RURAL HEALTH PHYSICAL 187 



distance, the district or visiting nurse, hospitals and dispensaries. 

 The country also is too frequently lacking in such other hygienic 

 and health aids as public and private bathing facilities, regular 

 and well regulated exercise and recreation, protection from sud- 

 den changes in temperature and inclement weather. But on the 

 -other hand the country does not suffer so extensively from the 

 health-destroying vices which are so common in the cities, 

 especially excessive alcoholism, drug addiction, and the venereal 

 diseases. Most of the leading diseases, in fact, are recorded in 

 census returns as being more prevalent in the cities than in the 

 country districts. There are certain notable exceptions to this 

 general rule. The rural communities exceed in malaria, in- 

 fluenza, dysentery, peritonitis, and the diseases of the nervous 

 and circulatory systems, and possibly also in pellagra and hook- 

 worm. Some health authorities have also attributed much of the 

 cities' excess rate of typhoid to rural vacations and an infected 

 milk supply, though the responsibility probably rests more 

 properly upon the cities' infected water supply. The cities' 

 excessive rate in certain of the largely prevalent diseases, such 

 as measles, whooping cough, diphtheria, croup, scarlet fever, and 

 pneumonia, is due primarily to the high contagiousness of these 

 affections which operates to advantage in crowded communities. 

 The country 's excess in the diseases earlier enumerated above, on 

 the other hand, is not traceable to the contagiousness of the 

 diseases, but to the inferior sanitation which exists there, and in 

 some cases to physical and nervous overstrain. 



Thus the comparative statistics of rural and urban health 

 indicate clearly to us the difficulties in each case. In the country 

 the difficulty is clearly lack of sanitation and physical and mental 

 hygiene. What then is our program for removing these abnor- 

 mal conditions? There are a great many things that can and 

 should be done. It will suffice here perhaps to suggest and out- 

 line a few of the more important of these. 



Perhaps the primary condition for the establishment of better 

 health in the rural community is the provision of a competent 

 health officer and sanitary inspector, one who not only under- 

 stands the dangers and difficulties of rural sanitary conditions, 

 but who also has the legal powers and 1lie courage to enforce the 

 changes which are necessary. A number of states already make 



