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* Ceased to be notifiable on 30.7.48. † Notifiable from 1.1.50.
Notification of Rheumatism.—The Public Health Committee considered the position regarding the notification of
Acute Rheumatism during the year. The history of the notification of Acute Rheumatism in Paddington is of some
interest.
On the 1st March, 1927, by virtue of the "Paddington (Acute Rheumatism) Regulations, 1927" Acute Rheumatism
became notifiable in this borough. It may be appropriate here to summarize the regulations. Acute Rheumatism was
defined as: (i) rheumatic pains or arthritis, if accompanied by a rise of temperature; (ii) rheumatic chorea; (iii)
rheumatic carditis, occurring separately or together in a child under the age of 16 years.
The regulations enjoined the medical officer of health to make the necessary enquiries and to take steps to
investigate the source of the disease, for removing conditions harmful to the patient, and arranging for the treatment
of the patient. These enquiries and necessary action were delegated to the Rheumatism Supervisory Centre which was
opened at Paddington Green Children's Hospital on October 9th, 1926. The Director of this centre was the late Dr.
Reginald Miller. The Borough Council made a financial contribution to Paddington Green Children's Hospital to
assist in the work.
Notifications of the disease varied between 30 and 70 per year between 1927 and 1939. The work had already
begun to decline and in 1937 the Borough Council grant was reduced from £100 per annum to £50 per annum. In
May, 1938, the supervisory centre was closed as the number of children attending did not justify the cost of the
establishment and the facilities were transferred to the Out-patients' Department of the hospital. With the outbreak
of war the notification machinery became of little value, and since 1940 the notifications have varied from a minimum
of 2 in 1942 to a maximum of 9 in 1945.
The paediatric consultants in the Borough were consulted, and they remarked on the reduced number of Acute
Rheumatism cases. Many of the younger practitioners in the district appeared to be unaware of the notification
regulations, and in the neighbouring borough of Kensington the notification regulations for rheumatism expired on
the 30th November, 1948. The Minister of Health took the view that the regulations should not be renewed as the
responsibility for rheumatism service now rested with the hospital boards and the local health authorities.
The Committee took the view that the existing regulations had outlived their usefulness and the Committee was
satisfied that the care of the rheumatic patient is well covered in other directions and that the limited powers of the
Public Health Department meant that there was very little action which could be taken to supplement the existing
facilities. The Committee realised that notification in such circumstances was of little value and that unless it was used
in connection with a comprehensive study of the disease, backed by the service of a complete medical and social team,
that there was little point in accepting a few notifications each year.