ATROPINE LN ENURESIS BY WM. PERRY WATSON, A.M., M.D., Attending Physician to St. Francis's Hospital and to the Central Dispensary (Department of Diseases of Children); Consulting Physician to St. Michael's Orphan Asylum, etc., Jersey City, N.J. Read before the Section on Diseases of Children, Ameri- can Medical Association, Newport, R.I., 1889. [Reprinted, from the Archives of Pediatrics, October, 1889.] ATROPINE IN ENURESIS. In December, 1888, Dr. Simon Baruch, of.New York, read a paper* before the Pediatric Section of the New York Academy of Medicine, in which he made such positive state- ments about the value of atropine in enuresis that I at once resolved to try its efficacy upon similar cases in my private practice as well as in the public institutions with which I was connected. While the length of this paper, with the time at my disposal, will not permit me to go into the various causes, and the different modes of treatment, of enuresis, I shall simply content myself at this time in detailing the results obtained in the thirty cases treated in this empirical manner. The following formula was used in all the cases,-viz.: R Atropiae sulph., gr. i; Aq. destillatae, §i. M. Of which one drop for each year of the age of the child was given at four and seven o'clock in the evening. It was found by actual counting that the ordinary medicine-dropper held eighty drops of this liquid. Case I.-Mary B., aged ten, has always had nocturnal enuresis, and for the last two years diurnal also. On January 5, 1889, she took ten drops of the solution at four and seven o'clock in the evening, and did not wet her bed that night, and has not since then had any difficulty in retaining her urine during the night or day. Case II.-James E., aged nine, has had nocturnal and diurnal enuresis since an attack of scarlatina when four years * Archives of Pediatrics, April, 1889, 2 Watson : Atropine in Enuresis. of age. He was circumcised when six years of age, but with only temporary benefit. Meatus inflamed. He was given nine drops of the solution twice every evening for a week, with alleviation of the diurnal symptoms, but no apparent effect on the nocturnal symptoms. In the beginning of the second week (January 13, 1889) the doses were doubled,-i.e., eigh- teen drops were given at the usual hours in the evening, and that night, for the first time in five years, he did not wet the bed and has not done so since, the medicine being discon- tinued the following day. Case III.-John E., aged six, a brother of the preceding patient, has always been troubled with nocturnal enuresis, and has received the usual routine of supposed appropriate remedies without apparent improvement. Prepuce elongated but easily retractable. The above solution was prescribed in six-drop doses twice a day, and after the first dose there was marked improvement, and at the end of the first week he was cured. Case IV.-John B., aged eleven, has always had noc- turnal but no diurnal enuresis. Prepuce normal; meatus in- flamed. After the sixth day's use of the solution his mother brought him to me and said that he was well,-wetting the bed less after the first day, scarcely any after the second, and not at all after the third ; and.now, after six months' interval, there has been no return of the disagreeable symptoms. Case V.-John C., aged six, has always had nocturnal and diurnal enuresis. Prepuce normal; meatus inflamed. After the third day's use of the drops his mother reported that he had not wet the bed at night or his clothes during the day since the first day's doses. Cases VI. to XXIX. were treated in the orphan asylums of Jersey City, where such cases are kept in separate beds, and are taken up every night about eleven o'clock, urged to urinate, and their clothing, if soiled, is changed. The previous habits, general surroundings, and mode of living be- fore entering the asylum are usually unhealthy, and it is found that cases of nocturnal enuresis are cured by the hygienic and dietetic changes met with in these asylums without me- dicinal treatment. Case VI.-Valentine S., aged twelve, has had nocturnal Watson : Atropine in Enuresis. 3 enuresis as long as he can remember. Prepuce elongated but easily retractable. The usual doses of the foregoing formula were commenced on January 15, 1889, and continued until February 14, 1889, with impaired vision on January 17 and 18 only, and remittent cessation of the nocturnal symptoms, frequently going three or four nights without disturbance, when he left the asylum on February 14. Case VII.-Louise McK., aged six, has been two years in the asylum, during which time she has had nocturnal and diurnal enuresis. January 14, 1889.