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65
APPENDIX I.
SIXTH ANNUAL REPORT
ON
THE KENSINGTON RHEUMATISM SCHEME
(October 1st, 1932—September 30th, 1933)
BY
JAMES FENTON, M.D., D.P.H., JANET K. AITKEN, M.D., M.R.C.P.,
and LUCY E. ELLIOTT, M.B., B.S., M.R.C.S., L.R.C.P.
PART I.
General
by JAMES FENTON, M.D., D.P.H.
The sixth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was
completed on the 30th September, 1933.
The functions of this centre are 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.
Under the Kensington (Acute Rheumatism) Regulations, 1930, acute rheumatism was made a notifiable
disease for a further period of three years from the 1st October, 1930. On the 1st October, 1933, the Minister of
Health made new Regulations for a further period of three years. The regulations, like their predecessors of
1927 and 1930, define acute rheumatism as denoting the following conditions, occurring separately or together in
a child under the age of sixteen years :—
(а) rheumatic pains or arthritis, if accompanied by a rise of temperature ;
(б) rheumatic chorea ;
(c) rheumatic carditis.
Response to Notification.

It will be seen that for the first time since the opening of the clinic there has been an increase in the number
of cases notified, and this is probably due to the reminders in regard to notification which were sent to medical
practitioners during the course of the year. In previous reports it has been stated that the steady decline in
the number of cases notified is partly due to the fact that a proportion of the patients notified in the earlier years
of compulsory notification might or might not have been suffering from notifiable rheumatism at the actual time
of notification, but they have had juvenile rheumatism at some previous date before compulsory notification
was in force. Thus, there was an accumulation of patients to be notified in the first year or two.
The percentage of attendances of the notified cases at the centre has fallen this year. There is often a delay
between the notification and attendance. If an acute case is under the care of the general practitioner, it will
not attend for supervision until the acute phase is over ; the attendance may therefore come into the next year's
figures. Also, a certain number of cases are now sent straight to Queen Mary's Hospital, Carshalton, and the
delay between the notification and the supervisory attendance may be still more prolonged. It will be noted
that a much higher proportion of the cases this year has been notified by general practitioners, therefore it will
not be wise to comment on this fall in attendances until the statistics for the next year are available.