This study demonstrates that injury to the central nervous system is the common explanation for incontinence in elderly individuals in a chronic hospital. Indeed all the twenty-one cases described here showed nervous system involvement without evidence of important local abnormalities in the urinary system. A considerable group of these individuals had lesions which could be localized in the spinal cord, brain stem or internal capsule. In most cases the changes were bilateral. In the remainder there was diffuse cerebral damage with no changes in the striated muscle or in the reflexes which are considered characteristic of involvement of the cortico-efferent pathways. In these patients the lesion must involve the highest correlation centers controlling vesical activity.A patient with changes in striated muscle characteristic of damage to the cortico-efferent pathways bilaterally, presented a fairly normal vesical reading. From the data presented in this paper it is demonstrated that bladder abnormalities may be produced by cerebral cortical lesions without abnormalities of striated muscle, and conversely the changes in striated muscle may be present without marked abnormalities in the graphic record. Even so, in all the cases showing striated muscle changes of marked degree, incontinence was present.
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