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Cases needing supervision are often referred by the school medical officers to the rheumatism supervisory centre
at Princess Louise Hospital, whilst others are referred to the London county council clinic at Shepherd's Bush.
School doctors often arrange the direct admission to appropriate institutions of children needing urgent
treatment.
(d) Notification from hospitals.
Notwithstanding the fact that frequent reminders as to duties in regard to notification are sent to hospitals,
notifications from this source have been very few. This is probably due to frequent changes in the resident medical
staff; the new doctors may not be aware that the disease is notifiable in this borough.
Conclusions.
1. Statistics.
(a) Incidence of the disease.
The statistics of the past nine years show that the annual number of notifications has decreased. It is by
no means certain, however, that the incidence of the disease has lessened in a like degree.
There has been a decrease in the severity of the lesions associated with the disease, particularly in lesions
of the heart, which, in many instances in the past, were due to neglect of early symptoms.
(b) Epidemiology.
The relation between poverty and the incidence of the disease has been confirmed, as has also the familiar
character of the disease. Throughout the period under consideration, by far the greater proportion of cases has
occurred in the northern part of the borough—that is, in the poorer and more crowded districts. The disease
has been found to be most prevalent in streets where the basement type of house predominates. Recently, many
of the basements have been closed for human habitation, and it will be interesting to observe in the future what
effect, if any, this measure will have on the incidence of the disease. During the past year investigations were
carried out to ascertain whether there was any connection between diet (e.g., certain types of food) and the occurrence
of rheumatism, but no new fact of importance was discovered.
2. The value of notification.
Notification of rheumatism has proved to be of definite value. This was particularly so in the early days,
but now that the activities of the supervisory centre are well known, it is probable that supervision of cases could
be carried out almost equally well without preliminary notification. Of the 35 cases notified during the past
year, 25 attended the centre, and nine were under the care of a private practitioner or under supervision in an
institution. In regard to the 25 cases attending the centre, it is impossible to state definitely how far their
attendance depended upon notification, but it can be stated with a fair amount of certainty that at least 80 per
cent. would have done so. It is therefore obvious that the centre is no longer dependent upon notification as
a means of obtaining material. This is further confirmed by the number of cases (shown in Part II of this
report) referred to the centre from other boroughs in which the disease is not notifiable.
Residential treatment of rheumatism.
Hospital accommodation.
Eight beds are available at the Princess Louise hospital for the treatment of rheumatism, and it is not
difficult to obtain beds at other institutions for cases of juvenile rheumatism.
Convalescent homes.
Since the early days of notification, facilities for convalescent home treatment have greatly increased. In
an earlier report it was stated that " the period of waiting has been excessive, the accommodation for the
residential treatment of rheumatic children being quite inadequate." Fortunately, this is no longer true, and
there is little, if any, delay in getting cases away.
In the past year, 19 children were sent for convalescent treatment from the supervisory centre, nine through
the Invalid Children's Aid Association, and 10 under the London county council rheumatism scheme. The latter
has been particularly useful, as under it arrangements are made to send rheumatic children to convalescent homes
for the summer holidays. Many of these children attend special schools and are under careful supervision during
term-time ; if these children remained at home during the long summer holidays, it is probable that a good deal
of the benefit gained from previous treatment and supervision would be lost.
PART II.
The Work of the Centre
by JANET K. A IT KEN, M.D., M.R.C.P.,
and ALBERTINE L. WINNER, M.D., M.R.C.P.
In the nine years 1927-36 during which the centre has been in existence, 2,074 cases of rheumatism or
potential rheumatism have been supervised. Although the centre was primarily established to deal with cases
from Kensington, it has been the custom to accept cases from other boroughs whenever advice was required.
Total new and old cases attending the centre during the last five years.
1931-32 1932-33 1933-34 1934-35 1936-36
Kensington 266 290 311 296 285
Hammersmith 47 51 45 39 37
Other boroughs 12 20 35 40 45
325 361 391 375 367