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Special Articles.THE

CENSUS OF HOUSING IN ENGLAND.

THE General Report of the Census of England andWales, 1921,1 now issued, contains much informationof interest to medical and other social workers, andthe wise worker will study carefully this record of themassed material on which he has to work. No partof this information possesses such vital importanceas that relating to the housing of the people ; and inthis article it is proposed to concentrate on thispart of the report, showing graphically and otherwisesome of the socially most significant facts bearing onthis problem.For the census purposes the groups of persons

included in a separate census schedule consist of either.,

private " or "

non-private " families. The last-

named includes people in hotels, hospitals, &c.,while a private family may include a lodger boardingwith the family, but not a lodger occupying separatelypart of the house.Thus defined the average number of families per

100 occupied dwellings was 109 in 1911 and 112 in1921, but owing to the smaller average size of familiesthe number of persons per 100 occupied dwellings wasonly 485 in 1921 as compared with 493 in 1911.

Neither of these figures can be regarded as indicatingimprovement or worsening of housing without furtherdetailed analysis which is given in the census report.

Size of Dwellings.Of the total dwellings 16.9 per cent. comprised three

rooms or less and 488 per cent., or nearly half, containedfour or five rooms only. Of the total 8,750,000private families in England and Wales 80.2 per cent.were living in the single occupation of separatedwellings, 13 7 per cent. were living two families toa dwelling, and in 6-1 per cent. of the dwellings therewere three or more families.

In mitigation of the apparent large departure fromthe ideal of one family to one dwelling, it should benoted that a single lodger boarding separately fromthe occupier is regarded as a separate family.

Local Distribution o,f Size of Dwellings.—As the chiefsocial interest centres in the smallest dwellings wepropose to consider these particularly (Table I.).

TABLE I.—Showing for Certain Counties the Proportiorrper 1000 Total Dwellings having Orre to ThreeRooms.

Highest. Lowest.Northumberland.. 538 Isle of Wight 50Durham ... 45g Middlesex.. .. .. 60Yorkshire, West Riding 340 Surrey .. .. .. cilCumberland ... 2.52 Sussex, West 75Yorkshire, North Riding. 21B Sussex, East 87Worcestershire 206 Devonshire ..134Warwickshire .. 199Yorkshire, East Riding.. 195London ...... 181

Northumberland and Durham stand out in respectof their very high proportions of dwellings of thesmallest type. Not only so, but on the average thesesmall dwellings are occupied by a larger numberof families than obtains elsewhere. But the data,so far illustrated do not give us an adequate ideaof housing conditions, and it is necessary to consideralso

Size of Family in Relation to Number of RoomsOccupied.

This distribution for England and Wales as a wholeis shown graphically in Fig. 1. It will be seen thatin 1921 only 46.0 per cent. of the private familiesoccupied dwellings containing five or more rooms

as compared with 49.6 per cent. in 1911. This is a

1 H.M. Stationery Office. 1927. 5s.

slight indication of the general t.endencv in recentvears to occupy smaller houses or flats. the propor-tion of four-roomed dwellings is almost the same atthe two censuses ; but it will be seen that the propor-tion living in smaller dwellings of one, two. or threerooms has increased in recent vears.The average size of family has dropped by per cent.

from 4 36 persons in 1911 to 4-14 in 192L, t naturatresult of the increase in the marriage-rate, along withthe greatly reduced birth-rate and the heavy mortalityin the war.To ascertain whether the population in 1921 was

really rather less densely housed than in 1911, furtherdetails are needed, especially in view of the generaldeclaration of house shortage throughout the country.We may first take the statement of a1:erage number

of occupants per room in the entire country. The relativeproportions are shown in the following table, omittingpersons living in tenements of over nine rooms. Itshould be noted that in the enumeration of roomskitchens are included, but not sculleries, bathrooms,or offices or shop rooms. Thus stated the averageresults do not differ greatly at the two censuses

(Table II.).

