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19
The descriptive report of the Papworth Village Settlement states:—
" If the consumptive working man is to maintain the progress he has made during his
sanatorium treatment, he must be assured of employment which is not too strenuous, of hours
which are not too long, and of a wage sufficient to provide a plentiful food supply for himself
and his family, and to free him from all financial worries.
" The same applies, of course, to the tuberculous woman who is dependent upon her
own efforts for a livelihood.
" The Papworth Village Settlement exists for the sole benefit of tuberculous men and
women and provides
" (1) Treatment for their physical condition.
" (2) Training in a variety of trades.
" (3) Permanent employment under ideal conditions.
" (4) Living accommodation in model cottages and hostels.
" (5) Constant medical supervision."
The second proposal of the Middlesex County Council is:—
(b) To reimburse any local authority any additional expenditure in excess of that incurred
in the provision of houses for the working classes under the Housing Acts, e.g.,
providing additional accommodation for tuberculous persons.
The establishment of such houses for arrested tuberculous cases in the ordinary housing estates
of local authorities is open to objection for the following reasons:—
(i) Tuberculous persons living with others on an ordinary housing estate are a potential danger
to all with whom they come into contact directly and a further potential danger in respect of indirect
contact by way of articles which may be used by others, e.g., public telephones. The most important
consideration is the prevention of the spread of the disease. It will be noted that the crude death
rate per thousand of the population for pulmonary tuberculosis for England and Wales has fallen
from .755 in 1928 to .584 in 1937 but this is not because patients have been cured but because the
disease has been prevented, the notification rate for the same period having fallen from 1.5 per 1,000
population in 1928 to 1.1 per 1,000 population in 1937.

While the fall in the number of notifications of the disease cannot be dissociated from the
removal to Hospital of active cases, I think that Local Sanitary Authorities may nevertheless claim
considerable credit for this fall on account of their efforts to improve housing conditions and sanitary
circumstances generally. The problem of the prevention of tuberculosis is a complex one—prevention
cannot be separated from treatment entirely nor can either be separated from measures designed
for the improvement of the public health.
I recently reported to the Health Committee on two families with housing difficulties arising
from tuberculosis and I beg to set out this information about these two families in this report.
Family S.
In this case the family consists of:—
The mother aged 27 years who is suffering from tuberculosis of the lungs and has been
in Clare Hall Sanatorium since the week ending 18-6-38.
A daughter aged 6 years who has been in Victoria Home, Margate, since the week ending
14-5-38, suffering from tuberculosis of the mediastinal glands.
A son aged 8 years who was in Victoria Home, Margate, suffering from tuberculosis of
the mediastinal glands for some 3 months and was discharged to his maternal grandmother's
home during the week ending 9-7-38.