RURAL HEALTH PHYSICAL 189 



they should be reasonably uniform, and adequate and thorough 

 administrative enforcement should be provided for, But where 

 adequate laws and administrative machinery for rural sanitary 

 protection do not exist and such apparently is everywhere the 

 case at the present time much may still be accomplished through 

 community cooperation, provided only there is leadership and the 

 dwellers in the community are made to see clearly the connection 

 between sanitary measures and improved health. The health of 

 most of the rural communities of the South could be vastly im- 

 proved without any considerable visible economic outlay merely 

 through voluntary cooperative drainage of swamps or wet places, 

 oiling, covering, or filling unused wells, the disposal of all wastes, 

 and the formation of rural improvement societies or clubs for the 

 purpose of observing properties for the detection and reporting 

 of improperly cared for manure piles, the accumulation of rain 

 water in bottles and barrels and other receptacles about the house, 

 and other nuisances, and for the creation of an effective public 

 opinion regarding these evils. Here the problem is primarily one 

 of education and effective leadership rather than of laws, or 

 cooperative labor rather than of a budget raised through taxation. 

 Valuable as such cooperative enterprise must always be for the 

 protection of rural health, with or without laws and administra- 

 tion, it can never completely take the place of the latter, nor will 

 it work with anything like the uniformity which the other pro- 

 vides. 



No rural health program can claim even approximate adequacy 

 which does not provide for the district or visiting nurse. The 

 visiting nurse has been an indispensable factor in the health im- 

 provement of the cities and is coming to be recognized as one of 

 the first objectives in rural health campaigns. Where the rural 

 district nurse has been emplo3 r ed results have amply justified 

 the expenditure required. Whether the nurse operates over the 

 whole county or a smaller division must necessarily depend pri- 

 marily upon the density of the population and the value of 

 property for taxation, though at least one visiting nurse to the 

 township, or consolidated school district where such exists, should 

 be the ultimate goal. In those States where township divisions 

 do not exist, commissioner districts or other similar divisions may 

 well serve as geographic units for her services. The function 



