Outside-the-home supervision is the next logical step in the anti-tuberculosis campaign. But valuable as this would be, from the point of view of the general health, it cannot be done until the community is prepared to care for all who would undoubtedly suffer as a result. Some patients, of course, would not lose their situations, but the majority would be turned adrift without a moment’s hesitation. These the community must take charge of. Therefore, before we can supervise tuberculosis beyond the boundaries of the home, we must have ample hospital facilities. Hospital accommodation must be so extensive, so complete, and so excellent that institutional care can be given to all who need it. In this way, the community will be relieved automatically of a vast amount of danger. Patients will either seek institutional care, or, if they continue at work, will do so under conditions which do not jeopardize other people. For the reaction from the first intense phthisiphobia will be a demand for carefulness on the part of the consumptive, and sane toleration of him. The one objection to this policy of supervision and publicity is the seeming interference with the personal liberty of the individual, but to curtail the liberty of the patient to transmit a communicable disease, is to increase the liberty of hundreds to escape it. There should be no question as to which has the superior claim. CHAPTER XIX Municipal Control—The Danger of “Political” Control—“Politics” in the Co-operating Divisions—Results in Baltimore—Tuberculosis and Poverty. =Municipal Control.= Tuberculosis is a communicable disease in which the patient himself must be relied upon to protect the community. We depend upon him for whatever protection he chooses to give, and whether this is much or little is determined by his circumstances, temperament, and environment. Whenever his ability or good-will breaks down, we are at his mercy. We may try to overcome his ignorance by education; to substitute ethical for unethical standards, and in a more or less unsatisfactory way to reconstruct his immediate surroundings. But the success of these efforts depends, in the last analysis, upon the patient himself. The public is exposed to a communicable disease, the control of which lies with the transmitter. For this reason, a disease which may be contracted by a neighbour becomes as much his affair as it is that of the patient or possessor. Should the interests of the two conflict, it is obvious that we must have some impartial arbiter to decide between them. At such a point—the right of one person to transmit, of another to acquire an infectious disease—the matter becomes one of public as well as private concern. The arbiter between these two interests should be the Health Department of a community, and the control of all infectious diseases should be placed completely under the municipality.