View report page

88
This chart clearly shows the evidence of overcrowding, for it should be remembered
that in almost every home up to three rooms the kitchen was also a bedroom,
and in many of the larger houses this also was the case. Only seven out of the
hundred occupied houses of five or more rooms, and at least one such house was a
veritable slum dwelling. Moreover, the majority of these rooms were of tiny dimensions,
often ill-lit and usually badly ventilated, the difficulty of conserving the heat
of the body is usually solved not by exercise, suitable diet and clothing and the
outdoor life, but by rigidly excluding " draughts " by keeping the windows closed
and all cracks hermetically sealed by rags. The inhabitants of such homes seldom
change their day underclothes for night attire, and as those of the rheumatic diathesis
are prone to sweating, much chilling and interference of the heat regulating
mechanism of the body is engendered. Some of their children could almost be
recognised by the sour sweaty smell of their underclothes. The diet of these children
was not considered. The conditions mentioned above are not peculiar to rheumatic
families, and although controls were not kept for this series, visits to these homes
gave the impression that the contiguous families were in similar situations.
Over and above the personal visit of Dr. Dobbie to each of the homes of these
children, trained care workers also visited and fully reported on the social and environmental
conditions, and much valuable information was so obtained. When such
conditions as dampness or sanitary defects were reported, action was at once taken
through the local medical officer of health, and, in addition, other nuisances brought
to light were remedied or ameliorated as far as was possible.

It is seen that fifty-three of the houses are classed as fair, but in Dr. Dobbie's
opinion they were in the main really semi-slum. Most of the crowded areas in London
are low-lying, in fact there are few high-lying parts within the County, and these
are mostly peopled by the wealthier classes. Dr. Jane Shrubsall, in 1913, and Dr.
F. C. Shrubsall in 1925 plotted out the distribution of rheumatic cases and showed the
heavy incidence along the old water courses; it is not surprising to find that seventythree
of the houses of these children were low-lying, for it is mainly in such sites that
the densest and poorest population is found. This, is however, not a fair sample in
which to discuss the matter of site, as it is a selected and not a random sample.
The home conditions were ere estimated not so much on the presence or lack of furnishings,
as on the general impression of cleanliness and orderliness and hgyiene, and
only twenty-five were considered to be good, forty-four fair, and thirty-one poor,
and where such houses were classed as poor they were indeed poor, a monument to the
ineffectiveness and inefficiency of the parents, inefficiency scarcely to be wondered at
when we remember that many of these poor parents were themselves the crippled
victims of rheumatism and or were constitutionally unable to face the exigencies
of everyday life.
Basements, ground floor and top floors, because of their greater liability to
damp and cold, have been blamed as contributory factors, and they may very well
be, but the proportion seen here is much what we would expect in any sample from
such dwellings, for it must be remembered that in many of the poorer localities the
houses are but two or three stories high, so that there does not appear to be any real
inference to be drawn by these figures. Most of the sampled families lived in