Incontinence in Old People

IN this monograph Dr. Brocklehurst outlines an active approach to a problem which too often is passively accepted as a necessary evil. The system of "laisser-faire," commonly adopted towards incontinence, entails endless use of skilled nursing care on frequent bed changes, and needless expense on laundering and replacement of bed linen. Dr. Brocklehurst has investigated this problem in the adult population in general wards and mental observation wards of five Glasgow hospitals, and made a study of cystometric and rectal pressure findings under certain conditions in a group of incontinent patients. The book is written in three parts, describing first, a review of the literature on this subject with special reference to the anatomy and physiology of bladder and rectum, and the theories of disordered mechanism leading to incontinence. In the second part the actiology of incontinence is discussed in the light to Dr. Brocklehurst's experience. His investigations suggest that the function of the sphincters is of less importance in the onset of incontinence than the tonus and movements of bladder and large bowel. The main predisposing factor is a lesion in the central nervous system, and obstetrical trauma or prostatic enlargement are of negligible importance as actriological factors. Precipitating factors are a cerebro-vascular accident, the patients' becoming bedfast, and mental confusion. He confirms the belief that the status of the nurses and nursing methods employed clearly affect the incidence of incontinence in hospital wards. The third part of the book is a discussion on treatment, and the bulk of this section is devoted to the design and construction of a special bed for bedfast patients with intractable incontinence. Like earlier workers in geriatrics, Dr. Brocklehurst has found that when an incontinent patient is back on his feet incontinence lessens or even clears up completely. If this fails, there is no simple remedy and one must still resort to the portable urinal or special bed. The possibility of commercial production of Dr. Brocklehurst's bed is being considered by the Dunlop Rubber Company. It is a pity, however, that the value of Wilson's cystometric treatment could not have been assessed in this series, for it is undoubtedly effective in certain cases although a time-consuming procedure. This book should focus attention on the possibility of alleviating one of the most distressing afflictions of old age, and to the need for further research into other neglected disabilities associated with degenerative disease. The book is attractively produced and illustrated, but although the subject is one of general interest the book is expensive, and most likely to be borrowed for reference, except by those with a particular interest in the management of these patients. G. F. A.