UPDATE: 13th August 2016 – I’ve felt uncomfortable about this article for a long long time and almost deleted it on several occasions. The reason is that I wrote it in 2010 from ignorance of the facts, that while it’s true that Victorian housing conditions and lack of ventilation exacerbated health problems, in the UK in the C21st the vast majority of tuberculosis is brought in from outside the country by people from developing countries. It is not racist to say this, it is a fact.

“These individuals account for nearly three-quarters of all tuberculosis notifications in the UK with an incidence that is 20 times higher than in UK-born individuals”


So I’m going to leave this article in place, with some sections struck out and other’s in bold in order to emphasise the important fact that TB in the UK has been largely eradicated and now comes from outside the country.

Dufton’s Yard Leeds from http://www.leodis.net/discovery/

[I found the following article as a result of looking through the blog statistics.  Often people search for things in unusual ways I hadn’t thought of and the string of Google returns they get includes articles I’ve missed.  This is one such. – Ed.]

From the Observer in 2004

The once-banned housing is now proving a popular city option, writes Chris Partridge

. . . Back-to-backs do not have a distinguished history. In the 18th and 19th centuries, mill and mine owners built mile upon mile of them to cram the maximum number of workers into the minimum space, at the lowest possible cost . . .

. . . The president of the Royal Institute of British Architects, George Ferguson, says: ‘There is increasing interest in what the street can offer as an intense form of urban development . . .

. . . ‘The time has come to break the rules that are preventing us building places that we find delightful, with narrower streets that we are allowed at present,’ he says. ‘We are plagued with a load of regulations that are outdated and prevent an awful lot of charm that we find in old places.’ The result would be a revival in the community life that the close-packed street patterns of the east end of London, the mining villages of South Wales and the mill towns of the North did so much to engender, he believes.

This is not to say that all future houses should be back-to-backs. ‘I would be against reintroducing back-to-backs leading to a monoculture,’ he warns. ‘The way forward is flexible housing regulations.’



George Santayana

From Building Design magazine 1/4/2010

Housing designers urged to tackle TB

Architects could become part of the solution to tackling the spread of tuberculosis in Britain, a charity has claimed

American-founded Archive (Architecture for Health in Vulnerable Environments) has launched a new initiative linking housing standards and TB in the north-west London borough of Brent, which is believed to have the highest rates of the disease in the capital . . . read on

I am sure George Ferguson meant well.  I am sure he really thought that intimate clusters of tiny houses in narrow alleyways with some barefoot tousle-haired Ready Brek ragamuffin like Mark Lester in Lionel Bart’s Oliver would warm the cockles of the hearts of would-be city dwellers, but he seems to have had a memory lapse.  The Dickensian world was notable for many things, but good health wasn’t one of them and in case it escaped his attention, even in 2004 tuberculosis was making a comeback among the homeless and in poor areas. However, this was not a UK generated problem, it was brought in from outside.

The annual risk of infection has declined from about 2% a year in 1950 to less than 1 per 1000 today, and the disease has become increasingly restricted to identifiable segments of the population, in particular immigrant communities: two thirds of cases in 2003 were in people born outside the United Kingdom.6


Architects have a responsibility if not to improve the lives of people they house then at the very least to ensure their conditions of habitation are not worsened and yet this would appear to be the path he favours.  Along with Peter Barber Architects , Assael Architects and Levitt Bernstein of course who are all in favour of single aspect flats and multi-storey back-to-backs.

UPDATE: Inside Housing has an article today entitled “A Healthy Home” 29th March 2011

“We are working with the NHS and council partners in the London borough of Brent to overcome stigma and raise awareness of simple strategies around the home that can mitigate the threat of TB, such as maintaining ventilation and maximising direct sunlight.”


The inhabitants of single aspect dwellings will suffer from a lack of sunlight if the dwelling faces N/NW/NE, and single aspect dwellings are poorly ventilated by design, something a dual aspect dwelling such as a house (not back to back) or dual aspect flat does not suffer from because air is able to flow from one side to the other.

Since nobody has yet seen fit to ban single aspect dwellings as a housing type, including existing back to back houses – which ought, in my view, to be demolished – then reports such as the above will continue.

A few words on the related issue of BCG

The reasons for stopping routine BCG vaccination in schools in the UK are explained in this article from the British Medical Journal, 2005:


The BCG vaccination program in schools ran for 50 years up until Autumn 2005. When the program was introduced in the 1950s, the chance of developing TB each year in the UK was 2% (1 in every 50 people). The risk of developing TB in the UK today is now less than 1 in 1000 people per year.

Those at most risk of developing TB come from a readily identifiable segment of the population – a ‘targetted’ vaccination program was thus considered more appropriate. BCG vaccination is now offered to infants in communities where the incidence of TB is 40 per 100,000 people, or whose parents or grandparents come from countries where the incidence is more than 40 per 100,000 people. Healthcare workers, travellers to and from countries of high prevalence and other ‘contact risk’ groups are also offered the vaccination.


One Response to “Back-to-back to make a comeback?”

  1. Lucy Fisher Says:

    “Back-to-backs” is now used to mean “terraced houses”. I’m all for terraces, but not back-to-backs (two fronts stuck together).

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