due to an enlargement of a gland at the neck of the bladder which prevents the bladder from closing properly. A concentrated and irritating urine, from excessive acidity or alkalinity, may induce incontinence.

Children may recover from it as they approach adult life, but they should not be punished, as it is a disease and not a fault. Exception should be made in case children wet their clothing during play, through failure to take the time and trouble to pass water naturally. It is more common among children at night, leading to wetting of the bed, but may occur in the day, and often improves in the spring and summer, only to return with the cold weather. Children who sleep very soundly are more apt to be subject to this disorder.

Treatment. In the case of a disorder depending upon one of so many conditions it will be realized that it would be folly for the layman to attempt to treat it. Children who are weak need building up in every possible way, as by an outdoor life, cold sponging daily, etc. If there is in boys a long foreskin, or tight foreskin, hindering the escape of urine and natural secretions of this part, circumcision may be performed to advantage by the surgeon, even in the infant a few months old. Sometimes a simpler operation, consisting of stretching or overdistending the foreskin, can be done.

A somewhat corresponding condition in girls occasionally causes bed-wetting and other troubles. It can be discovered by a physician. Children who wet their

beds, or clothes, should not drink liquid after five in the afternoon, and should be taken up frequently during the night to pass water. The bed covering must be light, and they should be prevented from lying on the back while asleep by wearing a towel knotted in the small part of the back. Elevation of the foot of the bed a few inches is recommended as having a corrective influence. Masturbation, if present, must be corrected.

It is a very difficult disorder to treat, and physicians must be excused for failures even after every attempt has been made to discover and remove the cause. Even when cure seems assured, the disorder may recur.

INFLAMMATION OF THE BLADDER (Cystitis). The condition which we describe under this head commonly causes frequent painful urination. Primarily there is usually some agency which mechanically or chemically irritates the bladder, and if the irritation does not subside, inflammation follows owing to the entrance of germs in some manner. The introduction into the bladder of unboiled, and therefore unclean, instruments is a cause; another cause is failure to pass urine for a long period, from a feeling of delicacy in some persons when in unfavorable surroundings. Nervous spasm of the urinary passage from pain, injuries, and surgical operations constitutes another cause. Inflammation may extend from neighboring parts and attack the bladder, as in gonorrhea, and in various inflammations of the sexual organs of women, as in childbed infection. Certain foods, waters, and

drinks, as alcohol in large amounts, and drugs, as turpentine or cantharides applied externally or given internally, may lead to irritation of the bladder. Exposure to cold in susceptible persons is frequently a source of cystitis, as well as external blows and injuries. The foregoing causes are apt to bring on sudden or acute attacks of bladder trouble, but often the disease comes on slowly and is continuous or chronic.

Among the causes of chronic cystitis, in men over fifty, is obstruction to the outflow of urine from enlargement of the prostate gland, which blocks the exit from the bladder. In young men, narrowing of the urethra, a sequel to gonorrhea, may also cause cystitis; also stone in the bladder or foreign bodies, tumors growing in the bladder, tuberculosis of the organ. Paralysis of the bladder, which renders the organ incapable of emptying itself, thus retaining some fermenting urine, is another cause of bladder inflammation.

Symptoms. The combination of frequency of and pain during urination, with the appearance of blood or white cloudiness and sediment in the urine, are evidences of the existence of inflammation of the bladder. The trouble is aggravated by standing, jolting, or active exercise. The pain may be felt either at the beginning or end of urination. There is also generally a feeling of weight and heaviness low down in the belly, or about the lower part of the bowel. Blood is not frequently present, but the urine is not clear, if there is much inflammation, but deposits a white and

often slimy sediment on standing. In chronic inflammation of the bladder the urine often has a foul odor and smells of ammonia.

Treatment. The treatment of acute cystitis consists in rest-preferably on the back, with the legs drawn up, in bed. The diet should be chiefly fluid, as milk and pure water, flaxseed tea, or mineral waters. Potassium citrate, fifteen grains, and sweet spirit of nitre, fifteen drops, may be given in water to advantage three times daily. Hot full baths or sitz baths two or three times a day, and in women hot vaginal douches (that is, injections into the front passage), with hot poultices or the hot-water bag over the lower part of the abdomen, will serve to relieve the suffering. If, however, the pain and frequency attending urination is considerable, nothing is so efficient as a suppository containing one-quarter grain each of morphine sulphate and belladonna extract, which should be introduced into the bowel and repeated once in three hours if necessary. This treatment should be employed only under the advice of a physician. In chronic cystitis, urotropin in five-grain doses dissolved in a glass of water and taken four times daily often affords great relief, but these cases demand careful study by a physician to determine their cause, and often local treatment. Avoidance of all source of irritation is also essential in these cases, as sexual excitement and the use of alcohol and spices. The diet should consist chiefly of cereals and vegetables, with an abundance of

milk and water. The bowels should be kept loose by means of hot rectal injections in acute cystitis.

RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.-Retention refers to that condition where the urine has been accumulating in the bladder for a considerable time-over twelve hoursand cannot be passed. It may follow an obstruction from disease, to which is added temporary swelling and nervous contraction of some part of the urinary passage; or it may be due to spasm and closure of the outlet from nervous irritation, as in the cases of injuries and surgical operations in the vicinity of the sexual organs, the rectum, or in other parts of the body. Overdistention of the bladder from failure to pass water for a long time may lead to a condition. where urination becomes an impossibility. Various general diseases, as severe fevers, and conditions of unconsciousness, and other disorders of the nervous system, are frequently accompanied by retention of urine. In retention of urine there is often an escape of a little urine from time to time, and not necessarily entire absence of outflow.

Treatment. Retention of urine is a serious condi

tion. If not relieved, it may end in death from toxæmia, caused by back pressure on the kidneys, or from rupture of the bladder. Therefore surgical assistance is demanded as soon as it can be obtained. Failing this, begin with the simpler methods. A hot sitz bath, or, if the patient cannot move, hot applications, as