This article is intended to set people to working out their own inquiries into the relation of tuberculosis to bad housing. Such is the hold of the slippery statistic upon the public mind that if there were any on this subject we would offer long columns of them. That there are none, except upon congestion, is due to the difficulties in the way of getting them, and to the lack of serious attention the subject has been given by most of us, because we have hunted the White Death everywhere except in his lair.

It is not figures but facts, however, that we are after. We do not need statistics to prove that there are too many murders. We do

not need affidavits of witnesses to prove a marriage that we have attended. If it be agreed by the authorities that sunlight and fresh air are necessary to the cure of tuberculosis, and also necessary to speedily kill the bacilli, then the windowless room, devoid of sunlight and fresh air-the worst form of bad housing-stands condemned for its relation to tuberculosis. It is condemned, not in proportion to the number of deaths from tuberculosis that occur in it, but in proportion to the number of dark rooms that exist, and the percentage of persons who at some time in their lives develop tuberculosis. We do not condemn an open, uncurbed well, on a playground simply because of the number of children who have already been drowned in it. It lies in wait. So does the dark room, but there is no way of counting its victims. We can count those who die in it, but not those who have slept in it, those who have gone in and out of it, with the seal of death upon them, carrying it to others.

'It seems strange that this protest should need to be made. If detectives are hunting clues to one murder, they collect every fingerprint, the dust in the room-every trace in every place they can think of. Why do we scrutinize the factory, the office, the street car, the school, even the church and not the home?

One reason why it is difficult to get statistics on this subject is the long duration of the disease. A man takes it in one house, moves into two or three more, and dies in the fourth. He may take it in a dark, damp, filthy room, without a single window, where someone else has died of tuberculosis. He may die in a room with four windows, having moved in when he was too far gone to

save.

To discuss the relation of tuberculosis to bad housing we must first define bad housing, and show how it disposes the patient to the disease. We must also recognize every other predisposing factor that may enter into

a case.

By

It must be remembered that bad housing is omnipresent in cities, towns and rural communities. Bad housing means any condition of the house that is bad for health, bad for safety, bad for morals. The bad housing that is bad for health is the house that, in any degree, is dark and damp, and generally unsanitary, lacking in drainage, water, sewerage, or the proper disposal of waste. dark rooms we mean those that have not a single window. Our towns are full of them, and people sleep in them. Then we find, too, the dimly lighted rooms, in cellars or garrets, or on the crowded city blocks, where the houses are built so close together that the side windows are of little use. find damp walls, damp floors, wet cellars, and people living in them. This dampness is oftenest caused by the yard not being drained, or by the overflow of cesspools.

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Among the cheap, flimsy houses, where the working people live, and in the homes of the poor, that, in their worst degree of neglect and abandonment we call slums, we find no drainage, no sewerage, no water, or none fit to drink. Often the water is polluted from the vault, often it is full of trash. We seldom find city water in such quarters. Often ten or more families use from one cistern, and then, as they say, they "have to be sparin' of the water."

Of course, this results in filth, filth of person as well as of the dwelling, for it is another quibble to try to separate the two. How can they keep clean, with no water, and no place to pour the suds and dishwater, except on the yard? The yards are covered with garbage, because they can't afford garbage pails, and strewn with ashes, because they can't afford to have them hauled. Where there is no housing law, the landlord cannot be made to supply receptacles, and most cities do not dispose of ashes as well as garbage. It is part of housing reform to include them, because they have to do with the general filth or cleanliness of the premises.

We find, in many places, old vaults that

bacillus. So here we have a fully equipped factory, running day and night, as carefully planned as if it were intended to turn out germs for export.

Let us go through it. Here we have darkness, where no sun or air enters to disturb or destroy the germs that are brought in. We have dampness, heat and moisture, ideally arranged for a hotbed. We have foul air, that we are told preserves and carries the germs of disease.

We have filth, that harbors the germs, and spreads them abroad in particles of dust. We have flies, in the garbage and vaults, that go where the dust of the place fails to reach, to all parts of the city. We find rough walls, broken plastering, deep cracks in the floors

have stood for generations. They reek with heavy, horrible, sickening odors. So does the garbage. Over the garbage and the vaults are swarms of flies. They breed most in the slums. The windows of the poor are unscreened. The flies cover the faces of the sick babies, crawl on the floor, over the tuberculosis patient and his sputum, over the typhoid patient, and everything he uses. Then they come to our butchers, our grocers, our markets-our baby's face.

Of course, in all this filth that is unavoidable, every "filth disease" is encouragedtyphoid, trachoma, the venereal diseases, smallpox-everything contagious. Also, in the happy family of germs, there is a warm nest for the Streptococcus, that ally of the

and woodwork, deep and wide, so that the rooms cannot be properly cleaned or disinfected. To disinfect some of these walls and floors would be an impossibility, unless they were burned.

