Health on the Farm and in the Village.

A REVIEW OF RURAL HYGIENE Dr. C. E. A. Winslow, professor of public health at the Yale School of Medicine, has undertaken a review and evaluation of the Cattaraugus County Health Demonstration, with special reference to its lessons for other rural areas.l Cattaraugus County is in New York State, and has a fairly stable population of 72,000, engaged chiefly in small inidustry and dairying, but included in the population are some thousands of Indians in a reservation, and Poles. As early as 1916 a county tuberculosis sanatorium had been provided, and in 1923 the health programme was launched, largely as a result of grants from a fund known as the Millbank Memorial Fund. The total appropriation bor public health work in the county reached a maximum of 176,000 dollars in 1927, and fell to 160,000 dollars in 1929, the latter figure being equal to 2.20 dollars per head of population, an expenditure greatly in excess of that of any other county in the United States. Of the 2.20 dollars per head, 1 dollar came from the county and its local units, 50 cents from the State, and 70 cents from the Millbank Memorial Fund. Prior to this commencement of the demonstration the total county expenditure in 1922 was only 34,023 dollars, or less than 50 cents per head. It is interesting to note that there are 3,000 counties in the United States, of which 2,500 are essentially rural, and of these less than 500 have a full-time county health service. In only 14 of the 442 counties having a full-time public health service does the per capita expenditure exceed 1 dollar, and 79 per cent. of the counties spend less than 51 cents per head oin public health services. Although the health expenditure in Cattaraugus County is nearly double that of any other county in the States, it is doubtful if it equals similar expenditure in many of the English counties, and any British reader of Dr. Winslow's review must realize the comparative inadequacy of the health services provided in the rural areas of the United States. The county board of health of Cattaraugus is a body of seven, of whom two must be members of the medical profession. The chief executive officer has the title of county health commissioner, and there is a whole-time deputy commissioner. Within the last five years legislation has been enacted which, in counties with a health service, abolishes the health officers of areas with less than 3,000 population, and in larger districts makes the health officers responsible to the county health department. Without doubt the health programme of Cattaraugus County is very comprehensive, but its execution is by Ino means complete.