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from which it is seen that the proportions of deaths in public institutions among males and females
were as follows :—

Thus nearly half the deaths among males and over 30 per cent, of the deaths among females
occurred in workhouse establishments.
The figures provide striking evidence of the intimate association of this disease with poverty.
It is seen also that a larger proportion of the deaths of males occur in public institutions, and especially
in workhouse establishments, than of the deaths of females, no doubt for the reason that destitution
especially occurs when the male fails in health. In some degree in females and more markedly in
males these proportions follow the grouping of districts when arranged according to social condition.
Thus, if the proportions of deaths among persons from 25—55 years of age occurring at home, in
workhouse establishments and hospitals, are studied in respect of the several groups the following
results are obtained :—

That the effect of social condition on the proportion of deaths occurring in institutions is not
more strongly marked in the above figures is no doubt due to the fact that this disease occurs
especially among the poor, and that in the main comparison is being made between deaths in very
similar populations.
Administrative effort in connection with the notification of phthisis.
As stated in previous annual reports, a system of voluntary notification of phthisis has for some
years been in operation in some of the London sanitary areas, and in the present year this system
has been supplemented by an Order of the Local Government Board requiring the notification of cases
of phthisis occurring in poor law practices and empowering local authorities to adopt measures for the
prevention of the disease.
The steps which sanitary authorities are empowered to take in respect of persons notified under
this Order are contained in Article IX., which reads as follows :—
(1) Nothing in these Regulations shall have effect so as to apply, or so as to authorise or require a medical
officer of health or a council, or any other person or authority, directly or indirectly, to put in force with respect
to any poor person, in relation to whom a notification in pursuance of these Regulations has been posted to a medical
officer of health, any enactment which renders the poor person, or a person in charge of the poor person, or any other
person, liable to a penalty, or subjects the poor person to any restriction, prohibition, or disability affecting himself,
or his employment, occupation, means of livelihood, or residence, on the ground of his suffering from pulmonary
tuberculosis.
(2) Subject as aforesaid, a council, on the advice of their medical officer of health, in the case of a poor person
in relation to whom a notification in pursuance of these Regulations has been posted to the medical officer of health,
may, for the purpose of preventing the spread of infection from pulmonary tuberculosis—
(i.) take all such measures, or do all such things as are authorised, in any case of infectious disease,
or of dangerous infectious disease, by any enactment relating to public health, and as have reference to the
destruction and disinfection of infected articles, or the cleansing or disinfecting of premises ;
(ii.) take all such measures, or do all such things as are appropriate and necessary for the safe disposal
or destruction of infectious material, produced and discharged, as a result of pulmonary tuberculosis; and otherwise
for the prevention of the spread of infection from any such material;
(iii.) afford or supply all such assistance, facilities, or articles as, within such reasonable limits as the
circumstances of the case require and allow, will obviate, or remove, or diminish the risk of infection arising
1 See footnote (2) page 6. 2 See footnote (2) page 17.