Forum — From the August 2013 issue

Bed-wetting

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Whereas child bed wetters in sixteenth-century England had been directed for their malady to consume the testicles of a hedgehog or the windpipe of a cock, Enlightenment science, which rejected symbolical approaches to medical problems, recommended direct interventions to cut off the flow of urine. Thus did treatment in the eighteenth and nineteenth centuries come to include:

Plugging the urethra.

Constriction of the penis with bandages, strings, adhesives, or vises, one of which was described as a “formidable rat-trap looking instrument.”

In severe cases, circumcision or clitoridectomy.

Ignipuncture of the perineum.

Sleeping on a hard surface.

Bladder and rectal irrigations.

Restricting the consumption of liquids.

Elevation of the feet.

Waking the child at regular intervals or otherwise preventing deep sleep.

Eliminating sugar.

Removing the child from school.

Cleanliness, fresh air, and exercise.

Sponging the lower part of the spine nightly.

Cold baths.

Belladonna.

Tinctures of strychnine, cantharides, or iron.

Injecting the bladder with gaseous carbonic acid.

Dilating the urethra and applying a strong solution of silver nitrate.[1]

[1] In 1902, Dr. D. Hamilton Kyle wrote in to the British Medical Journal to denounce this technique, advocated by another practitioner, as being “somewhat heroic.”

For those living in orphanages or workhouses, changing sheets in front of other children.

Ten grains of potassium bicarbonate and acetate in infusion of buchu, taken every four hours in water drawn from the healing mineral springs of Pitkeathly Wells, a town north of the Ochil Hills in Scotland.

Visiting Saint-Pissou (St. Piss), a spring whose powers date back to 1789, when revolutionaries destroyed the saints’ statues and drank its water, and died in terrible pain while urinating.

Fright induced by, among other things, smooshing a live mouse in the child’s hand, bringing her to witness a death, or startling her with a gunshot.

[2] Half a century later, at least one student at St. Cyprian’s School in East Sussex, eight-year-old Eric Blair (a.k.a. George Orwell), found in corporal punishment the seeds of self-improvement. “I knew that bed-wetting was (a) wicked and (b) outside my control,” he wrote. “[T]his was the great, abiding lesson of my boyhood: that I was in a world where it was not possible for me to be good.” Shortly after a disciplinarian broke a riding crop on Blair’s backside, the nightly accidents ceased.

By the late nineteenth century, nighttime wetting, like flushed cheeks, paleness, paralysis, and an inability to sit still, had been recognized as a symptom of masturbation. (Those who know Dora’s case history will recall this as Freud’s explanation of her childhood lapse into bed-wetting.) Like bed wetters, masturbators were subjected to a regimen of cold baths and hard beds, as well as all-purpose child whipping, though that could be a bit like pouring water on a grease fire: according to William Acton, a Victorian specialist in child sexuality, spankings were the cause of, not the remedy for, wetting and other nighttime accidents.[2] Nothing can make water flow upstream, of course, and the body’s tendency to leakage, particularly the boy’s body, was troubling. (Girls are more prone to diurnal enuresis, or daytime accidents, while boys are more frequent nocturnal enuretics.) Experts were required. At a time when households in London were piling excrement in their cellars, damp sheets did not quite amount to a public-health crisis, but close living quarters, institutional residences, and the social unpleasantness of foul-smelling domestic servants made it a problem of not insignificant medical interest. Unlike self-abuse, it was a practice that all parties were united in their efforts to eradicate.

In 1882, a doctor named Nye wrote to New England Medical Monthly with an idea. He suggested fastening one pole of a battery to a moist sponge or metallic plate that would be placed between the shoulders of the enuretic; the other pole of the battery would be attached to a dry sponge laid over the urethra. Bound and wired, comforted and relaxed by the hum of the battery, the patient would soon submit to rest. At the onset of evacuation — which for most child bed wetters occurs within the first two hours of sleep — the patient would wake in shock, “caught in the very act.” Dr. Nye concluded with confidence that a “repetition of like experience for a sufficient number of times ought, I am inclined to think, cure the patient.”

