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44
two officials in the Health Department were not working in
the same room, but there were many opportunities of infection.
The same telephone was used by both.
It is always very difficult to ascertain the date of the
onset of the disease. It is certain that in the two second cases
in each department the onset of the first symptoms was much
earlier than the date of the incapacitation from duty, and the
date of the infection with tubercle is thrust still further back.
As stated in a preceding paragraph it is extremely difficult to
estimate how far chance may have been operative, but from
the history of the cases it is quite possible for the second case
to have been infected from the previous case that occurred in
the department.
Other instances might be quoted where the source of
infection seemed to be more definitely located. In November
1909 a case was notified from a house in Goldsmith Road.
The patient had resided there as a lodger for three years. In
April 1908 another case had been notified from the same
house. The two cases were in no way related to each other,
but naturally came into intimate contact with each other.
In the second case there was no family history of Tubercle,
but the nature of his work may have predisposed him to
attack. He was employed as a pattern maker, and the workshop
was dusty. This may have rendered him susceptible to
attack, and to infection at the house where he lodged.
Although an exaggerated fear of infection in pulmonary
tuberculosis is unnecessary, these examples emphasize the
desirability of inculcating more exact knowledge of the
disease. Fortunately, Phthisis differs in several important
respects from most of the acute infectious diseases. Its
infection is derived under ordinary circumstances from one
channel only, that of the lungs, the infectious material being
discharged as expectoration or as cough spray. This mode of
infection can be controlled by the patient with but little
trouble, if he is intelligent and scrupulously careful. The