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118
The following report comes from the enuresis clinic at University College Hospital:
'The clinic is in charge of the Paediatric Registrar, assisted by a medico-social worker
who arranges all appointments and attends each session. This history of a new case
is obtained from the mother in the absence of the child. Reports from Care Committee
workers on the home conditions are brought by the medico-social worker. These
reveal any overcrowding in the home, and prove of great value in augmenting the
doctor's impression of the parental attitude to the problem and the general atmosphere
of the home. School reports are also obtained to help assessment of the child's mentality
and behaviour. A general physical examination of the child is made and the history
augmented by conversation with the child. An examination of the urine is made in
every case. A full urological examination is either carried out initially if the history or
physical signs suggest the presence of organic disease, or later in cases showing no
response to treatment.
The main points in treatment are :
1. An attempt to correct any faulty attitude to the problem on the part of the
parents and to improve poor home conditions.
2. An attitude of sympathy, encouragement and optimism is adopted in the clinic.
3. The child is asked to keep a calendar of dry nights.
4. The parents are instructed to waken the child fully to micturate at their bedtime.
5. Drug treatment. Amphetamine is the main drug used, even in children who are
said not to sleep deeply. If necessary the dosage is raised to the limit of tolerance—
an important point in treatment. In cases made too restless or wakeful by
amphetamine, methyl ephedrine is the usual drug employed. For nervous
children with unduly frequent daytime micturition a morning dose of phenobarbitone
may be used in addition.
6. The assistance of a child psychiatrist is sought for children who show severe
behaviour problems.
A clinical trial to compare three methods of drug treatment is at present in progress.
Only severe cases (wet 6 or 7 nights a week) are included in the trial and are allotted by
random selection to one of the three methods of treatment. The doctor will know
which treatment a given child received only at the end of the trial.
Results.—With these methods of treatment, some children are rapidly and completely
cured. Of the remainder, the majority are improved to a varying extent, and
only a few are completely resistant to all forms of treatment.'

One encouraging feature of the Council's rheumatism scheme is that a high percentage
of the children discharged after treatment at Queen Mary's Hospital remain fit for