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74
The mode of referral is also shown in table 55, and lumping the years
together it will be seen that 56% of 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 55 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 55 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 55 shows
that the number of collections rose from 607 in 1951 to 3,427 in 1954
and has remained at about that figure since. Deliveries of course double
the visits paid as they are made at different times to the collections. No
issue of replacement articles is made and if the patient has not sufficient
material, such as bed linen, it is found that the National Assistance
Board will sometimes help in this matter, or additional help may be obtained
from the Red Cross or the WVS. The soiled articles, before being
collected from the house, are put into open mesh bags, which are
numbered. At the time of collection the person is asked if the bag
contains woollen or highly coloured articles and if so these are taken
out at the disinfecting station and washed separately by a special process.
People are asked to avoid the use of this type of article as much as possible
The bag on arrival at the disinfecting station is put into the foul washing
machine which is capable of dealing with 40 lbs. dry weight. The average
weight of the bags as received is 12 lbs. Although normally washed in
the bag in which it is collected, if the case is known to be a particularly
bad one the contents of the bag are emptied out and washed loose.