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These considerations are of importance in showing how it comes about that
notification plays such an unexpectedly small part in supplying the rheumatic material of
the Centre and they show that the present Regulations concerning rheumatism only apply
to approximately one-third of the children suffering therefrom. It would appear to be a
justifiable conclusion that if notification is to be of value the restricted definition now in
official use must be modified so as to cover all cases which the doctor regards as suffering
from any of the various manifestations of juvenile rheumatism.
The Work of the Centre.
At the end of the first year 225 cases were under supervision, by the end of the second
this number had grown to 323. From time to time names had been removed from the books
because the children were not rheumatic, had died, moved away or passed over the age limit.
The medical officers at the Centre and the Invalid Children's Aid Association so frequently
come across rheumatic cases which have not been referred to the Centre and are not under a
doctor's supervision that we are convinced that the rheumatic material is not exhausted. In
view of the fall in the notification rate we are not surprised that the number of new cases
coming to the Centre in the second year is also slightly lower. We are of the opinion that the
existence of the Centre is sometimes forgotten by those dealing with rheumatic children and
the establishment of other centres would help to make its existence and its functions more
widely known.
The work of the Centre in regard to the disposal of severe cases and the arrangements
made for operative treatment, convalescence, etc., may be summarised as follows :—
^Tonsillectomy 30
Admission to St. Mary Abbots Hospital 17
Admission to Princess Louise Hospital 5
(Special) P.D. School 7
Convalescence (average length of stay 11½ weeks) 20
INVESTIGATIONS CONCERNING ENVIRONMENT AND ACUTE
RHEUMATISM.
Housing.
Evidence of Dampness.
Information concerning the presence of dampness in the rooms occupied by the rheumatic
children notified during the year 1928-1929 shows that the Health Visitors reported dampness
to be present in twenty-five instances while in seventy-three instances no dampness was found.
In six there was no report and in one instance access to the house was not obtained.
Dampness present 25 (25.5%)
Dampness absent 73 (74.5%)
No report 7
Total notifications 105
The proportion of damp houses in this series is considerably less than the proportion
in the 1927-1928 series when dampness was found in 37.7%. In this connection, it
should be recalled that a pumping station was installed at the mouth of Counter's Creek
Sewer in 1927. The improvement in the flood areas of Kensington resulting from this installation
and the fact that a considerable part of the year under consideration was unusually
dry, would be sufficient to account for the lowered percentage of damp houses ; and it is
suggested that a similar diminution in the proportion of damp houses to dry ones would be
found in those areas of North Kensington from which the bulk of the rheumatism notifications
came. Combining the figures for both years, our series consists of 220 notifications ; dampness
was present in 71 and absent in 149. This gives a percentage of 32.3 damp houses, a figure
within the limits of the findings of the Report of the Medical Research Council* and one giving
no substantial support to the view that dampness of housing is an important aetiological
factor in the causation of acute rheumatism.
In pursuance of the policy of the previous year, the houses reported by the Health Visitors
to be damp were re-inspected by the Sanitary Inspectors :—
Dampness confirmed by Sanitary Inspector 19
No dampness remediable under the Public Health
(London) Act, 1891 6
25
†All tonsillectomy cases remain in the Princess Louise Kensington Hospital for Children for two nights.
* Report of the Medical Research Council : " Social Conditions and Acute Rheumatis' 1927.