Enuresis of Allergic Origin.

Persistent enures:s is a common complaint, difficult to eradicate and obnoxious to all concerned, whether patient, parent, or physician. It is not mv desire, in this preliminary communication, to recapitulate the multitudinous etiological factors nor discuss the numerous recognized therapeutic aids in this condition, but rather to expand an observation which I made in an article on the asthmatic child which appeared in this journal last yearl. In this I stated that, in my experience, a few cases of persistent enuresis in children were allergic in origin. The cases to which I referred may be classed into three categories :-First, cases in which enuresis occurs along with such allergic manifestations as asthma, hay-fever, eczema, urticaria and migraine: secondly. cases in which enuresis is present along with conditions that have proved allergic in origin: thirdly, cases in which enuresis occurs as the sole manifestation of allergy. Parents of young allergic children are loath to admit that the child wets himself as they regard it as an infantile weakness that will soon disappear at the age of seven or puberty. Thev are always more concerned with the asthma or other allergic complaint that has commenced recently and which, in their view, is liable to persist throughout life. It is only in the case of older children that the statement is volunteered, for they have been distracted to find that the habit did not cease with the second dentition. In a thousand allergic children I have found that 3 per cent. over the age of seven years suffer from some degree of enuresis. If we compare the nerve supply of the bladder with that of the lungs the reason for the association between enuresis and such an allergic condition as asthma becomes obvious. For just as constrictor fibres are supplied to the smooth muscle in the walls of the bronchi through the cranial division of the parasympathetic system, motor fibres are supplied to the detrusor muscle of the bladder and inhibitory fibres to the internal vesical sphincter through the sacral division of the same system. On the contrary, the bronchi are dilated through svmpathetic fibres inhibiting their smooth muscle, and the internal sphincter of the bladder and the trigonal region are contracted and the detrusor muscle inhibited through a similar innervation. Obviously stimulation of the parasympathetic system may lead to bronchospasm, or to the discharge of urine, or both, accordinrg to the location …