To give this information should be the duty of the Health Department. The municipal nurses are aware of the facts, and they also know when a patient changes his occupation, or place of employment. But to give this information without following it up, would not be enough. To notify an employer of the presence of a tuberculous worker, would not necessarily mean that any action resulted. A poor workman might be summarily dismissed, and a good one retained, without those in his vicinity being enlightened as to the nature of his disease. To make this information of value, it would be necessary to supervise the patient in the factory, just as he is supervised in the home. This double supervision would demand a greatly increased staff of nurses, since factory visiting should not be done through curtailment of the nurse’s other duties. We must once more emphasize the fact that the home is the fountainhead of tuberculosis, and that every infection which occurs outside the home circle (or its equivalent) is practically an accidental infection. But, as we have already said, a comprehensive plan for checking tuberculosis must include the stoppage of all leaks, and the unknown, unsupervised consumptive, at large in the community, is a leak which should be recognized by common-sense. Yet certain conditions must be complied with before we can extend this municipal supervision. Outside-the-home supervision will create an enormous amount of phthisiphobia. Consumptives are now tolerated because their presence is either unknown or but dimly guessed at; when this ignorance is dispelled—as it must be if the nurse visits them at their places of employment, and their presence and numbers are made known, a great wave of fear will spread over the community. Such a result is inevitable when for the first time the public realizes, suddenly and concretely, the extent to which it is threatened. Tuberculous workers will be discharged by hundreds, and there will be widespread suffering in consequence. On the other hand, however, thousands of non-tuberculous workers will be relieved of a great danger. Our factories already produce workers so worn out and devitalized as to fall ready victims to any disease that presents itself. Would not these same factories be somewhat less dangerous if swept clear of consumptive employees?[9] Footnote 9: However bad certain factory conditions may be, these of themselves cannot produce tuberculosis any more than they can produce scarlet fever or diphtheria. The disease itself must be brought into the factory by a carrier—someone who is himself infected.