Rickets, TB and poor nutrition: Dickensian diseases return to haunt today's Britain

Lighting the cooker and leaving the oven door open is the only way that Tracy McCormack can afford to heat the front room of her house in north- west London. The bedrooms are cold and damp, the doors have been taken away because of damage by woodlice, and her two-year-old is recovering from pneumonia.

Ms McCormack, 25, a mother of two, is one of the many whose living conditions match those of the 19th century, according to a national survey by the Health Visitors Association.

The new study - which follows the revelation in the Independent on Sunday yesterday of government figures showing that one in three British babies is born into poverty - was compiled by 500 health visitors and found widespread child malnutrition, poor living conditions and a high number of people struggling with fuel debt and service disconnections.

It paints a bleak picture of families living in overcrowded housing. Nearly three-quarters of health visitors care for families in these conditions and 48 per cent have caseloads including families who have to share kitchens and bathrooms.

The health implications of this hardship read like a passage from Dickens. Nearly one-third of health visitors found tuberculosis among their clients last year. According to the chairman of the British Lung Foundation, Dr John Moore-Gillon, the disease is concentrated in poor areas and has been on the increase since 1988. "Tuberculosis has never gone away. But we are witnessing an increase whereas we expected to see a continuing decrease," he said.

Two-thirds of health visitors encountered iron deficiency among the families they cared for, 93 per cent had to deal with cases of gastroenteritis and 4 per cent reported cases of rickets.

The findings also show a high number of households having their gas, electricity, telephone and water cut off. The majority of these households include children.

Living on less than pounds 80 a week from benefits, Ms McCormack can hardly afford her bills. She spends only pounds 16 a week on food; essential items such as nappies are carefully rationed. Unless she can find pounds 70 overnight, her phone, which takes only incoming calls, will be cut off and she will not be able to communicate with her absent, unemployed husband. He left on their fifth wedding anniversary after several rows over money.

But keeping her children warm and the electricity bill low is her greatest worry. Coal at pounds 4 a bag is too expensive for her to consider lighting the fire and she cannot afford to run an electric heater all the time. Her children wear several layers of clothes, but that did not shield Cally, two, from pneumonia. Since the disease sent the child to hospital in an ambulance a year ago, she has regularly revisited the doctors and only recently finished another course of antibiotics.

"Pneumonia is a serious thing," Ms McCormack said. "Having pneumonia as a kid can affect her later on in life. She was so dehydrated they couldn't even get a needle into her veins. I don't think my cold house helped her condition because it starts off as a cold and just gets worse and worse." Despite her child's continuing illness, Brent council says it can not afford to install central heating in Ms McCormack's home this financial year, although the situation will be reviewed next April.

Jackie Carnell, director of the Health Visitors' Association, is concerned that social conditions in Britain are returning to those of the last century. "It is a tragedy that as we now approach the end of the 20th century, the many improvements in health and welfare are being undermined by the effects of desperate poverty on a national scale."

Bleak House 1996: The ghosts of poverty past

It is a black, dilapidated street, avoided by all decent people; where the crazy houses were seized upon, when their decay was far advanced, by some bold vagrants, who after establishing their own possession, took to letting them out in lodgings. Now, these tumbling tenements contain, by night, a swarm of misery. As, on the ruined human wretch, vermin parasites appear, so, these ruined shelters have bred a crowd of foul existence that crawls in and out of gaps in walls and boards; and coils itself to sleep, in maggot numbers, where the rain drips in; and comes and goes, fetching and carrying fever...

Charles Dickens in Bleak House, published in 1853

It is a chilly, dank room even with the tiniest flicker of heat that can be afforded - a flame from the oven. But that is still better than the rest of the flat, which gets no heat at all. It lacks suitably thick walls and even doors to insulate from the winter wind. The children catch colds. The colds turn into pneumonia. pounds 4 for a bag of coal is too expensive and an electric heater is beyond her means. The local council can't afford to install cental heating this year, so she will wait until it can reconsider her case in April. Maybe by then her two-year-old will be over the pneumonia that has kept her under medical care for the past year.

Life for Tracy McCormack in

Harlesden, London, 1996