TABLE IL-Proportioiz per cent. of the Total Popitla-tion Living with (on an Average)—

Per Room. 1911. 1921Less than one person.... in’7 .... 3-!’.3One person ........ 10.0 .... 16.1One to two persons.... 39’1 .... 38’4Two to three persona .... 7.6 .... 7’8Three persons and over per room.. 1.5 .... 1.8

It will be seen that for 9’6 per cent. of the populationthere are more than two persons to a room. The ratioof more thantwo persons to FIG. 1.a room hasbeen taken in 1921, as m the

precedingcensus, as an

approximateindex of theprevalence anddistribution ofovercrowding.The utility

of this ratio isundoubted,although it hasbeen criticised.It does not, ofcourse, dis-tinguishbetween largeand smallrooms, but it isprobably thebest measure-

ment we have,at present, ofrelatively goodor deficienthousing accom-modation. Thepercentage 9.6

compares with91 in 1911.More detailed ROOMS OVER

figures thanare given above show that, excepting families com-prising only one person, for whom there is obviouslyno scope for improvement,

" a deterioration has taken

place for all sizes of family, including the larger familieswhose density was already approaching the region ofovercrowding." The amount of worsening during theten years is approximately 3 per cent.

Comparison of Urban und Rural Districts.The distribution of families (per 1000 total families}

according to the number of rooms occupied in 1921

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is shown in Fig. 2 for London, county boroughs. andrural districts in the aggregate respectively. It willbe seen that the smaller units preponderate in Londonto a much larger extent than in the average of countyboroughs and of rural districts. This is doubtless inpart due to the much larger proportion of lodgers inLondon to total population. In London the mostfrequent unit of occupation is three rooms ; in

FiG. 2.300

boroughs and rural districts it is four rooms. InLondon 13-2 per cent. of the total families live insingle rooms as compared with 34 per cent. in thecounty boroughs and 0-7 per cent. in the rural districts.The approximation of the urban to the rural death-rate, and particularly the approximation of thedeath-rate from tuberculosis in urban and ruralareas, is noteworthy in view of these figures.The marked and consistent superiority of housing

in the rural areas is further shown in Table III.in which is given the proportion per 1000 total popula-tion living in private families with the average numbersof rooms per person, for dwellings with the greatestroom-density.

TABLE III.

Census 1911. Census 19?1.

Less Less — than half Half to than halt Half to

a room one room room one roomper

per per per

person. person. person. person.London ...... 178 . 409 i 161 413Aggregate of- !County boroughs .. 94 415 i 108 404Other urban districts 74 i 383 81 380Rural districts.... 66 360 65 350

Both in 1911 and 1921 the superiority of rural overurban housing, of the housing in the smaller urban-districts over those in the county boroughs, and ofthat in the average for the county boroughs over London housing is most striking.

But far and away the most important tables in thiscensus report—tables which should be thoroughlystudied by every medical officer of health andsanitary inspector—are Tables XXVI. and XXVII.,which give for each administrative county, for eachmetropolitan borough. and for each of the largertowns its average condition as tested by various testsof adequacy of housing.

Degree of Local Overcrowding.These tests are (a) the average number of families

per dwelling; (b) the room-density or average numberof rooms per person : (f) the last test in which variationsassociated solely with differences in size of familieshave been eliminated; and (d) the proportion ofpersons living in overcrowded conditions, which istaken as represented by densities of less than one-halfa room per person. For our present purpose we takethe last-named test. It is evident that it is morelikely to give valuable indications of circumstancesaffecting health than the three other above-mentionedtests. For the country as a whole 9.6 per cent. ofthe total population is within the defined overcrowdinglimits. In Northumberland and Durham, whichhere also are the worst in the series, the proportion is30-8 per cent. and 29.5 per cent. respectively; inLondon it is 16.1 per cent.. in the West Riding11.5 per cent., in Stafford 11.1 per cent., in Ciimber-land 10,() per cent.. in Denbigh 10-1 per cent., and inthe Xorth Riding of Yorkshire 9.7 per cent.

