TUBERCULOSIS AS AN ECONOMIC AND SOCIOLOGIC FACTOR 191 



culosis than do the other boroughs where conditions of living average 

 better. 



The poor have not only insufficient food but they are often quite 

 ignorant of proper methods of cooking and know nothing of the 

 ''balanced ration" which is made up of necessary amounts of protein, 

 carbohydrate, and fat. It may be said that housewives of famiHes 

 in moderate circumstances are likewise ignorant of such matters, and 

 this is all too true. But where there are sufficient funds, people 

 usually have a diet made up of meat, eggs, milk, bread, butter, 

 vegetables and fruit, so that average men and women are Ukely to 

 get fairly nutritious food. The poor, however, do not know how to 

 make the best use of the Uttle money they have, and are hence often 

 worse fed than need be. 



The Tenement House Problem.— In all large cities many people 

 Uve in tenement buildings, three- to five-story structures arranged to 

 house a great many famiHes in a very small space. Such buildings 

 are cheaply constructed in the beginning and are seldom kept in good 

 repair. The sanitary arrangements are likely to be bad and the 

 hallways dark. Many rooms have no window at all, the only way 

 in which air is admitted being through the door or transom from an 

 unventilated hall. Such dark buildings are almost necessarily 

 dirty because the dirt is not easily seen. Oftentimes no pretense is 

 made of keeping halls clean, and in a few cases there is a pretense 

 and that is all. So long as such insanitary tenement houses are per- 

 mitted, so long will tuberculosis be a scourge of the large cities. There 

 are certain areas in lower New York where cases of tuberculosis are 

 reported in the same houses year after year. This condition has 

 been strikingly pointed out by Dr. Hermann M. Briggs of the New 

 York Department of Health. He shows maps of congested areas 

 with a black dot for each case of the disease (''spot maps"). Two 

 maps of the same area showing cases of tuberculosis in different 

 years have much the same appearance. The disease persists in 

 infected houses year after year, new cases developing to take the place 

 of those removed by death. 



It is gratifying to note that health authorities the world over 



