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18
Treatment
in hospital.
Enuresis
(bed
wetting).
In the past the cost of feeding has varied considerably as between school and
school, but the average weekly cost per child in all schools during the year 1930-31,
before the new dietary scale was introduced, was about 4s. 3£d. In a booklet containing
the dietary which has been prepared and issued to all the residential schools a
series of menus and recipes, compiled from the dietary chart by the Council's superintendent
of domestic economy, is included, giving examples of varying meals covering
four weeks. It is anticipated that the cost of the new dietary will not exceed that of
the old.
Further progress was made in unifying the methods of dealing with those
children where definite hospital treatment was indicated. Formerly, in some of the
homes cases of infectious disease and grave illnesses were treated in a special hospital
section within the curtilage of the home. In other instances, it had been usual to
obtain accommodation for such cases at local hospitals, but, generally speaking,
the principle has now been established that a school is not a proper place in which
to nurse children suffering from acute illnesses, and that such cases must be transferred
to one of the Council's special or general hospitals, except in the case of serious
accidents or urgent cases occurring at the extra county schools, where the officers
have been advised to telephone to any local hospital in the first instance.
The problem of nocturnal enuresis is one that arises in connection with all
residential institutions for children. It is also a matter of deep concern to many
parents of children living under normal home conditions; so much so that, when,
in 1926, special attention was given to the subject so far as it affected the Council's
residential special and open-air schools, it was arranged that a leaflet of helpful
suggestions should be drawn up and forwarded to the care committees of day schools
in order that they could advise parents when necessary.
The matter was also specifically discussed at a conference in June, 1930, at the
County Hall of the medical officers of the transferred residential schools. On this
occasion several members of the conference explained the methods they employed
for dealing with the trouble at their schools. The general impression appeared to
be that the psychological factor was of prime importance, that each particular method
of treatment had cured a certain number of cases, but that there were a few
" obstinate " cases on which existing methods make no impression. In 1931 Dr.
W. H. P. Sheldon visited typical residential schools of the " barrack " and the
" cottage home " type, and also the training ship " Exmouth," and submitted a
detailed report resulting in the following recommendations :—
(1) As part of the initial examination when a child is first admitted, examination of the urine
for reaction, specific gravity and albumen should be carried out and recorded on the medical
record card. In the case of the bed-wetters this examination should be repeated at intervals of
three months until such time as the habit is overcome.
(2) It would be an advantage if all the homes kept a daily register of enuresis. The register
should be kept in a ledger and maintained by the master so that the rise or fall in incidence and
the improvement of individual cases could be quickly seen.
The following recommendations apply to persistent cases (when a child is temporarily
out of health as from a cold or bilious attack, temporary bed-wetting is
likely to occur; for these, routine measures are not needed):—
(1) General health.—It is important to attend to the general health ; particularly with
regard to such disturbances of health as may interfere with sleep. Infection of the nasopharynx,
caries of the teeth, disordered appetite, impaired digestion or constipation may all play a part in
maintaining the habit.
(2) Bedding.—It is important that the children should be warm at night and their beds
made so that they can be well tucked up and excluded from draughts. The mattresses should be
firmly stuffed, unevenly filled palliasses and mattresses are unsuitable as likely to disturb the
sleep, and it is better that the mattresses should be buttoned. The mattresses should be protected
from soiling by being covered with a large mackintosh sheet which should be prevented from
wrinkling by being ringed at intervals along the edge and tied with tapes to the sides or under the
bed. The mackintosh should be covered by a thin blanket and this, in turn, covered by an undersheet.
These children often need more bed covering than others, and, as a rule, should be
provided with one extra blanket.
(3) Chambers and lavatories.—For children under seven years of age chambers should be
provided at the bedside and these should not be emptied by the children but by attendants.