-The regular doses at stated intervals were given, with the result that she was cured as far as the diurnal symptoms were concerned, and would frequently go two or three nights without the nocturnal occurrence, and then they would resume for a night, possibly two, and then disap- pear. On February 14, 1889, the doses were doubled, and she had no return of the symptoms until June 15, 1889, when the nocturnal symptoms again became intermittent, following an attack of measles. Case VIII.-Joseph P., aged six, has been three years in the asylum, during which time he has had nocturnal enuresis. Prepuce elongated but easily retractable; meatus normal. January 15, 1889.-Began the usual doses of formula at the stated intervals, with the result that every once or twice a week did the symptoms return until February 14, 1889, when the doses were doubled and the symptoms have not since returned. Case IX.-Gus. M., aged seven, has been one year in the asylum and thinks he has always wet the bed at night. Prepuce elongated, tight, but retractable with the use of a little force; meatus inflamed. January 15, 1889.-Began the usual doses at stated in- tervals, but without cessation of the symptoms until February 14, 1889, when the doses were doubled, and since then he has had no recurrence of the symptoms. Case X.-James B., aged eight, has been four years in the asylum, during which time (previously he does not re- member) he has had nocturnal enuresis. Has a tight phimosis, which is not retractable. 4 Watson : Atropine, in Enuresis. January 15, 1889. Began usual treatment, with cessation of the symptoms for one night in a week until February 14, 1889, when the doses were doubled, and since then there has been a recurrence of the symptoms about two nights in the week. Case XI.-William M., aged nine, has been four years in the asylum, during which time he has had nocturnal enuresis. Has hypospadias. January 15, 1889.-Usual treatment, with intermission of two or three nights in succession, until January 30, 1889, since which time there has been no recurrence. Case XII.-James M., aged four (a brother of Case IX.), has been one year in the asylum, during which time he has had nocturnal and diurnal enuresis. Prepuce elongated but retractable; meatus normal. January 15, 1889.-Usual treatment began, with the result that his diurnal symptoms were cured, and a remission of the nocturnal symptoms,-i.e., he would wet the bed one night and then not for two nights, and again he would wet the bed for two or three nights in succession and then not again for several nights, until February 14, 1889, when the doses were doubled, but since then he wets the bed on the average of about twice a week. Case XIII.-Mary R., aged four, has been in the asylum three months. Has always had nocturnal enuresis. January 15,1889.-Usual treatment, resulting in a cessation of the symptoms for over one-half of the time, until February 14,1889, when the doses were doubled, and after the first day there has been no return of the symptoms. Case XIV.-Irene D., aged three, has been only three days in the asylum, but the history obtained by the sister in charge is that she has always had nocturnal and diurnal enuresis. January 15, 1889.-Usual treatment, resulting in an im- mediate cure of the diurnal symptoms and an intermittent cessation of the nocturnal symptoms, until February 14, 1889, when the doses were doubled, and she has had no return of the symptoms (nocturnal or diurnal) since. Case XV.-James A., aged twelve, has been one year Watson : Atropine in Enuresis. 5 in the asylum, and says he has always had nocturnal enuresis. Prepuce elongated but easily retractable; meatus normal. January 15, 1889.-Usual treatment, resulting in a complete cessation of the symptoms on January 31,1889, and they have not since returned. Case XVI.-Bernard S., aged fifteen (brother of Case VI.), has always had nocturnal enuresis. He was circumcised in early childhood without permanent results. January 15, 1889.-Usual treatment (only one dose daily, however, on account of his absence from the asylum during the day), with the result that he would go one or two nights during the week without a recurrence of the symptoms, until February 10, 1889, when he left the asylum. Case XVII.-Frank McC., aged five, has been two years in the asylum, during which time he has had nocturnal and diurnal enuresis. Prepuce elongated and tight, but can be retracted with a little force. January 15, 1889.-Usual treatment, resulting in an im- mediate cure of the diurnal symptoms and a remission of the nocturnal symptoms,-i.e., going two or three nights without wetting the bed and then a return of the symptoms,-until February 14, 1889, when the doses were doubled, since which time he has had a recurrence of the symptoms about two nights in twelve weeks. Case XVIII.-John T., aged six, has always had noc- turnal and diurnal enuresis. Prepuce normal; meatus in- flamed. January 15, 1889.