It is a fear of this professional isolation which causes the average young doctor to start his practice in the city where he has better facilities, and which is largely responsible for the small number of young doctors in rural counties. It is, of course, impossible to have a hospital in every hamlet, but it is possible to have a good hospital and laboratories at every county seat or small city center, so that there will be at least one such medical center in a county. Legislation has now been enacted in several states making it possible for counties to support a public hospital just as the larger cities have done for many years. Here clinics may be held from time to time, to which eminent specialists may be brought for the diagnosis of different cases, to the advantage of both patient and physician. It is quite impossible for a busy country doctor to maintain a private laboratory and to provide himself with all the expensive equipment for making examination and tests of blood, sputum, urine, for X-ray examinations, etc., but the hospital may have all this equipment at his service.
One of the most important features of the domestic program of the American Red Cross is the promotion of so-called "Health Centers," a movement which is also sponsored by the American Medical Association and other national health organizations. Such a health center may include a hospital with well equipped laboratories and clinical facilities, or it may be nothing more than a room in a small village, equipped with scales for weighing children, with first aid kits for accident cases, and used for occasional clinics for the examination of babies and children of pre-school age and for classes in home nursing or first aid; but every community of any size should have some place which will be a headquarters for its local health Service, equipped as may be most practicable to meet its needs, according to the size of the community.
Curiously enough the local physicians, who would be most helped by such improved health facilities and whose practice would be benefited by them, are often their chief opponents. The leaders in the medical world, who are keen for all practicable means of improving the public health, heartily support the "health center" movement.
We are coming to the time when the maintenance of health will be regarded as a public function just as education is now provided for all the people and supported by them. That country people are alive to the need of better health facilities is shown by a resolution of the recent (February, 1922) Agricultural Conference called by President Harding at Washington. Its committee on farm population reported:
"The safeguarding of the health of the people in the open country is a first consideration. Any program that looks toward the proper safeguarding of health must include adequate available facilities for the people in the open country in the way of hospitals, clinics, laboratories, dispensaries, nurses, physicians, and health officers. This committee endorses the growing tendency through public agencies to maintain the health of the people by means of these facilities and agencies."
The life of rural people in America is no longer threatened by the invasion of human foes, but it is constantly threatened by disease. It would seem that the first public concern would be for the maintenance of the health—the very life—of its people, but as yet we have given much less thought to health than to education. The New York State Department of Health has as its slogan: "Public health is purchasable. Within natural limitations any community can determine its own death rate." This is no longer theory, but can be demonstrated by official mortality statistics. The death rate has declined more rapidly in cities than in rural communities because the cities have given more adequate support to public health organization. The rural community has all the natural advantages in its favor and will ever have the most healthful environment, but it must recognize that if preventable disease—with all its attendant evils to the family and to the individual—is to be reduced, this can be accomplished only through education and public health agencies. Better health is a matter of the hygiene of the home and the individual, but it has also become a concern of the common life—a community problem.
FOOTNOTES:
[54] "A Study of Sickness in Dutchess County, New York." State Charities Aid Association, New York City.
[55] L. L. Lumsden, "Rural Sanitation," U. S. Public Health Service. Public Health Bulletin No. 94, Oct., 1918.
[56] See Dr. W. S. Rankin, "Report of Committee on Rural Health," Proceedings Second National Country Life Conference, p. 93.