Hysterical Enuresis.

I have an exceedingly troublesome case of enuresis which possesses some very peculiar properties. The loss of control seems to be a mental one, as there is but little local cause for the irritation, the patient is free from any trouble when the mental condition is right. If the patient makes up her mind that she is going to be troubled with frequency of urination, or that she is going to be embarrassed in places where there are no conveniences, or if she loses confidence in her power to control herself, then she will surely by affected in the extreme. There will be a frequency amounting to every half hour and a large quantity of urine will be passed at each time. This loss of control extends to the bowels frequently, and causing great inconvenience and serious embarrassment by the necessity for frequent bowel movements.

I have not been able to find any local conditions to blame for this. She is, however, inclined to be much worse, and even hysterical at the regular time of her 'monthly sickness. If any one has had a similar experience and can make any suggestions as to permanent cure, I should like to have them do so. So far, remedies directed to the cure of renal or cystic conditions or conditions of the urine itself, have no influence whatever upon this trouble.

C. G. HICKS, M. D.

COMMENT:—The above comes nearly being a case for the nerve specialist. If the doctor is sure that there is no local cause of irritation, the nervous system must receive almost the entire attention in the process of cure. However, I remember an article which was written a number of years ago by Dr. Fisk, of Nashville, Tenn., in which he mentioned some cases the conditions of which were almost precisely the same as those mentioned above, with the addition that the nervous condition was much worse at the menstrual epoch and consequently at that time the eneurisis was more troublesome. He claimed that he cured his cases very satisfactorily with the following formula:

Mix. Sig.: A teaspoonful every two or three hours.

As the symptoms of the above patient are worse at the menstrual time some such prescription as the above might meet her indications. The doctor believed the agrimony to be the potent remedy, but the macrotys and pulsatilla will probably be indicated if a close diagnosis be made.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.