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The following is the Second Annual Report on the working of the Rheumatism scheme
during the period October 1st, 1928, to September 30th, 1929, prepared by the Physicianin-charge
of the Centre and the Medical Officer of Health.
The Rheumatism Scheme of the Royal Borough of Kensington, incorporating, as it
does, a trial of compulsory notification of acute rheumatism in a Metropolitan Borough,
is an important experiment in public health organisation. The First Annual Report of the
Rheumatism Scheme discussed at some length the place and value of notification in schemes
for the supervision of rheumatic children. The experience of the Second Year of the Scheme
has placed us in a surer position in putting forward our views. The results of notification
in the Second Year may now be discussed.
The Response to Notification in the Second Year.
The total number of notifications under the Kensington (Acute Rheumatism) Regulations,
1927, for the second year (October, 1928—September, 1929) show a reduction of 34 per cent.
Some diminution in the notifications coming in was expected because there was an accumulation
of cases which immediately became due for notification on October 1st, 1927, when
notification first operated. These cases may have developed their rheumatism months or
years previously. Again, any children developing fresh attacks of rheumatism in the first
year would be notifiable, but if after recovery they developed fresh attacks in the second year,
no additional notifications would be required.
Further, the tendency of practitioners to forget to notify a disease not usually notifiable
would be accentuated after the first interest in it had subsided. It should be mentioned that
circular letters have been addressed to medical practitioners reminding them of their duty
to notify. Nevertheless, it is probably true that the tendency to overlook notification was
more marked in the second year.
An analysis of the sources of the notifications shows a general reduction under all headings
except that of the Rheumatism Supervisory Centre itself, whose medical officers notified
rather more cases than in the first year.
Analysis of (First) Notifications of Acute Rheumatism.
First Year, Second Year,
1927-1928. 1928-1929.
Private Medical Practitioners 53 40
Rheumatism Supervisory Centre 32 37
School Medical Officers 28 1
Hospitals and Institutions other than St. Mary Abbots Hospital 27 15
St. Mary Abbots Hospital 19 12
159 105
The reduction in the number notified by the School Medical Officers from twenty-eight
to one is a noteworthy feature. It should be remembered that children suffering from
rheumatism of a character severe enough to come within the restricted definition of the
regulations would be unlikely to attend school or school inspections, and the small number
notified by the School Medical Officers is probably to be explained in this way; but the
difference between the School Medical Officers' notifications in the first and the second years
cannot be so explained. The number of cases referred to the Supervisory Centre by the School
Medical Officers has not fallen and it is clear that the School Medical Officers are potentially
in a position to bring to light the majority of the children suffering from rheumatism. Perhaps
the reduced number of notifications from School Medical Officers may be ascribed to the
fact that these officers are beginning to make use of the Centre and to send cases there for
opinion and diagnosis rather than to take the bolder step of notifying, and the increase of
the notifications by the Centre is probably accounted for by the fact that cases coming from
the schools had not previously been notified.
Value of Notification.
In the First Annual Report, it was stated that the work of the Rheumatism Supervisory
Centre was of primary importance and notification should only be regarded as a means of
feeding the Centre. Of the 105 cases notified in the second year (1928-1929) seventy-seven
attended the Centre, but of these 37 were notified by the Medical Officers attached
thereto. All the notified cases have been visited by the Health Visitors and many
of them by the voluntary workers of the Invalid Children's Aid Association as well,
and the non-attendance of the remainder has been due to one or other of the following reasons :
admission to a hospital or attendance as an out-patient at a hospital; the regular supervision
of the family doctor ; or the parents not wishing to take advantage of the Rheumatism Supervisory
Centre.