American Agriculturist 
« 
THE FARM PAPER THAT PRINTS THE FARM NEWS 
“Agriculture is the Most Healthful, Most Useful and Most Noble Employment of Man ”—Washington 
Reg. U. S. Pat. Off. Established 1842 
Volume 111 For the Week Ending June 30, 1923 Number 26 
The Rural Health Problem 
A Doctor Tells Why Country Physicians Are Growing Scarce 
T he numerous letters in the Ameri¬ 
can Ap’iculturist suggesting various 
remedies to the dwindling of country 
physicians, prove that the problem of 
medical service in rural communities has- 
become a burning question and that its solu¬ 
tion is becoming increasingly difficult. 
During his first term, Governor Smith had 
realized the seriousness of the problem and 
had directed the State Department of Health 
to make a thorough survey of the situation. 
At the beginning of his present administra¬ 
tion, realizing that there was a considerable 
difference of opinion regarding the'matter, 
he invited some two hundred physicians, 
representing the medical societies and the 
medical colleges from all over the State, to a 
conference on several medical 
questions. The conference met 
on February 26, 1923; this be¬ 
ing the first time in the history 
of the Empire State that the 
chief executive officially recog¬ 
nized the interest of doctors in 
proposed legislation that might 
affect them. The conference ap¬ 
pointed a committee for the pur¬ 
pose of studying the rural health 
problem, among other questions, 
who made a report to the 
Governor within a short time. 
This report, owing probably to the short 
time at the disposal of the committee, is 
somewhat disappointing. Basing themselves 
on the statistics collected by Dr. Hermann 
Biggs, the State commissioner of health, they 
reach different conclusions. The extent and 
urgency of the problem are minimized and 
the wisdom of passing legislative measures 
for the subsidy of rural health agencies is 
deprecated. As it often happens with officials 
of organizations, those representing the State 
medical society are inclined to be conserva¬ 
tive and seem to be morbidly afraid of such 
catch-words as paternalism, State-socialism, 
etc., although there is little reason to be 
afraid of any change, no matter how radical, 
when one reflects that the average income of 
physicians in this State is about $900 per 
year. Furthermore, from the farmer’s point 
of view, if the Federal and State Govern¬ 
ments may establish experimental stations 
for the improvement and sanitary care of 
his livestock and crops, there is no earthly 
reason why provision should not be made for 
the prevention of disease to himself and his' 
) family. 
Governor Smith, therefore, acted with rare 
Wisdom, when he recommended, in his mes¬ 
sage to the legislature,’that steps be taken to 
remedy the rural health situation at the ear¬ 
liest possible moment, and that subsidies be 
granted whenever and wherever necessary. 
Factors Involved in Rural Health Problems 
A thorough study of this problem shows 
that it is not peculiar to New York State 
alone; nor to the rural districts of the United 
States, exclusively. Every State in the union 
is confronted with the same difficulties. 
Pennsylvania has taken legislative action in 
By PAUL LUTTINGER, M. D. 
the matter which unfortunately has degen¬ 
erated, in many instances, into a source of 
political preferment. New Hampshire has 
just passed a law by which the various coun¬ 
ties are to establish hospitals for which the 
residents are to be taxed. European coun¬ 
tries, for a number of years, have had to con¬ 
tend with the rapidly diminishing number of 
country practitioners and a recent report in 
the British Medical Journal shows that the 
problem has entered an acute stage in Eng¬ 
land. 
Hitherto, those who have tried to remedy 
the evil, have taken in consideration only 
some of the factors which keep physicians 
from establishing themselves in the country. 
A thorough study shows that they are numer¬ 
ous; let us classify them: 
Owing to the unfortunately shrinking pop¬ 
ulation of the rural communities, the phy¬ 
sician finds it increasingly difficult to gain a 
fair livelihood, without undue hardship. 
Why? 
The doctor must spend a large amount of 
time visiting his wiWly scattered patients. 
