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The close relationship between phthisis and poverty is illustrated by this table, in which the
death rate from consumption in North Kensington is more than twice as high as the rate recorded
for South Kensington.
Tuberculosis Regulations, 1908.—In December, 1908, the Local Government Board
issued the new Tuberculosis Regulations, under which all cases of consumption in " poor persons "
have been made compulsorily notifiable. The Regulations came into force on 1st January, 1909.
" Poor persons " are defined as persons in receipt of relief from the Poor Rate, and it is only to this
class of the population that the Public Health (Tuberculosis) Regulations 1908 will apply. Boards
of Guardians through their officers are required to furnish to Medical Officers of Health the
following information in respect to consumptive persons in receipt of relief, namely:—
1. The addresses from which consumptive persons have been admitted to the infirmary.
2. The addresses to which consumptive persons go on their discharge from the infirmary.
3. The addresses of consumptives who are being attended in their homes by the District
Medical Officer, and
4. Any change of address by a poor person who has been previously certified as suffering
from consumption.
For the purpose of preventing the spread of infection from pulmonary Tuberculosis, sanitary
authorities are empowered to disinfect rooms, to disinfect or destroy infected articles, and to
provide sputum bottles and disinfectants for the private use of consumptives in their homes.
Article IX provides that no Medical Officer of Health or Council shall put into force any enactment
which subjects any person notified under these regulations to any restriction or disability
affecting himself, his employment or his residence on the ground that he is suffering from consumption.
Compulsory powers of removal to or detention in hospital are thus deliberately withheld,
neither will it be possible to forbid the employment of consumptive persons on premises, such as
dairies, where their presence is a danger to large sections of the community. Nevertheless a large
field for useful work remains, and public opinion will no doubt approve the provision of reasonable
safeguards against the excessive hardship. which might otherwise result from compulsory
notification.
The total number of notifications received from officers of the Board of Guardians was 446,
the total number of consumptive persons notified being 230. Of this number 100 were notified in
the first instance by the district medical officers and 130 by the medical superintendent of the
infirmary. Seventy-three of the persons certified as consumptive by the district medical officers
were subsequently admitted to the infirmary and re-notified. The Public Health Department thus
received information of the admission to the infirmary of 203 consumptive patients during the year.
Twenty-five patients were admitted twice, six were admitted three times and one patient was
admitted no less than four times during the year. In many instances these unfortunate people
tiring of institutional life return to different lodgings each time they take their discharge and passing
in and out of the infirmary in an advanced stage of consumption which may last for several
years they cannot fail to spread infection broadcast. Since compulsory detention would involve
unjustifiable cruelty to the individual the remedy must be sought in increasing the popularity of
institutions for incurable cases.

Under the voluntary system practically the whole of the notifications received came from the
District Medical Officers or from the Medical Superintendent of the Infirmary. With the introduction
of compulsory notification of poor law cases, the number of voluntary notifications has been
reduced from more than 200 to 14, a clear indication that private practitioners do not wish to bring
their consumptive patients to the notice of the Health Authority.