Incontinence of Urine in Children. By J. SimoN, Esq., F. R. S.
Surgeon to St. Thomas’s Hospital.—Irritability of the bladder in
children usually takes, with more or less completeness, the form of
incontinence of urine: the child wets its bed. Whenever this symp-
tom is presented to you, if you proceed to examine the urine (as in
every such case you should do,) you may pretty confidently expect to
find copious crystals of lithic acid. This condition of urine in children
is very far from painless; and in severe cases the symptoms cannot at
first sight be distinguished from those of calculus. The child makes
water very often, and a little at a time, doubles itself up, and cries with
the pain of each effort, and pinches and pulls its prepuce, just as it
would with stone in the bladder. The pain experienced is a severe
scalding in the urethra, and sometimes this passage will be so much
irritated as to inflame and secrete pus. There was recently a case
under my treatment which, though not one of incontinence of urine
(for it was an adult), will yet serve to show the manner of dealing with
inconveniences, generally, as depend on the passage of crystals of
lithic acid in the urine. The patient, W. M., aged 22, had for two or
three years suffered occasionally with symptoms, which made it pro-
bable that he had a calculus lodged in his left kidney; but the immedi-
ate cause of his admission to the hospital was the circumstance of his
then habitually passing lithic acid gravel, occasionally mixed with
blood. His urination was frequent and painful; his pulse was feeble,
and he was of little muscular power ; his skin acted fairly; his tongue
was white and coated; his bowels a little constipated. I ordered him
five grains of Plummer’s pill every night till his tongue was quite clean,
and then changed the treatment; giving him quin, disulph. gr. ii. twice
a day, and potass, bicarbon, half a drachm, five hours after his chief
meal. He left the hospital after a month’s stay, quite free from uneasi-
ness in his urinary organs, and materially improved in general health.
This case will illustrate the sort of treatment which I generally pur-
sue in similar instances of chemical derangement of the urine. If the
tongue is coated, and if (as is usually the case with children) the intes-
tinal secretions are unhealthy, I give hydrarg. c. creta, or some other
preparation of mercury, till that evil is remedied ; I then commence the
the exhibition of alkalies, giving usually a single large dose daily, after
the completion of the digestion of the chief meal of the day ; and almost
invariably I find it highly advantageous to give quinine twice a day
during the same period. In my hands it has answered far better than
any preparation of iron, and especially so in the combination 1 have
mentioned. I give it usually before breakfast and before dinner, and
the alkali, in copious solution, five hours after the latter meal. Extreme
attention to the quantity, quality, and simplicity of the diet, is essential.
With this treatment you will seldom, I think, have occasion to resort
to blistering over the sacrum, and other measures of a similar nature,
which have been recommended for the cure of incontinence of urine in
children.—Lancet.