654 ANNUAL. EEPORT SMITHSONIAN INSTITUTION, 1910. 



disease. The separation of individual cases, the slowness and free- 

 dom from complication of the intercommunication, render health 

 work in the country much easier than in cities. With trained men 

 and an adequate system for promptly collecting and studying mor- 

 bidity statistics, preventive work in rural districts may be made to 

 have the efficiency of a well-oiled machine. 



Even here, however, it is obvious that all the phases of sanitation 

 which arise in the study of rural conditions can not be studied fully 

 by the limited force at the disposal of the average state health de- 

 partment. Some limitations must be made and some problems in the 

 country must receive more attention than others. We, have carefully 

 considered the subject and have concluded that, for the present at 

 least, particularly in the South, typhoid fever and hookworm diseases 

 should receive first attention. The reason for this decision will, I 

 think, be obvious to all. Typhoid fever is and will probably remain 

 the greatest single problem of rural hygiene. High as is the death 

 rate from typhoid fever in the country as a whole, it is highest in the 

 South; and awful as is the toll which most southern cities pay to 

 this disease, their burden is not so heavy as that of the rural sections 

 of the same territory. Hookworm has been placed beside typhoid 

 fever in this work because we are convinced that hookworm plays a 

 part hardly less important than that of typhoid fever in the South 

 and is essentially a disease of the country. 



If we must study rural hygiene for its own importance, and if we 

 must limit our study for the present at least to these diseases which 

 are the most disastrous, we must begin our study on the farm. We 

 should not, of course, omit the small towns, as they offer problems 

 intermediate between those of the city and those of the country. But 

 a study of these towns convinces us that in the main the dangers are 

 essentially those of the farm, and the problem is practically the same 

 in its fundamental aspect as that to be encountered in the country. 



The farm is the point of attack, and in the work against the dis- 

 eases I have mentioned the farm is the unit both in the spread and 

 prevention of infection. Each farm is, to all intents and purposes, a 

 separate community, with its own population, its own problems of 

 sanitation, and its own forces for good and evil. The work we 

 would do for the improvement of rural conditions of sanitation must 

 be done for the improvement of the farm. 



Studies of sanitary conditions on farms show facts that are almost 

 unbelievable in the light of our knowledge regarding soil pollution. 

 We have inspected in the course of our work against typhoid and 

 hookworm diseases thousands of farms, and it is the exception rather 

 than the rule that we find adequate sanitary arrangements in use. 



Wells are often carelessly dug, carelessly protected, if protected at 

 all, and carelessly kept. The well tops, almost without exception, 

 show wide cracks through which filth is washed at all times into the 