Overcrowding in Metropolitan Borotighs.-In Londonthe following extremes of overcrowding—as definedabove—are seen (Tables IV.A and B.).

TABLE IV.A.—Proportion per cent. of PopulationLiving more than Two per Room.

Worst. Best.1911. 1921. 1911. 1921.

Finsbury .. .. 39.8 34-0 ’ Lewisham 3’9 4-7Shoreditch .. 30.6 .. 32.0 Wandsworth . (;’3 .. 6’SStepney ... 34.9 .. 29-0 Hampstead .. 7’1 .. 6’5Bethnal Green 33.2 .. 27’8 Westminster .. 6.3 . 7’SSouthwark .. 25.8 .. 23’5 Woolwich .. 12’9 .. 10’1St. Pancras .. 25.5 .. 22’4 Hackney .. 12.4 .. 11.5Bermondsey .. 23.4 .. 23 2 Greenwich 12-1 .. 13’8

TABLE IV.B.—Overcrowding in Large Towrzs.Worst. Best.

1911. 1921. 1.11. 1921.Gateshead .. 33.7 .. 37.0 Northampton .. 1’1 .. 2’7South Shields 32.9 .. 36.5 OSforV ... 2’.1 .. 2’3Newcastle-on-Tyne 31.6 .. 33.6 Great Yarmouth. 2.5 .. 2’1Tynemouth .. 30.7 .. 34.4 Ilford .... 2’1 .. 3-1Sunderland .. 32.6 .. 33’8 Luton.... 3-1 3-7St. Helens .. 17.0 .. 21.0 Gilliiigham . 2.3 .. 3-4Wig,-tl.IL .... 12.9 .. 15’3 Derby ... 1-9 . 35

The tables from which the above extracts have beenmade throw much light on the relative degree ofroom-density in different districts. Their teaching isso obvious as to require little or no comment. Thecomparisons between 1U11 and 1921 are also interesting.In London the small reductions in room-density shownin most metropolitan boroughs are not so great asmight have been anticipated in view of the reducedbirth-rate. The worsening shown in the coal-miningand iron centres in the north is not surprising, as inthese districts the reduction in the birth-rate has beenrelatively small. There is abundant evidence in theseimportant tables of the need for further housing

, provision, especially for those who need two, three, orfour rooms only.

Institutions iu. Relief of Housing.It is too little recognised that hospitals, Poor-law

institutions, asylums, homes for cripples, blind, &c.,house a considerable proportion of the total populationat any given time, and that were it not for this steadilyincreasing provision modern difficulties in housingwould be immensely greater than they now are.

The relief thus given is the more significantly import-ant, inasmuch as it is given on behalf of those whootherwise would suffer most by remaining in theirexiguous homes, and who if they remained there might

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injure the health or reduce the efficiency of thoseremaining at home. The figures published in thecensus report give a clue to the amount of relief tohousing thus achieved.The institutions whose numbers are tabulated

comprise workhouses and other Poor-law institutions,homes for lunatics, &c., homes for cripples, blind, deafand dumb, hospitals and convalescent homes, prisonsand reformatory schools, and some others. Only someof these are enumerated in Table V.

TABLE V.—Proportion per 10,000 of the Total Popula-tion of England and Wales who at the Census wereResident in Institutions (Innzates only).BVorkhouscs and other Poor-law institution:- .. 49

Lunatics, &:c............. 32

Hospitals and convalescent homes ...... 28Homes for cripples, blind, deaf and dumb .. 2-2

Reformatory schools .......... 4.2

In addition prisoners comprised 3 per 10,000 of thepopulation.The age-distribution of inmates of these institutions

has much social interest, and we may in conclusiongive this distribution for the most important of these(Fig. 3).

