ing urine of a slight access of fever
may, by its passage over the irritable mucous lining of the prepuce, be
the initial starting-point of a serious or fatally-ending disease. In
all of these, it must be admitted, the presence of the prepuce is either
actively or passively the cause of the most serious disease processes
that may follow.

Ultzmann, of Vienna, in his work on the "Neuroses of the Genito-Urinary
Organs," gives the subject of enuresis considerable attention. It is not
a work on diseases of children, but it, nevertheless, goes into the
subject as if it were, and furnishes the profession with considerable
information. He defines enuresis to be the passage of urine of a normal
quality in a child who, with the exception of this involuntary
urination, is healthy. In the first periods of life, a slight vesical or
intestinal expulsive effort is sufficient to overcome the guarding
sphincter muscles at their outlet; the child first obtains a voluntary
control of the rectal sphincter; and, generally, with the second year it
gains control of the vesical. Those who pass their second year without
obtaining this control, but in whom the organs and urine are normal, may
be said to be afflicted with enuresis. He divides enuresis into three
varieties; that involuntary urination which takes place at night during
sleep he terms the _nocturnal_; that which takes place while climbing,
laughing, coughing, or in the course of any violent muscular exercise is
the _diurnal_; and that wherein the involuntary evacuation takes place
day and night alike he terms as the _continued_. This last is again
subdivided into the continuous and periodical. As a cause, he cites
anaemia, scrofula, rachitis; but adds that physical debility is not
necessary for its presence, as well-developed, vigorous, puffy children
are as liable to be affected as thin and scrawny ones; while not all
scrofulous or rachitic children are so affected, only a small portion
being enuretic. Sex has no influence on the liability that tends to
being attacked, the proportion between the sexes being about equal. As
to age, he finds the greatest proportion to be between three and ten
years, but he has often treated those of either sex even at the age of
fourteen and up to seventeen years. It is absolutely necessary to
examine the external genitals and the urine of those affected by this
disease, as phlegmasiae of the vagina, of the vestibule or urethra in
girls, or the pract