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these should extend to people and experiences outside the school walls ; and that
sex education should be looked upon as a part of the general question of character
training.
(h) That officers in charge of children should be trained in the inculcation
of good habits, in the proper way of answering children's questions, and in the
giving of simple sex instruction.
Anerley
residential
school—
Enuresis
unit.
(i) That a course or courses of lectures on sex instruction for children
should be arranged for the staffs of residential schools.
The problem of nocturnal enuresis continues to vex the administration of the
residential schools. None of the schools is free from it, but some suffer far more
than others. The objectionable and disabling habit is especially troublesome in
the case of boys who have arrived at the age of 16 and who are sent out into the world
under a system of " after-care."
In order to study the question of the prevention and cure of this condition in a
scientific way, a special unit has been organised at the Anerley residential school
to which 20 boys selected from various schools were admitted in September, 1935.
The unit was placed under the observation of Dr. W. A. Scott. The ages of the
boys ranged from 10 to 15 years.
Dr. Scott, from whose report the subjoined sentences are derived, points out
that many of these boys had previously had hospital treatment for the complaint
with only temporary relief.
During their stay in the unit the boys follow a normal school life, but sleep in a dormitory
where special facilities are available.
The nursing staff were instructed in the objects of the unit and an effort was made to secure
the confidence and co-operation of each boy. The physical and mental build of the boys was
observed and an estimate of the intelligence quotient was made. All causes of local irritation in
the excretory organs and the urine were, as far as possible, eliminated.
An investigation was made of the relationship of fluid intake to the occurrence of enuresis,
the most frequent time at which each boy wetted his bed during the night was determined, and the
importance of waking the sufferers at stated periods during the night was evaluated. The effect
of treatment by various drugs was also noted. While there was no physical type found which
could be said to be typical, intelligence testing made it possible to divide the boys into three
types : (a) highly sensitive boys of superior intelligence ; (6) boys of average intelligence ;
(c) very dull boys on the border of mental defect or even beyond it.
In group (a) the results of treatment were found to be especially good, although one boy
with an I.Q. of 110 has not responded well. In group (6) the results, though not as good as in
the (a) group, were satisfactory. In group (c) no permanent improvement has as yet been
effected.
Taking all together, the frequency of wet beds has fallen to about one-third, while treatment
has been continued, but, in the main, cessation of treatment brought about some relapse.
Six boys have been discharged from the unit and returned to their own schools. Two have
remained without any recurrences, two have had recurrences but greatly diminished in frequency,
two have relapsed into their former condition. The last two were very difficult cases in which
there were moral deficiencies and lack of co-operation on the part of the boys.
During the last two weeks of February, 1936, the number of wet beds in the unit has been
75 for 18 boys, this is 30 per cent. The percentage expected from their old history, if no improvement
had been obtained, would have been 83. The failures are largely made up of boys whose
mentality is low and in whom co-operation with the doctor and staff is almost impossible to obtain.
With regard to local irritation the question of circumcision appeared to have no effect, but
attention to constipation was of definite importance. Self-abuse does not appear to be specially
connected with bed-wetting.
In order to ascertain the relation between fluid intake and bed-wetting, the boys were
divided into two sets in which the incidence of wet beds was approximately the same.
Both sections were wakened at 10 p.m. and at this time one set was given 1/3 pint of milk,
observation over ten days showed no appreciable change in frequency of wet beds.
Dr. Scott is of opinion that it is the total fluid intake for the day that affects the question
rather than the amount taken about bed time. The old instruction " nothing to drink after
5 p.m." is of little importance unless combined with a limited total fluid intake in the 24 hours.
Careful records are kept by the staff and Dr. Scott finds no evidence that there is a constant
time at which a particular boy wets the bed.
Sedative drugs (including belladonna) proved on the whole disappointing. Of all the drugs
tried ephedrine proved the most useful. The Anerley results, it is true, do not justify any claim
that this drug is a specific for the condition. It was found that the boys are very tolerant of this
drug, and it was gradually increased beyond the normal dosage. At first it was administered
daily in J grain doses ; in the absence of result in particular cases the amount was gradually
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