Now, in such places we find the conditions not only that breed the disease when it once gets a start but that predispose people to take it. There is the filthy air; the filthy water, that brings on the intestinal troubles that lower one's vitality. There are the sickening smells that take the appetite and reduce vitality. There is the dampness that induces colds, with their long train of bad results, induces inflammation of the mucous membranes and respiratory organs, brings about the conditions that induce rheumatism, that breaks

down the strength and reduces vitality. One finds all of these diseases in such places. Here we find the limited air space, in small rooms, with low ceilings, where often a large family is crowded into one room. Often the room is "ventilated" from a hall, and rooms which contain other families open onto the same hall, and the hall is dark and poorly ventilated. (The fact that some insist on nailing windows down does not justify us in building houses without windows.) It need not be pointed out that the congestion is not to blame here, for in a room full of windows the congestion would not count for as much. There need be no quibble about congestion being simply "too many people in a house or block," and "not a condition of bad housing." It is the result of inadequate housing facilities, often means too small rooms, and the housing reformer is left to prevent it, as he does by housing laws. We have to deal with congestion of every kind-land congestion, where there are too many houses on a block, and the block is built up solid, so that very little air passes between the houses. The room congestion is the worst of all. With the overcrowding and filth and foul air this gives, we have one of the worst aids to tuberculosis. And besides, in these closely built up blocks, we have the house gloom, which is so depressing.

Now, it is seen that there is everything in such a house to protect and prolong the life of the bacillus, everything to fit the patient to take the disease, everything to make it impossible for him to get well while he stays there. We must not forget that, while the slums offer the most helps to the bacillus, a dark, unventilated room is deadly anywhere, and so is congestion.

If one wants to know why the impression prevails among social workers that tuberculosis is a "house disease," one must quit the study and laboratory and the sanitorium, for a brief space, and come down into the street, where one meets the masses. One must go into their homes, see their surroundings, their habits of life. The social worker goes into a tuberculosis campaign because he finds so much tuberculosis among the poor -so much that the doctors are never called to attend, so many cases that are never reported. Then he goes into housing reform, because he finds that a housing campaign is the best find of tuberculosis campaign.

In cities that have no tuberculosis camp or clinic, the visiting nurses report that half, often more than half, of their cases are tuberculosis cases. The charity workers find that an amazing percentage of their dedependency is due to the death of the breadwinner-once an independent working manfrom tuberculosis!

There is nothing that the social worker is more impressed by, in the homes of the poor, than the tuberculosis cases. To see six or eight in a room, cooking, eating, sleeping in one room; to see the father or mother sick in bed, with tuberculosis; to see one of the children lying in the same bed with the

sick one; to see the baby crawling about on the floor, when the patient is careless with his sputum; to see the flies all over the floor and the bed; to see the children with enlarged glands; to follow up the case, and see the family wiped out by it; to see other families move in an take it-to see neighbors coming in and out, and making calls; to see a house where several families have tuberculosis, and take in washings from all over town-one wonders why the city is not swept away by it. And when one sees a house, with a lot of families in it, each family living in a single room, without one window, one does not wonder why we have tuberculosis, one wonders why more do not die. "Lung blocks," of course, do not furnish statistics. They furnish only victims, in one column of figures-one procession, and they are not correlated with anything but families. But when every family that moves into a house takes tuberculosis, we have reason to think it is infected. And when a house with a tuberculosis record has dark rooms and damp floors, everything to keep germs alive, everything conducive to tuberculosis, everything to make it impossible to cure it, we do not need statistics, only putting two and two together, to see the relation between such a house and tuberculosis. And every city has such houses.

Now, this question cannot be discussed without recognizing every other predisposing cause that may enter into a case of tuberculosis. We must reckon on the physical heritage with which a man begins life, whether he has disease or alcoholism, or any weakness or disability or tendency that makes him an easy prey. We must consider the facts of improper and inadequate nourishment. We must look out for the occupational environment-factory dust, and all that. We must consider all the causes that lower his vitality. But the fact remains that many people overcome their physical handicap, even with poor food, if they have plenty of sunshine and fresh air, which cannot be had in slums. The fact remains that one cannot find as many predisposing causes, as many causes to reduce vitality and vigor and resisting power anywhere as can be found in the slums, where there is darkness, dampness, filth and foul air. The fact remains that factory dust never reaches a larger percentage of the victims, especially mothers and children, who are in the home all of the day and night. We find children shut up in a third or fourth story tenement room. We find mothers who never leave the premises, but wash every day in the week.

The fact remains that these people, having tuberculosis in the slums, when taken from this environment soon enough, and put into a sanitarium, will recover, but if they are brought back home they become reinfected, and cannot get well in that environment. It will be said, they have rest and good food in the sanitarium. Yes, and the whole plan of the sanitarium is built around pure moving air, and plenty of it, and all the sunshine