still more in boarding-schools, 

 orphan asylums, poor-houses, and prisons, punishment for this offence 

 is inflicted all the year long, generally without effect ; and if we only 

 take the trouble to listen to the shocking stories of " piss-a-beds " of 

 the lower classes, it will be clear to any one that the ineffidacy of the 

 punishment was not due to its want of severity. Without attempting 

 any explanation of the fact, I will merely call to mind that the dread 

 of going to sleep often has a soporific effect, the desire to do so the op- 

 posite, and that, if one wishes to awake at a certain hour, the fear of 

 oversleeping is injurious, while the confidence that one will awaken in 

 time is beneficial. In the same way, we find that children with noc- 

 turnal incontinence, who have been severely chastised the day before, 



