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49
The following table shows the mortality from phthisis in groups of London sanitary districts,
arranged in respect to the proportion of their population living more than two in a room in tenements
of less than five rooms.
London. 1901.7.

Tables similar to the above have been published in several previous annual reports, and the
close relationships existing between " social condition " as measured by " overcrowding " and phthisis
mortality is conspicuous. It will be seen that in the most overcrowded group of districts the death
rate from phthisis is approximately twice that in the least overcrowded group.
The decline in phthisis mortality is being maintained in London, the rate of mortality in the year
1907 being less than that of any year which has preceded it. The rate of 1907 is, indeed, less than
half that of the decennium 1861.70, less than 50 years ago. The statistics of phthisis mortality have
been examined by many students of public health, who have endeavoured to derive from them indications
of the particular circumstances which have brought about this decline, in the hope that they will supply
a basis for administrative effort capable of producing more rapid decline than that which has already
been observed.
The fact which first claims recognition and which stands in the forefront of all consideration of
the question is that this diminution has occurred without any effort being especially directed to the
attainment of this end. Among the points of interest which have been observed in the behaviour
of phthisis mortality, is that the decline in the mortality of females has been greater than in that of
males. A likely hypothesis of this difference in the behaviour of the mortality of the two sexes is that
the tendency of the times has been for the increase of employment of men in indoor occupations to be
greater than the increase of women to be so employed, urbanisation, thus affecting the male sex
in larger degree than the female sex. A second hypothesis, which may also be borne in mind, is that
improvement in the dwelling began at an earlier date than improvement in the workshop. It
may be that both factors have been concerned in producing this result. The broad fact, however,
remains that both sexes have participated, in respect of phthisis, in the improvement in the social condition
of the population, and in this improvement must be included not only dwelling and workshop,
but the food of the people. Whether this improvement has resulted in making the population more
resistant to a contagium of constant virulence, or whether the virulence of the phthisis contagium has
itself declined must be matter for speculation. The relative strength of each of the two opposing
forces must finally determine the death-rate, but there is much reason for thinking that the power
of resistance is the alliimportant factor in determining the liability to attack from a widely distributed
infection.
In the study of this subject, the statistics of mortality in Ireland have been examined in
comparison with those of England and Scotland, for the reason that while in the two last countries
phthisis has declined, the disease appears in large degree to have behaved differently in Ireland, and so
inferences have been drawn from this difference in behaviour and suggestions for administrative action
have been made which are based upon social differences, real or conjectural. It is impossible to discuss
these differences in the short space available in an annual report, but it may be pointed out that the
decline in phthisis mortality in England and Scotland has been accompanied by decline in mortality
from other causes less phthisis, as will be seen from the following figures :—

1 See footnote (1), page 19.