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APPENDIX I.
Third Annual Report on the Kensington Rheumatism Scheme.
(October 1st, 1929—September 30th, 1930, by
James Fenton, M.D., D.P.H. and Janet K. Aitken, M.D., M.R.C.P.).
PART I.
The third year of work at the Rheumatism Supervisory Centre of the Royal Borough of Kensington is nowcompleted.
The function of this clinic is to assist in the early diagnosis of rheumatism in children, the early treatment
of this disease being of paramount importance, and also to compile statistics with a view to determining
etiological factors and thereby assist in the prevention of rheumatism. The statistics, up to date, are
mainly negative in character.
Response to Notification.
The total number of notifications under the Kensington (Acute Rheumatism) Regulations 1927, for the third
year, October, 1929—September, 1930, show a reduction of 9.9 per cent, on the second year. In the second year
there was a reduction of 34 per cent, on the first year. It was pointed out in the second year that a reduction
was to be expected for three reasons:—
1. The notification in the first year of an accumulation of cases, in whom the first symptoms had occurred
before the year 1927.
2. The fact that it would not be necessary to notify again in 1928 a case which had had a previous
attack in 1927.
3. The natural tendency of practitioners to forget to notify a disease, not usually notifiable, some
time after their first interest in this new duty had been aroused. The decrease in notifications in the third
year is smaller than in the second year, and probably these three factors can still account for it.

This shows a general reduction, but items under certain headings have increased. The most notable
variations are under the headings school medical officers and the Supervisory Centre itself, probably the decrease
in the latter is largely dependent upon the increase in the former. It will be seen later that the number of cases
sent up to the Rheumatism Centre by the school medical officers has also increased considerably from 32 to 6,
showing that these officers are very much awake to their opportunity and responsibility for detecting rheumatism
in children in its early stages, and for seeing that supervision is maintained.
Value of Notification.
This question was discussed at length in the 1928-29 Report.
It was apparent that notification was providing only 23.5 per cent, of the new cases at the clinic and was
therefore not necessary in the provision of the bulk of the material. This year the percentage is slightly higher,
i.e., 28 per cent., but the same conclusion can be drawn. It is obvious, however, that provision of material
for the centre is not the only function of notification.

It must be remembered that acute rheumatism as defined by the Kensington Regulations denotes:—
1. Rheumatic pains or arthritis, if accompanied by a rise of temperature.
2. Rheumatic chorea.
3. Rheumatic carditis.