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they are now put. They were planned to accommodate one family,
and not several; and the consequence is that, for the latter
purpose, the water-supply and water-closet, &c., accommodation
are inadequate. A house which possesses every convenience for
decent and healthy living where one family is concerned, has, under
the altered circumstances, its sanitary provisions overtaxed, with
the result that apparatus frequently gets out of order, and it is
difficult—in some cases quite impossible—to keep the premises in
a sufficient state of cleanliness. In addition to presenting conditions
which are favourable to the appearance of disease, these
tenemented houses, by reason of the overcrowding in them, favour
its spread when the disease is of an infectious nature; and the
difficulties of dealing efficiently with such cases is very great
indeed. It is estimated that in the whole of London there are at
least 100,000 people who live four and five in a room, a standard
at which neither health nor decency can be maintained, and it is
not surprising that areas on which such overcrowding exists
should always furnish higher death-rates than adjacent areas where
such conditions are absent.
Fortunately, in the Metropolitan area, we are now able to get
the cases of infectious illness promptly removed, but in crowded
households this can rarely be effected before the whole of the
occupants have ran some risk of infection. I have found that,
even in Stoke Newington, the patient has been occupying the
same room as two, three, or even four others, who, while it is
impossible to pronounce at the time as free from infection, cannot
be prevented from exposing themselves; and the scant measures of
precaution which we are able to take with regard to these latter
are beset with the greatest possible difficulties. Then after such
premises become infected there is the problem to solve as to how
efficient disinfection can be practised. Frequently the only two
living rooms occupied by the family require disinfection, and the
question is as to where the occupants are to go during the 12 hours
that are taken up in the process. A friend or relation, who