Turning the body into a circuit that jolted the wetter to consciousness, electrical remedies trained him to recognize the sensation of a full bladder and to wake himself in time. Some also credited electricity with strengthening the muscles of the bladder and the urethral sphincters, whose flabbiness was blamed for accidents. But there were two problems. The first was that electrical remedies required access to electrical rooms equipped with batteries (constant-current and interrupted-current), which needed to be kept charged and in good repair. The other problem was that applying electricity directly to the skin frightened both children and their parents.

In 1938, Dr. Orval Herbert Mowrer and his wife took the business of bed-wetting prevention into the modern age. Their apparatus consisted of two bronze plates, separated by cotton and covered in cloth. Insulated wires connected to a relay circuit housed in a locked box with batteries and a loud bell. The first drop of urine completed the circuit and caused the bell to ring, waking the child or, in some cases, the parent, who in turn woke the child. Together they disconnected the pad and plugged in a dry one; experts have long thought it necessary for the child to take charge of her own therapy.[3] Perhaps this explains why hypnosis has so far failed as a cure.

[3] In later experiments also involving electric shocks, Mowrer concluded that the anxiety that precedes fear is worse than the fear itself. In the late stages of his career, dissatisfied by three stints in psychoanalysis and haunted by an extramarital affair, Mowrer determined that neurosis was caused by moral guilt — not imagined guilt, but real guilt, caused by real misdoings. He founded Integrity Groups, in which participants, who were meant to commit to the program for life, achieved mental healthiness by the confession of secrets.

With the exception of Dr. Crosby’s Dri-Nite method (1950), which placed electrodes directly on the pubic area, the anti-enuretic devices of the twentieth century redirected currents to trigger alarms, not to deliver a shock. Such researchers as Seiger (1952), Lovibond (1964), and Coote (1965) updated the Mowrer technique, connecting pads, electrodes, and batteries to trigger bright lights, buzzers, blasts of air, or repeated hoots. When an alarm seemed inconvenient — in a school dormitory, for example — one could rig a water-soluble tablet to trigger the release of a stream of cold water at the first warm drop of urine. Another system used tablets to snap rubber bands, twisted in wait in a snug part of the undergarment.

These days no one much worries about a child of five or six who wets the bed now and again; a child of eight, ten, or twelve years who has been completely toilet trained and relapses will meet a battery of Mowrer-derived behavorial training. Tonight, in America, 5 million of these wetters will worry themselves to sleep, many of them lying atop rubber sheets, moisture alarms clipped, velcroed, or otherwise fastened to their pajamas. “Night after night I prayed, with a fervour never previously attained in my prayers, ‘Please God, do not let me wet my bed! Oh, please God, do not let me wet my bed!,’ ” wrote Orwell, “but it made remarkably little difference. Some nights the thing happened, others not. There was no volition about it, no consciousness. You did not properly speaking do the deed: you merely woke up in the morning and found that the sheets were wringing wet.”

Blind, volitionless caprice is a poor villain; it is always preferable to have something, or someone, to blame. At midcentury we faulted mother. As Dr. Stevenson Smith cautioned in The Psychological Origin and Treatment of Bed-Wetting (1948), “Remember that you have made the child what he is by being what you are.” Nowadays experts point to a variety of biological factors such as diabetes, sleep apnea, sickle-cell anemia, an underproduction of the antidiuretic hormone vasopressin, seizures, nocturnal constipation, sleep-arousal dysfunction, small bladder capacity, delayed maturation of the central nervous system, urethral abnormalities, spinal-cord trauma, genetic predisposition, cerebral palsy, and miscellaneous other neurological disorders; psychosocial disturbances such as sexual and physical abuse, stress, and enrollment in a new school are also admitted etiologies.

Origin stories are fine as far as they go, but too much looking for cause can distract from the matter at hand. Onanism is not the only pleasure associated with soiling the bed. Remember when Stephen Dedalus’s mother put the oil sheet on the mattress for him? She smelled nicer than his father and, one can only presume, nicer than the oil sheet. It must have been a comfort to have her so near.

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