Lack of medical attendance is most serious for the farm mother during confinement, and the mortality of rural mothers during childbirth, as shown by the investigations of the U. S. Children's Bureau, is an indictment of our supposed civilization. When we learn that in a homesteading county in Montana there were 12.7 deaths of mothers per 1,000 births, which is twice the rate for the United States as a whole, which is higher than that of fifteen foreign countries for which statistics were available in 1915, we face a condition which cannot be neglected. When we find that in Wisconsin this rate was but 6 per 1,000, and that 68 percent were attended by physicians, and in Kansas it was but 2.9 per thousand and 95 percent had physicians, while in Montana only 47 percent were attended, loss of life due to isolation and lack of medical care is apparent. In sparsely settled regions the solution of this problem seems to demand the provision of local maternity hospitals, for the difficulty is primarily one of isolation.
Since medical science has shown that sparkling spring water may carry the deadly typhoid germ as a result of distant contamination, that wells are frequently contaminated by nearby privies or barn yards, that malaria is carried by mosquitoes, and that the house fly may carry typhoid fever and intestinal diseases of infants, we have come to appreciate that isolation and pure country air do not insure freedom from infection, and that sanitation is as important on the farm as in the city. Indeed the transmission of disease by flies is much easier on the farm, for too often the manure pile where they multiply is not far from the house, while in many a city the smaller number of horses and the cleaning of manure from the streets prevents their increase. The sanitation of the farm home thus becomes a very large factor in the health of the rural community. Surveys made by health officers in recent years have shown the general need of better sanitary provisions and also the possibility of the direct benefits secured from their improvement. In Indiana the State Board of Health surveyed nine typical rural counties taking only the homes on farms and in unincorporated villages. The average score of 6,124 rural homes in these nine counties was but 56.2 percent, the average for individual counties varying from 43 to 61 percent. In 1914, 1915, and 1916, the U. S. Public Health Service made sanitary surveys of 51,544 farm homes in 15 rural counties scattered throughout the United States, but mostly in the South. Its report[55] states that only 1.22 percent of these farm homes were equipped for a really sanitary disposal of human excreta, while in one county in Alabama less than 20 percent of the farm homes had toilets of any kind. "Sixty-eight percent of the water supply used for drinking or culinary purposes was obviously exposed to dangerous contamination from privy contents"; and only 32.88 percent of the houses were effectively screened against flies. A very considerable improvement in farm sanitation has resulted from the educational campaigns conducted during the past decade, but effective rural sanitation awaits the employment of public health officials who will convince the people of each local community of their individual responsibility for the health conditions on their own farms and of their common liability for the health of each other.