Intimations of Senility

Yet though with years my body downward trend As trees beneath their fruit in autumn bend. Spite of my snowy hair and icy veins My head a cheerful temper still retains. Blake paints a bearable picture of old age and it is necessary to recognise that while the ageing process inevitably brings change, in the absence of disease normal people should retain understanding and mobility and can expect to continue as acceptable members of society to the end of life. If ever an organ failed from age alone it would follow that recovery was impossible and progressive further failure must probably ensue with the passage of time-Irretrievable deterioration may be induced by recurrent or progressive disease but this is a different matter and a clear grasp of the distinction is important. Senility with characteristic failing power and changing personality must not be accepted in medical circles as a diagnosis; it is a symptom which demands investigation and explanation. Geriatric physicians learn this very early. It is not merely that the term senility has a derogatory flavour to which they are hypersensitive, but the misuse of the concept often leads to mismanagement. Once it has been accepted that the patient behaves as he does because he is old there is clearly no more to be done. The laiety are as much to blame in this matter as are doctors. If it is expected that in late life incontinence of urine will probably occur (and what an offensive idea when one thinks of one's own increasing years), the onset of this symptom, which should call for urgent investigation, excites no comment. A devoted daughter may put up with incontinence of urine for weeks or months when her mother really needs treatment for pyuria or her father slowly passes into uraemia for lack of a prostatectomy. It is sad how often, when at last she does call in medical help, the idea of curing the patient arises less quickly than the idea of disposal. Some examples of this sort of situation follow. A man of 80, native of another county, was brought to Cheltenham by his landlord and dumped on his brother's doorstep. He had recently developed incontinence of urine but managed fairly well by wrapping himself in towels. Some days later after a tumble he took to his bed and was referred as being " just senile ". On admission to hospital …