de, but one of Dutchess County,[54] New York, in
1915 well illustrates the conditions which would doubtless be found in
many another rural county. This survey covered five districts of the
county with an aggregate population of about 11,800--most of which was
rural territory. 1,600 cases of serious illness were found to have
occurred during the year. "Some 9,000 days were lost by men and women of
working age (15 to 54 years). Children lost 13,700 school days. On the
average this cost the community for each child at least 33 cents a day
for which it received no return. These two items safely represent a
money loss of $20,000 to $25,000." As a result of the study it was
estimated that the total money loss occasioned by sickness in a year
within the whole county would be at least $412,000. "Of the 1,600
patients whose care has been analyzed in this report, 72 percent could
have been cared for adequately in their own homes had there been
available medical and nursing service. The remaining 28 percent (442
patients) could not have been cared for adequately in their own homes
... 24 percent of the patients secured no medical care. Many startling
instances of unnecessary and indefensible suffering and misery were
found.... Of the 113 women who went through childbirth in their homes,
only one had the continuous care of a graduate nurse, and only 18 had
any service whatever from graduate visiting nurses. 35 percent of the
children born came into the world under unfit conditions and
surroundings." Largely as a result of this study, Dutchess County now
has an efficient county health association through which a number of
public health nurses are employed, who visit all districts of the
county.

One of the most serious handicaps in maintaining the health of the rural
community is its frequent lack of medical service. The number of doctors
practising in the open country was always inadequate, but in recent
years it has decreased until now many large sections are without any
resident physician. The influenza epidemic of 1918, following the
shortage of doctors during the war, revealed the plight of many a rural
community without medical service. The higher standards now required by
medical colleges and state licensing boards has resulted in a real
shortage of physicians and the young men are not going into the country
to practise. A recent study made by the New York State Department of
Health showed that in 20 rural counties 88 percent