SAXITATIOX OX FAEMS.^ 



By At.t,f:t W. Fbeemax, M. D., 

 Assistant State Health Commissioner of Virginia, Richmond, Ta. 



The careful student of sanitary progress in the United States to- 

 day is early impressed Tvith the great contrast bet^veen the sanitary 

 conditions in country districts and those in the cities. Recent years 

 have witnessed great progress in the cities. Effective health depart- 

 ments have been organized, and the effect of measures, such as the 

 supervision of water and milk supplies, the visiting nurse, and the 

 tuberculosis dispensary, medical inspection of schools, and the accu- 

 rate control of contagious diseases, has been so pronounced as to place 

 their work on a firm basis, and to insure its continuance and exten- 

 sion. A\liile much remains to be done in the cities, the foundation 

 has been laid and the methods of work more or less standardized. It 

 is not too much to say that we are within sight of the solution of 

 many of the problems of municipal sanitation. 



"Wliile these facts are true of the cities, in those States with which 

 we are familiar no such condition exists in the country districts. 

 They remain as they have been for years, without efficient organiza- 

 tion, depending on the methods and beliefs of 30 years ago. In only 

 a few States is there adeqiuite supervision of the rural communities; 

 only a few States require the reporting of even the most dangerous of 

 contagious diseases, and in most cases what activity there is in the 

 country districts is confined to the control of smallpox, diphtheria, 

 and scarlet fever, with occasional attention to a flagrant nuisance. 

 The vast contributions of modern science to the prevention of disease 

 are for the most part lost to the people of the country for the lack of 

 organization and education. There are, of course, isolated exceptions 

 to this statement, such for instance as the wonderfid work of the 

 Pennsylvania department of health in comiection with tuberculosis 

 in rural districts, but for the most part conditions are as stated. 



1 Read in the section on preventive medical and public health of the American Medical 

 Association, at the sixty-first annual session, held at St. Louis, June, 1910. Reprinted by 

 permission with author's revision from Journal American Medical Association, Aug. 27, 

 1910. 



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