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APPENDIX I.
Fourth Annual Report on the Kensington Rheumatism Scheme.
(October 1st, 1930—September 30th, 1931,)
by
James Fenton, M.D., D.P.H., and Janet K. Aitken, M.D., M.R.C.P.)
PART I.
GENERAL.
by JAMES FENTON, M.D., D.P.H.
The fourth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was
completed on the 30th September, 1931.
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.
Under the Kensington (Acute Rheumatism) Regulations, 1930, acute rheumatism, as defined in these
regulations, was made a notifiable disease for a further period of three years from the 1st October, 1930. The
regulations, like their predecessors of 1927, define acute rheumatism as denoting the following conditions,
occurring separately or together in a child under the age of sixteen years:—
(a) rheumatic pains or arthritis, if accompanied by a rise of temperature;
(b) rheumatic chorea;
(c) rheumatic carditis.
Response to Notification.
The notifications under the Kensington (Acute Rheumatism) Regulations, for the fourth year, October,
1930, to September, 1931, show a reduction in number from 95 to 69, or 30 per cent. In the second year,
there was a reduction of 34 per cent., and in the third year 9.9 per cent. It was pointed out last year that
a reduction might be expected for the following reasons:—
(a) the notification in the first years of an accumulation of patients, in whom the first symptoms had
occurred before the year 1927;
(b) the fact that it would not be necessary to notify again in later years a case in which there had been a
previous attack during the period since notification was begun in 1927;
(c) 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.
It appears, however, that the third reason cannot have had much effect on the figures this year, as, although
there is a general reduction, the proportion sent to the rheumatism supervisory centre by private medical
practitioners is high. This indicates a satisfactory co-operation between the general medical practitioner and
the centre.
An Analysis of the Sources of Notification.

Although the number of cases notified is lower than in previous years, the percentage of new notified cases
referred to the supervisory centre is greater, which suggests that the centre is becoming increasingly appreciated
by the doctors.
In 1930-31, 45 per cent. of the notified cases attended the centre, whereas in the previous year the
percentage was only 38.