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81
increased and there were cases that did not respond until 4 grains daily were given. The
beneficial results of ephedrine were aided by adopting subsidiary methods of treatment.
The aim during the experimental period was to obtain three weeks complete cessation of
the habit under treatment; at the end of this time the dose was reduced until the patient
remained dry for three weeks without administration of any drug. When these conditions were
fulfilled it was considered a boy was fit to return to his own school. It is now thought that the
three weeks' freedom can be reduced to two. In order to estimate the psychological effect of
the administration or withholding of the drug, it was arranged that the administration of
ephedrine should be stopped in all cases for four nights, but calcium lactate tablets were substituted
so that the boys were unaware of any alteration. From the first night of this experiment
a great increase in the amount of bed-wetting took place. Under ephedrine the average wet
beds for nineteen boys was 4.5 nightly, under calcium lactate this average rose to 12.1.
Waking at night is a most valuable manoeuvre in the treatment. In some cases this alone
will be sufficient to effect a cure.
At Anerley it is customary to wake the boys in the unit at 10 p.m. If any boy was found
to be wet in the morning, he was placed on the list of those to be wakened at 5.30 a.m. If this
did not secure dry beds he was aroused also at 3.30 a.m. The actual wakening disturbs the boys
but little. They go to sleep again almost immediately upon return to bed.
Summing up the results of the experiment, Dr. Scott concludes that there is at present no
specific cure for nocturnal enuresis, nor can any one line of routine be laid down for the satisfactory
treatment of cases. Each case has to be individually studied and the procedure must
be modified by the physician as each case demands.
The condition is not a disease but an infantile habit, which has been carried on into school
life through the failure of appropriate training at the proper time. The reason why so many
boys in the residential schools are found to be sufferers is that proper care and training was
lacking at the appropriate age.
So far as the Anerley experience has yet gone, the following suggestions appear to be the
best which at present can be made for old standing cases :—
(1) Provide facilities for close observation and attention nightly, the general arrangement
being directed by an experienced physician.
(2) Deal with local predisposing causes.
(3) Limit total fluid intake.
(4) Administer ephedrine gr. 1½ nightly and increase if necessary.
(5) Arouse patient at 10 p.m., and if this does not assist then at 5.30 a.m. and if
necessary also at 3.30 a.m.
(6) Endeavour by the combination of the above measures to secure two weeks complete
freedom from the habit, and then gradually reduce the treatment until the boy is not having
drugs, is taking an average amount of fluid in the day and is being aroused only at 10 p.m.
Special inquiries and reports.
Certain special reports have been included in their appropriate sections. They
include Mr. A. G. Wells' report upon the audiometer (p. 17), and Dr. W. A.
Scott's report upon the enuresis unit (p. 80).
Special attention has been given to questions of nutrition and physique.
Reference is made to the reports of the medical officers in charge of the nutrition
centres on pases 20-26.

Comparison
of the
physique of
athletic and
non-athletic
boys.
Dr. W. A. Scott undertook an investigation into the physique of athletic boys
in elementary schools compared with that of their non-athletic class-mates. It
was desired to ascertain how those boys who were in training and in a condition
of fitness, which permitted them to excel in sport, compared with non-selected boys
who were undistinguished in games, and thus obtain a criterion as to the validity of
" using the average as a norm." Several elementary schools were visited, and the
head masters brought forward the best athletes—those who represented the school
in competitive contests in football, boxing, swimming and other athletic games.
The measurements were taken of 280 such boys, and for each athletic boy a classmate
of the same age, undistinguished in sport, was taken at random.