Enuresis in Adolescents

R. C. Browne, A. Ford-Smith
1941 BMJ (Clinical Research Edition)  
The Subjects and their Surroundings The subjects of these observations were boys whose ages ranged from 14 to 20 years. They were members of a farm training colony, some 300 strong, to which they had been sent by the Public Assistance Committees of England and Wales. Most of them had been brought up *in institutions, and many of them had been " problem cases." In general the boys were of poor type and intelligence, inclined to lack discipline and to show anti-social traits. Many of them had
more » ... any of them had started life with the adverse bias of illegitimacy, separated parents, or an unkind step-parent. The boys at the colony received training to fit them for farm, gardening, or domestic work or boot-repairing. Positions were found for them in one of these spheres at the completion of their course. They played organized games daily, with swimming in the summer, and went to the pictures once a week, on Saturdays. A few of them had started model aeroplane and fretwork clubs. The colony was run rather along Public School lines, being divided up into several houses, with the usual system of internal government. Everything was done to kindle a feeling of responsibility and public spirit, and much of the government of the colony was in the hands of the boys themselves. Twenty-one per cent. of them were bed-wetters: this high figure is explained by the fact that the colony is one of the few in England admitting uch boys, who thus tend to gravitate there. Most were intractable cases who still wet their beds when admitted to hospital in different and possibly happier surroundings. Occasionally some went home, but the trouble nearly always persisted. It was the custom to segregate the enuretic boys in a separate dormitory with beds equipped with rubber sheets. In an effort to avoid a wet bed later in the night, they were waked two hours after going to bed and made to pass water. Thus it was probable that the conditions tended to encourage * With a grant from the Medical Research Council. enuresis rather than otherwise, in view of the segregation at night and the constant riminder, in being called, that the worst might happen. Alongside this camp there happened to be a colony of forty Jewish refugee boys of similar ages. They were mostly the sons of Austrian artisans and small shopkeepers. These boys were of good intelligence and physique,. and when competing in the sports against the boys in the colony had won all the cups and prizes. Enuresis among them was unknown. Description of Cases more fully Investigated Twelve boys from the colony together with one from an external source were admitted to hospital for a more detailed investigation. In addition to careful histories and physical examinations, perianal swabs were taken for threadworms, the lumbar spines were radiographed for spina bifida, and an investigation was made to determine whether the boys passed an abnormal volume of urine by day or night. Intravenous pyelography was performed, and each boy was sent for interview by a psychologist. The method employed to determine whether they passed an abnormal volume of urine consisted, at first, in weighing the bed-clothes before and after sleep. This was found to be not very satisfactory, and eventually a comfortable bag for collecting urine was fitted on before they settled for the night. Ten of the boys had enuresis in hospital. The average age of the subjects was 17, the youngest being 14 and the oldest 20. Ten of them had unsatisfactory family histories, such as the early death of the parents, a broken home, or a father who suffered from "shell shock." There was a family history of enuresis in only one case. All but one were dull, and even this boy was emotionally immature. This dullness was quite obvious on simple conversational contact, and required no special test for its demonstration. All the boys, except one whose development was retarded; were physically normal. Threadworms were found in three of them. There was no significant chemical or cytological abnormality in their urine, of which they passed a normal volume both by day and by night. Intravenous pyelograms showed norm'al urinary tracts in every case. Radiographs of the lumbar and sacral spines demonstrated some.abnormality in nine out of the thirteen boys. This was frank spina bifida occulta in seven, but a congenital abnormality of the first piece of the sacrum was reported in one, and flattened vertebral bodies in another. The incidence of congenital abnormalities is greater than even the most generous estimates for healthy people. Common factors in the histories and examinations that were noted, among others, were: (1) an unsatisfactory family history, often with some disruption of the home; (2) poor intelligence; (3) normal physique; and (4) a congenital spinal abnormaldy. Spontaneous Course of the Disorder A record of the number of wet beds caused by each of three boys was kept for a period of rather more than two years, during which they were untreated. This is shown in Fig. 1 . It will be seen that the disease follows an irregular course, being slightly less troublesome in midsummer. In the case of boys C. and M. there was an exacerbation in the early part of 1940 corresponding to the intense cold at that time. Boy W., however, seemed to be unaffected by this. The course of the illness is not unlike that of epilepsy, a similarity which fits in with the low level of intelligence of most of the boys. The frequency of spina bifida occulta further suggests some abnormality in the central nervous system. The demonstration of spontaneous remissions n a t u r a l l y r a i s e s t h e q u e s t i o n o f a n y t r e a t m e n t u s e d I f a
doi:10.1136/bmj.2.4222.803 fatcat:cdblzsu5zjhadmrvf6xky4bole