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With regard to geographical situation, 29% of the cases came from
the West division, 29% from the North division and 42% from the
South division. It is not apparent as to why there has been this higher
number of cases in the South.
The mode of referral is also shown in table 22, and lumping the years
together it will be seen that 56% of all cases came to our attention through
being referred by one of the district nurses ; 19% were referred by the
Old People's Welfare Association or by the home help service ; 17%
by the private doctor and only 4% by hospital. These percentages are
much what might be expected, the district nurse being the person on the
spot who knows what help is required, but it does rather indicate that the
cases were being referred only at a late stage of deterioration. It is
pleasing therefore to see that an analysis of the figures shows that the
proportion referred by private doctor is tending to increase—thus,
whereas in the first year this was only some 6%, last year it was 20%
(and was in fact 24% the year before). There may also be another reason
for this : in the early days there were some doubts about one or two legal
points involved and we did not specifically call the attention of the district
nurses or the doctors to the service. It therefore spread by word of mouth
and so it is rather more natural that it would spread more rapidly through
the few district nurses concerned than through the very much greater
number of doctors who practise in the borough.
Table 22 also shows the reasons for referral, and from the total figures
for the period it will be seen that the most common reason was debility
or senility—in other words the slow deterioration of old age. This
accounted for over a third«of the total number of cases. Rather under a
third were cases of stroke, and about one-sixth were cases of cancer. Other
figures in table 22 indicate whether the cases were due to urinary or faecal
incontinence. Here however the figures require explanation. Some 46%
are put down as " ?," but the vast majority of these were cases which
were taken on for only one or two collections while being removed to
hospital. The exact type of incontinence is not recorded in these cases,
but it is safe to assume that nearly all of them were cases of faecal incontinence.
In certain other cases the fouled articles were due to discharges
from other parts of the body.
Collection of soiled laundry is made once, or more usually twice,
a week, depending on the severity of the case, and the articles are taken
back the next day, or on some occasions the same day. Table 22 shows that