This becomes especially burdensome in dis¬ 
tricts where the roads are bad and during 
the winter when the bad weather prevents 
communication altogether, or requires an ex¬ 
penditure of time entirely out of proportion 
to the compensation. 
Only a Few Survive 
It is true that there are still a few sublim.e 
souls, like the Dr. Brown, so lovingly de¬ 
scribed by Mrs. R. M. Roberts in a recent 
article in the American Agriculturist, who 
labor in the vineyard of the Lord without 
any thought of monetary considerations. 
But when ministers of the church themselves 
are insisting on getting a higher living, ow¬ 
ing to the increasing demands made upon 
them by the exigencies of modern life, no 
one should expect the physician to be the only 
self-sacrificing individual in the community. 
It would be an injustice to himself and to 
those depending upon him. Even a young 
physician, just out of college, could not do it 
if he would, as he is usually heavily in debt 
for his college course; the expenses of a mod- 
' ern college course amounting to from $5,000 
to $8,000. 
A generation ago, the country physician 
not on'iy had a larger population to draw 
from, but treated all classes—the rich, the 
poor and the middle class. Nowadays, the 
wealthy and even the middle class, thanks 
to the improved methods of transportation, 
go to the city and even to the metropolis for 
the cure of any ailment which seems to be¬ 
come more serious than an ordinary cold. 
Those depending on the rich, such as poor 
relatives and servants are also attended by 
the city physician or hospital. 
The cost of living was formerly lower in 
the country; but this difference has disap¬ 
peared. This is due to the fact that clothing, 
furniture and other household necessities 
have to be fetched from the city and that the 
cost of ordinary food is about the same. Any 
article of food to vary the monotony of the 
rural diet must be brought from the city. 
The fees paid the country prap- 
tioner are lower than those paid 
to his urban colleague, besides, 
he is supposed to furnish his 
own drugs in the majority of 
cases. Furthermore, he loses 
valuable time doing the work that 
the nurse and orderly are dele¬ 
gated to do in the city. As an 
added drawback may be men¬ 
tioned the fact that his bills are 
not paid promptly, while the 
city practice is a 90 per cent 
cash practice. 
The average farmer is not prone to call the 
doctor frequently while the city physician 
has a lucrative practice from slight or even 
imaginary ills. 
Years ago, the sanitary conditions in the 
country were better than in urban communi¬ 
ties, or rather city conditions were worse 
than those prevailing in rural districts. The 
reverse is true now, as may be gathered 
from the statistics collected by the State de¬ 
partment of health. While in former times 
the farmer boy was warned against con¬ 
tracting disease in the city, the vacationists 
are now vaccinated against typhoid fever be¬ 
fore they go to the country. The water sup¬ 
ply, the sewage disposal and the unsanitary 
conditions of many homes, are sources of 
constant danger to the country physician’s 
family. 
Hospital accommodations are almost non¬ 
existing in most of the rural communities 
and the physician knows that in case of 
serious illness or accident to his family or 
himself, he would have to be transported to 
the distant city, which means lessened 
chances of recovery due to exposure or shock. 
Nurses are scarce in the country; con¬ 
sultants, specialists and diagnostic labora¬ 
tories are found in the cities only. All this 
adds to the dread of sickness, not counting 
the extra expense that it may involve. 
The schools in the country are of the gram¬ 
mar grade and the children must often go 
far to reach the “little house with the red 
roof.” If he wants his children to receive 
a higher education, the doctor must send 
them to district high schools or still farther 
colleges. As an alternative he may employ 
expensive private tutors. In most instances 
l {Continued^ pri page 542) 
Keeping the Country Doctor 
W E have had a number of discussions by our readers on the 
problems of medical service in the rural districts. These dis¬ 
cussions were written by laymen. Here is an article from a doctor’s 
standpoint. Do you agree with him?—The Editors. 
