Anaesthesia for Caesarean Operation

Abstract

NOCTURNAL ENURESIS~- MEDICAL JOURNAL proportion of cases come for treatment they are in the secondary stage, and in such the original causative factors may no longer be operative. The condition is in fact a self-perpetuating one. The course of development from the primary to the secondary stage is complex, but as the child becomes aware that his symptoms produce unpleasant penalties he becomes anxious and uncertain, and a vicious circle of anxiety develops. The enuresis is no longer a response but a stimulus-a stimulus to both child and parent, or foster parent, creating in its wake still further anxiety and enuresis. If the causative factor is no longer operative there is every justification in using what might be criticized as symptomatic treatment. Only by preventing or minimizing a wet bed can the vicious circle be broken, and this conditioning apparatus seems to achieve the desired result. By such means not only is the child's anxiety allayed but, more important still perhaps, the parent's anxiety is also quickly reduced.Suggestion plays a prominent part in the cure of many cases of enuresis, a factor often forgotten by the advocates of painful surgical procedures. Such suggestion may take the form of a pill or the purposeful use of suggestion under hypnosis as recommended by Strauss (1944). The effect, however, is much the same; the child is urged, either directly or indirectly, to believe that he will be dry in future, and sometimes this is indeed the case. The conditioning bell also has a suggestive effect. This is evidenced by some of our patients who were dry from almost the day the apparatus was installed. At least, from the time the apparatus is installed the patient feels secure in the knowledge that, if he does void, he is sure to wake up in time to prevent a very wet bed. In treating our cases by means of this apparatus we have taken full account of this factor, and have not hesitated to reinforce treatment by strong suggestion and reassurance. The child falls asleep knowing, in fact feeling, the pad is there.Personality difficulties are often a prominent feature of enuretic individuals, but we are in some doubt whether such traits are not the effect rather than the cause in a good many cases. A surprisingly high proportion showed positive personality changes after acquiring the dry habit. Some patients were noticeably assertive, whereas previously they had been shy or introspective. In no case, however, did this over-compensation continue for longer than a week or two, and in no case was it by any means pathological. Children previously labelled dull even appeared brighter and more co-operative in their homes and school. We know that some enuretics are problem children, and that the enuresis is merely a symptom of general maladjustment, but we feel that in a good many cases personality difficulties are the effect rather than the cause of the enuresis. A few, especially during the early stages of treatment, refused to co-operate and did their best to sabotage our efforts. In this way the condit...