These villages do not differ materially from the boroughs of like population except in their municipal government. Many of them have public water supplies and lighting systems and their streets and sidewalks are kept up in about the same manner as in the boroughs. The General Inspector would respectfully suggest that, if

the appropriations made by the Legislature for the next two years will justify such additional expenditures, a system of sanitary inspection of villages be inaugurated, and that the Health Officers in the various districts be instructed to make these inspections and report to the Department concerning the care of the water supplies, the methods of disposal of sewage and garbage, sanitary conditions of streets, alleys and surface drains, housing conditions and such other matters as in the opinion of the Commissioner of Health might be necessary or advisable.

Late in the month of December the General Inspector made a preliminary investigation of housing conditions in the eighth ward of the borough of Nanticoke. This ward is detached from the borough proper and formerly known as the village of Hanover. The residents of the ward are largely coal miners in the employ of the D. L. & W. Railroad Company. This investigation was prompted by the result of the medical inspection of schools in this ward which showed about sixty tuberculous children in the schools and others whose condition was suspicious and was made at the request of the school authorities and the Board of Health of Nanticoke, Housing conditions in this ward were found to be in a uniformly congested condition. The buildings are all built about upon the same general plantwo-story frame cottages containing from four to six rooms. Out of 285 single dwellings three of these houses were found to be occupied by three families each, forty-two by two families each and forty-four were occupied by only one family but accommodated boarders or lodg ers ranging in number from two to nine in each house. The highest census found in any one dwelling was twenty-seven while many of them ranged from fifteen to twenty. The houses in most instances are owned by some individual living in the house, the D. L. & W. Railroad Company some years ago having opened up a plan of lots which were sold on easy terms to the miners and encouragement given to them to build their own homes. It would appear to the eyes of a layman that this generally congested condition might easily be responsible for the unusual prevalence of tuberculosis in the children of the public schools. The crowded conditions are due largely to the demand for labor in the immediate vicinity at the coalbreakers and the lack of a sufficient number of dwelling houses properly to accommodate those so employed. About forty or fifty additional dwelling houses and a half dozen or so houses especially adapted for lodging and boarding detached men should be provided in this immediate vicinity for the relief of these congested conditions.

During the year the General Inspector was absent from the Harrisburg office on business of the Department 103 days, twenty-two of which were spent in the Philadelphia office assisting in the prepara

10-15-1916

tion of the Department's inventory, Reports to the Dependents Commission, to the Economy and Efficiency Commission, and to the Gov

ernor.

During the year the General Inspector traveled 12,704 miles and the expense incident to these inspections amounted to $637.51.

THE UNDERLYING FACTORS IN THE SPREAD OF TUBER

CULOSIS.*

By ALBERT PHILIP FRANCINE, A. M., M. D.

There are two broad phases in the communicability and spread of tuberculosis, which in orderly procedure are best discussed separately, the social and economic side of the problem, and the more strictly medical side.

In placing the responsibility for the spread of infection, we must in the last analysis begin with the individual, rather than the institution. It is, theoretically, more the fault of the people than the fault of their surroundings. It is the fault of the people who make the homes. This great plague lives and flourishes in the homes of the ignorant, amid poverty and squalor; but, as has been well said, it is not alone the buildings which make the slums, but the people who live in them. Of course, bad housing conditions play a profound rôle in the endemicity of tuberculosis, but even could we give every family an airy, clean house, so long as there were ignorance, carelessness, filth, dissipation, and alcoholism we would still have slums, infected houses, and tuberculosis.

It is perfectly apparent, that better housing conditions would be an enormous stimulus to better living and better home management; and, therefore, while the first remedial step is education and uplifting among the poor and ignorant themselves, the second corollary need which is of equally pressing importance is to improve physical conditions of living, improve housing conditions. The problem of proper housing conditions for wage earners and others of small income is of vital importance to every community and the baneful effects of basement housing and overcrowding are in no way more apparent than in the spread of infections of all sorts, particularly of tubercu losis, and the entire physical and moral health of a community is adversely affected by bad housing conditions. Next in importance in

*Read before the College of Physicians of Philadelphia, March 4, 1914.