London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
Kensington 1931
[Report of the Medical Officer of Health for Kensington Borough]
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65
In only one house from which juvenile rheumatism had been notified was there serious dampness. Also,
the incidence this year again confirms the observation of last year that the areas in which the largest number of
rheumatic cases occur do not coincide with certain small damp areas where there is difficulty in preventing
dampness.
Rats and Soil.
The areas of incidence of juvenile rheumatism this year confirm the opinion previously expressed that there
is no evidence to show an environmental etiological connection between this disease and areas where rats are
prevalent or the soil is clay.
Poverty.
In the first annual report of the rheumatism scheme, it was stated that about 90 per cent. of the acute
rheumatism notifications came from North Kensington. The same figure applies to the distribution between
North and South Kensington of the second, third and fourth year's notifications ; and the combined figures show
that in a series of 428 notifications only 36, or 8 per cent., come from South Kensington.,
The incidence of a disease is also related to the number of susceptible persons, and in the case of a malady such as juvenile rheumatism, which has a particular age incidence, the population must be corrected for age ; therefore, the ratio of the total number of children under sixteen in North and South Kensington has been calculated. This calculation, based on the Census figures for 1921, corrected by the births and child deaths in each year since 1921, is presented below :—
| Ward. | Estimated population in wards, 1931. | Estimated child population under 16 years of age in 1931. | Notifications of acute rheumatism under 16 years of age. | |||
|---|---|---|---|---|---|---|
| 1927- 28 | 1928-29 | 1929-30 | 1930-31 | |||
| North Kensington | 93,362 | 32,295 | 147 | 95 | 86 | 61 |
| St. Charles | 26,303 | 9,539 | 34 | 22 | 19 | 17 |
| Golborne | 25,731 | 9,932 | 44 | 39 | 30 | 13 |
| Norland | 21,630 | 8,136 | 55 | 28 | 29 | 26 |
| Pembridge | 19,698 | 4,688 | 14 | 6 | 8 | 5 |
| South Kensington | 81,438 | 11,026 | 12 | 10 | 9 | 5 |
| Holland | 18,181 | 3,048 | 9 | 3 | 5 | 3 |
| Earls Court | 17,625 | 2,545 | 1 | 1 | 2 | — |
| Queens Gate | 13,476 | 1,252 | 1 | — | — | 1 |
| Redcliffe | 19,682 | 2,852 | 1 | 6 | 1 | 1 |
| Brompton | 12,474 | 1,329 | — | — | 1 | — |
It will be seen that North Kensington has 74.5 per cent. of the children under sixteen years of age and 91.5
per cent. of the notified cases, whereas South Kensington has 25.5 per cent. of the children under sixteen years
of age and only 8.5 per cent. of the notified cases.
The 66 cases notified during 1930-1931 are distributed in a way similar to that of the 1927-8-9 notifications
and show a definite grouping in the "poor" areas of the Golborne, Norland and St. Charles wards of North
Kensington.
On investigating the home conditions of 52 of this year's notified cases and adding the figures of the 78
cases already reported, it is found that in 33, or 25 per cent., the homes can be described as being reasonably
comfortable, while in 97, or 75 per cent., the circumstances were reduced or very poor.
The enlarged statistics, therefore, continue to support the view of Dr. Alison Glover, who holds that the
incidence of acute rheumatism increases directly with poverty, malnutrition, overcrowding and bad housing,
and do not support those who hold that the incidence is greater in the artisan class, or in those just above the
poverty line rather than in classes below that line.
Social Services.
Various enquiries have been made during the year about the social services associated with the medical
work of the clinic. The following is the usual routine, and is carried out under the supervision of the honorary
secretary, Mrs. Jacobson, who has largely initiated and organised the system. The honorary secretary is also
a member of the Invalid Children's Aid Association (Kensington Branch), and works in close co-operation with
that society.
(1) When the honorary secretary is informed through the Invalid Children's Aid Association or health
authorities, or possibly from neighbours while visiting another case, that a child is ailing and the symptoms
are suggestive of rheumatism, the home of this child is visited and enquiries are made as to whether the
child is under treatment. If it is found that this is not the case, it is suggested that the child should be sent
either to a private doctor or to the rheumatism centre, according to the means of the patient.
(2) All cases in Kensington which are sent to the centre are visited after their first attendance. If a child
is found to be suffering from rheumatism, it is sent home from the centre to rest in bed under the care of a general
medical practitioner or to await admission to a hospital. If the case is one of doubtful rheumatism needing
special rest and perhaps the attendance in the home of the district nurse twice daily for taking the pulse
and the temperature, the honorary secretary or her assistant visits the home to see that the prescribed
routine is carried out. A card giving details of the home conditions, which are required for the investigations
into the etiology of rheumatism, is filled in by the health visitor in notified cases, and by the social
worker in unnotified cases.
(3) At the centre, the doctor indicates in each case at what future date the child should attend. This
is noted by the honorary secretary and an appointment is made. If there is no active rheumatism the doctor
may not wish to see the child for some months. The home is then visited or a postcard is sent a week before
the appointment in order to remind the parents. If the appointment is not kept, a second one is made and
a further reminder is sent.