652 ANNUAL EEPOET SMITHSONIAN INSTITUTION, 1910. 



The reasons for this contrast are, in the main, perfectly obvious. 

 There is in the first place a greater survival of the individualistic idea 

 of life in the country than in the city. Government touches the life 

 of the individual in the country to a limited degTee only. His per- 

 sonal liberty, so called, is seldom invaded. He is, and he considers 

 himself to be, a law unto himself. In the city the communal idea 

 prevails; no man lives unto himself alone; government is at the elbow 

 of every citizen. In the second place, the very isolation of the country 

 makes it almost impossible in the circumstances to educate the coun- 

 try people in the importance of health measures. A single successful 

 campaign against measles or diphtheria or impure milk wdll generally 

 convince the people of the city of the importance of health measures. 

 As such a campaign is difficult or impossible under present conditions 

 in the country, education comes more slowly and the support of 

 health measures is always more doubtful. In the third place, the con- 

 trast between country and city is largely due to the fact that health 

 measures are more obviously necessary in the city than in the country. 

 The crowded city demands health protection. A\^iere our nearest 

 neighbor lives half a mile aAvay he may suffer from a wide variety of 

 diseases and we may never feel the danger, but where we are sepa- 

 rated from contagious disease only by the partition wall of an apart- 

 ment house, we feel the necessity for and yield more readily to pre- 

 ventive measures. 



The explanation for this contrast, however, is not its justification. 

 The country no less than tlie city needs health education. The 

 country, even more than the city, stands in need of fundamental 

 health precautions. The very mass of disease in the country districts 

 of itself requires that this problem be attacked, but the bearing of 

 rural sanitation on the health of our cities is perhaps a still more 

 immediate reason why our point of attack should be shifted. The 

 health of the city depends in a large measure on the health of the 

 country. Practically all the food products of the city come from 

 more or less remote country districts. A single case of typhoid fever 

 on a dairy farm may, under certain conditions, infect a whole city, 

 and emphasize to all the intimacy of the sanitaiy connection. In the 

 same way close intercourse between cities and the countrj?^ renders 

 the former particularly liable to infection from the latter. Expe- 

 rience in many places has convinced us that the prevention of small- 

 pox in the cities is ver^^ largely dependent on the close inspection of 

 smallpox in the countiy, since most cases of this disease are brought 

 into the cities from rural districts or small towns. Then, again, there 

 is a crying need for better rural sanitation because of the more or 

 less general residence of city people in the country during vacation 

 time. The country boarding house has been one of the great sources 

 of typhoid fever, and many of the cases which appear in the cities 