FIG. 3.—Age-distribution per 1000 Males at all Ages

in Poor-law Iostitutions and

Asylums.500

1. At ages uuder 5. 2. 5-15. 3. 13—40. 4. 40-65. 5. Over 65.

In the first set of columns is shown the age-distribu-tion of the male population of England and Walesat five periods of life ; in the second the same isshown for Poor-law institutions, and in the thirdfor homes for lunatics. It is clearly seen that themajority of patients in asylums is at ages 15-65,while the majority of occupants of Poor-law institutionsare over 40 and especially over 65 years of age. Old ’,,age pensions have reduced the proportion in institu-tions at these higher ages, but it still remains truethat Poor-law institutions serve chiefly for the care ofpersons disabled by age combined with infirmity. ’,

DUBLIN VICTORIA EYE AND EAR HOSPITAL.—A newwing is being added to this institution and it will be openeda few months hence. It is the only hospital in Dublin devotedexclusively to the treatment of diseases of the eye and ear.and the annual report shows that last year there were 1620in-patients and 9995 new out-patients in addition to 2836out-patients receiv ing further treatment.

OPHTHALMOLOGICAL SOCIETY OF THEUNITED KINGDOM.

ANNUAL CONGRESS.

(Concluded from p. 992.)

THE Thursday evening session was opened by apaper, read by Dr. GORDON HOLMES, onTumours involving the Chiasma, excluding Pituitary

Tumours.He said that when meeting with cases of intra-cranial tumour suggestive of a lesion of the chiasmait was usual to think of a new growth of the pituitarybody. He had noted that in a considerable proportionof these cases the tumour did not take origin in thepituitary itself ; indeed in his experience 40 per cent.of tumours causing these symptoms did not do so.

The other tumours which might compress the chiasma.or otherwise interfere with its functions includedtumours growing from the pedicle of the pituitary,and of these there were two types: (1) simple cysts ofRadcliffe’s pouch, (2) adamantinoma, a variety ofepithelial tumour characterised by a peculiar arrange-ment of epithelial cells.’ Or there might be tumoursgrowing from the base of the brain, teratomata beingcommon in this situation, or primary tumours of thechoroid plexus, and of the third ventricle involvingthe chiasma. Another type of tumour was that whicharose from the meninges, the commonest being theendotheliomata. Tumours might spring from thebasisphenoid and involve the chiasma, or the basi-sphenoid might be the seat of malignant growths,such as primary sarcomata or metastatic carcinomata.Or tumours--e.g., aneurysms—might grow fromvessels. Dr. Holmes quoted a number of cases ineach group.

Dr. A. W. MULOCH HOUWER read a paper on

Keratitis Filamentosa and Chroreic Arthritis,in which he drew attention to the association betweena form of conjunctivitis (later becoming keratitis)and arthritic disability of a chronic and lastingcharacter, which proved very resistant to treatment.

Mr. J. GRAY CLEGG discussed the paper, and said hehad generally used for the condition a mild applica-tion of borax and salt, with drops of paroleine. Whenthere were definite adhesions of the cornea he usedammonium chloride. One of his patients had peliosisrheumatica, and there was an absence of tearsecretion.

Colonel H. HERBERT read a paper on

Glass Membrane Formation in Iridocyclitis.It dealt with the question of the formation of a

glass membrane in the anterior chamber, which heconsidered took place by means of cells which hadmigrated from the ciliary epithelium. It could onlybe found in very chronic cases of iridocyclitis. Thepaper was illustrated by a large number of micro-scopical slides.

Mr. TREACHER COI,Li-,;-s discussed the paper andColonel Herbert replied.

Mr. G. F. ALEXANDER sent two papers which wereread, one on a new method of controlling the eyein the operation for cataract, the other on a factor inthe causation of keratitis striata.

Edward Nettleship Prize.The PRESIDENT presented this prize to Mr. C.’.

Howard Usher in recognition of his original work,which was, he said, of value not only to ophthal-mology but also in a wider sphere. If in the futureeugenics should become a science it would be largelythrough such spade-work as that which had been doneby Mr. Usher.

Ætiology and Treatment of Hypopyon Ulcer.The discussion of this subject occupied the whole of

Friday morning.