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Older children should use the lavatory. This should be lighted all night. The floor of the dormitories,
of the corridor leading to the lavatory and of the lavatory is, in most homes, made of
stone and, therefore, all children should have at night socks or slippers under their beds or else
the floors should be covered with some warmer material such as cocoanut matting.
(4) Fluid intake.—The fluid intake should be limited at teatime to one breakfast-cup of
weak tea. As far as possible extra fluid should not be given after this. As, however, in most homes
children have free access to the taps, this limitation of fluid would not always be practicable.
(5) Rousing at night.-—At bedtime those in attendance should see that the bed-wetters
always pass their water before getting into bed. If it is found that these children wet their beds
before 10 o'clock it is a good plan to get them up in twenty to thirty minutes after first going to
bed in order to pass their water again so as to be reasonably sure that their bladders are properly
emptied.
Persistent cases should again be roused at 10 o'clock. Regularity in doing this is important
and the time of rousing should always be as near 10 o'clock as possible, otherwise it is impossible
for the child to acquire a habit of waiting until 10 When roused at 10 the child should be
thoroughly awakened so that he realises fully the purpose for which he is got up. As a rule
the child should not be roused again during the night. For children below seven a regular night
staff should be employed in order to attend to their needs at any hour.
In order to facilitate the control of enuresis the affected children should be grouped together
at night-time. In the barrack homes the cases should be grouped in that end of the dormitory
which is nearest to the lavatory, or, when a few cases only occur, these should be drafted to a
dormitory set aside for this condition. In the cottage homes the cases might well be grouped
in one cottage under the control of the most suitable foster-mother. The routine measures
outlined above should then be carried out. When a child has been dry for three weeks without
failure, he should no longer be roused at 10, but should be expected to deal with his needs as the
occasion demands. After another three weeks, without failure, in this group, he should be transferred
back to a " dry bed " without a mackintosh sheet. One value of this grouping is that it
indicates to the child that a dry bed is something to be striven after, and, while there should be
no blame attaching to a child for going into the wet ward, he should receive definite praise for
getting out of it.
(6) Specific measures.■—In nervous children who seem anxious to rid themselves of the habit,
but have no confidence in their power to do so, it is often helpful to increase their confidence
in their powers during the day. This may be done by making them pass water every hour by
the clock during the day. Between these occasions they are not allowed to go to the lavatory.
After a week the interval is increased to every two hours and so on until it can be pointed out to
the child that he is capable of holding his water without difficulty for as long as four or five hours
at a stretch. He will then appreciate that there should be no difficulty in keeping a dry bed until
10 o'clock at night. For dull and backward children such a system is of little use. For them a
desire for a dry bed is best encouraged by making it worth their while. They should be roused
two or even three times during the night by the attendants so that they are not given a chance
of wetting their beds. These children can sometimes be encouraged by incorporating competitive
schemes into the routine management, as, for instance, by having a large calendar hanging over
each bed. The child rings in colour each day on the calendar when he wakes with a dry bed. One
complete month ringed in this way should be the child's object and, in addition to being changed
to a dry bed, some suitable reward should mark the satisfactory completion of the competition.
As a rule the cure of enuresis lies in the general management of the child by the attendants.
The frequent giving of homilies to the children is undesirable, since the children either soon
get to know what is coming to them and take no notice, or their incapacity to cure themselves
is accentuated into a morbid dread of having a wet bed. Medical measures such as drugs, faradism,
etc., play but a minor part, and it should be the aim of the attendants to stop bed-wetting by the
children in their homes by their own efforts.
Institutional care of children under 3 years of age.
The administrative scheme for discharging the functions transferred to the
Council by Part I of the Local Government Act, 1929, provides that the Council's
Central Public Health Committee shall be charged with the duties relating to the
institutional care of " separated "* children under three years of age. The Council,
however, in December, 1930, decided that, subject to the necessary accommodation
being available and to the selection being made by the medical officer of health,
healthy separated children under this age should be admitted to transferred schools
and children's homes under the management of the Education Committee.
A survey of the whole " nursery " accommodation under the control of the
Council was made by Dr. Hogarth, and, as a result, the principle of grading by age
was adopted, and the older healthy children of 1^ to 3 years are transferred to the
Education Committee's institutions, leaving the younger children in institutions
* For definitions of " separated " and " non-separated " children, .tee Annual Report of the Council,
1930, Vol. IV (Part I)—44 Public Health—General and Special Hospitals " (p. 80).
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