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 1936
[Report of the Medical Officer of Health for Kensington Borough]
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79
APPENDIX I.
NINTH ANNUAL REPORT
on
THE KENSINGTON RHEUMATISM SCHEME
(1st October, 1935—30th September, 1936)
BY
JAMES FENTON, M.D., M.R.C.P., D.P.H., JANET K. AITKEN, M.D., M.R.C.P.,
and ALBERTINE L. WINNER, M.D., M.R.C.P.
PART I.
General
by JAMES FENTON, M.D., M.R.C.P., D.P.H.
In 1927, the Minister of Health made regulations under which acute rheumatism became a notifiable disease
in Kensington for a period of three years; similar regulations were made in 1930, 1933 and 1936. These
regulations defined 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 in temperature ;
(b) Rheumatic chorea;
(c) Rheumatic carditis.
By the end of September, 1936, notification had been in force for nine years, and the following table shows the notifications received and their source :—
| Year. | NUMBER OF NOTIFICATIONS BY— | Total number of notifications. | Total number of patients notified in the year who attended the rheumatism supervisory centre. | |||
|---|---|---|---|---|---|---|
| Medical officers at rheumatism supervisory centre. | Private practitioners. | School medical officers. | Hospitals and other institutions. | |||
| 1927-28 | 32 | 53 | 28 | 46 | 159 | 95 |
| 1928-29 | 37 | 40 | 1 | 27 | 105 | 70 |
| 1929-30 | 12 | 33 | 10 | 26 | 81 | 48 |
| 1930-31 | 9 | 28 | 12 | 17 | 66 | 40 |
| 1931-32 | 12 | 21 | 1 | 7 | 41 | 24 |
| 1932-33 | 6 | 43 | 2 | 7 | 58 | 24 |
| 1933-34 | 11 | 43 | 6 | 3 | 63 | 32 |
| 1934-35 | 4 | 22 | 4 | 1 | 31 | 17 |
| 1935-36 | 9 | 19 | 3 | 4 | 35 | 25 |
| Totals | 132 | 302 | 67 | 138 | 639 | 375 |
(a) Notification by medical officers at the rheumatism supervisory centre.
A number of possible sufferers from acute rheumatism are referred to the supervisory centre by other
departments of Princess Louise Hospital (at which institution the centre is established), school medical officers
and various health workers, such as the Invalid Children's Aid Association and school visitors ; these are
examined and duly notified if a positive diagnosis is made.
(b) Notification by private practitioners.
It will be seen that the percentage of the notifications received from private practitioners has been fairly
constant throughout the period the disease has been notifiable. It would thus appear that there is a satisfactory
response from this source. There are, however, a number of children who are suffering from rheumatism, but
in whose cases a prolonged observation is required to make a diagnosis. Parents are often unwilling or cannot
afford to pay a private practitioner for a long period of observation, and so the doctor has no chance of arriving
at a final opinion satisfactory to himself. Thus, a number of cases escape notification ; and, in addition, there are
others which escape notification because they are frequently changing doctors, which may make it difficult for
any one to make up his mind about the case. New doctors are not likely to notify cases, for the regulations are
local, and they may not be aware of them. The public health department attempts to counteract these
difficulties by periodically circularising all the doctors known to be practising in the borough. They are not only
reminded of their duty to notify cases, but are also informed that children may be observed over long periods
at the supervisory centre.
(c) Notification by school medical officers.
Notifications from this source have, except in the first few years, been low. It should not be inferred,
however, that this indicates failure to obtain adequate supervision and treatment for rheumatic school children.