-Usual treatment, resulting in a cessa- tion of the diurnal symptoms after the third day and of the nocturnal after two weeks. Case XIX.-Henry D., aged five, has been in the asy- lum one year, but has always had nocturnal and diurnal enuresis. Prepuce elongated but easily retractable; meatus inflamed. January 15,1889.-Usual treatment, resulting in immediate cure of the diurnal trouble with remissions of the nocturnal, until February 14, 1889, when the doses were doubled. Since the 16th of February there has been no recurrence of either symptoms. 6 Watson : Atropine in Enuresis. Case XX.-Charles S., aged eight, has always had noc- turnal enuresis. Prepuce elongated but easily retractable; meatus normal. January 15, 1889.-Usual treatment, resulting in a remission of the symptoms, until February 14, 1889, when the doses were doubled, since which time he has had a recurrence of the symptoms about two nights in the week. Case XXI.-Joseph S., aged eight (twin brother of Case XX.), has always had nocturnal and diurnal enuresis. Prepuce elongated but easily retractable. January 15,1889.-Usual treatment, resulting in an imme- diate cure of the diurnal symptoms and a remission of the nocturnal, until February 14, 1889, when the doses were doubled, and since the third day of their use there has been no return of the symptoms. Case XXII.-James T., aged three, has been six months in the asylum, during which time he has had nocturnal and diurnal enuresis. Prepuce elongated but easily retractable; meatus inflamed. January 15,1889.-Usual treatment, resulting in a cessation of the diurnal symptoms after the third day and a remission of the nocturnal symptoms, until February 14,1889, when the doses were doubled, and since the 16th of February there has been no return of the symptoms. Case XXIII.-Michael H., aged six, has been three years in the asylum, during which time he has had nocturnal and diurnal enuresis. Prepuce elongated but easily retracta- ble ; meatus slightly inflamed. January 15, 1889.-Usual treatment, resulting in the imme- diate cure of the diurnal symptoms, with marked remission of the nocturnal symptoms, until February 14, 1889, when the doses were doubled, and since February 16, 1889, there has not been any return of the symptoms. Case XXIV.-William T., aged twelve, has been over six years in the asylum, during which time he has had noc- turnal enuresis. Prepuce and meatus normal. January 15, 1889.-Usual treatment, resulting f5r the first three days in pains in the forehead with dimmed vision, but after that they passed away and a gradual remission of the Watson : J.fo'qpme in Enuresis. 7 nocturnal symptoms, until January 31, 1889, since which time there has been no return. Case XXV.-Susan D., aged eleven, and Case XXVI., Mary H., aged twelve, have always had nocturnal enuresis. February 5,1889.-Usual treatment for each, with the aston- ishing results that they have not had a recurrence of the symp- toms since that day. The treatment, however, was continued during the 6th, 7th, and 8th of February, when it was discon- tinued.' On the 7th and 8th they each complained of pains in forehead and impaired vision, which entirely disappeared in a day or two. Case XXVII. - Nancy C., aged fifteen, and Case XXVIII., Josephine C., aged thirteen, have always had more or less diurnal enuresis, which, however, entirely ceased after the first daily doses of the solution (February 10, 1889), and has not since returned. Case XXVIII. complained of a fulness in her forehead the following day only. Case XXIX.-Honora B., aged nine, has always had nocturnal and diurnal enuresis. February 10, 1889.-Usual treatment, resulting in an im- mediate cure of the diurnal symptoms and of the nocturnal after the fourth day of treatment. Case XXX.-John M., aged seven, has always had noc- turnal enuresis. Prepuce and meatus normal. February 10,1889.-Usual treatment. February 17, 1889. -Mother reports that he has not wet the bed since the third night after taking the medicine. From a careful review of these thirty unselected cases I am justified iu saying that we have a remedy in sulphate of atro- pia-given to its full physiological effects-which is unequalled in our materia medica. ARCHIVES OF PEDIATRICS A MONTHLY JOURNAL DEVOTED TO THE DISEASES OF INFANCY AND CHILDHOOD. EDITED BY WM. PERRY WATSON, A.M., M.D., Attending Physician to St. Francis's Hospital and to the Central Dispensary (Department of Pediatrics); Consulting Physician to St. Michael's Orphan Asylum, etc., Jersey City, N.J. THE ONLY MEDICAL JOURNAL IN THE ENGLISH LANGUAGE DEVOTED EXCLUSIVELY TO THE DISEASES OF INFANTS AND YOUNG CHILDREN. Containing nearly 1000 large octavo pages per annum. 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