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.

_(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
p