The conditions under which homes and their surroundings are kept healthful in the city and in the country differ in many respects, although the principles underlying them are essentially the same. In the city the sanitary condition of homes is maintained chiefly by a system of cooperation and centralization which brings into existence extensive sewerage systems, water supplies, and the collection of house waste by public authority. Regulations are prescribed and enforced under which the individual household must avoid all conditions which are likely to prove dangerous to the health of the immediate neighborhood and of the entire community. In the country districts, and more particularly in isolated homesteads, the conditions affecting the health of the household are largely in its own hands, and more individual effort is required to maintain healthful surroundings than in cities. The farmer must supply himself with his drinking water and must get rid of the waste of the household as best he can. On the other hand, the inhabitant of the country is in many ways better off than the dweller in large cities. Not only has he pure air to draw upon at all times, but he can supply himself often with purer food than is possible in large communities. Though he must procure for himself drinking water, he is, in most cases, able to get a purer water from the ground than the sewage-polluted fluid which is the only water accessible in many cities. While he must get rid of night soil himself rather than have it disposed of by a water-carriage system conveniently located within the house, he may avoid the annoying complications of plumbing, bringing with it the leakages of sewer gas, the plugging up of soil pipes by the roots of trees or by articles carelessly thrown into them. Moreover, he has it often within his power to acquire sufficient land around his house to take charge of all sewage and waste and to utilize it as a manure for enriching the soil. Nevertheless, it must be acknowledged that when the circumstances under which healthful surroundings are procurable are under the immediate control of each individual household they are apt to be perverted through ignorance and neglect. Conditions may then arise which are not only unfavorable to health, but which are likely to lead to severe sickness at any time when the opportunity presents itself.

Standing between the fortunate inhabitant of a large city whose water-supply and sewerage systems are above reproach and the farmer who bas it within his power to make them so with reference to his own wants, is the half-developed village or town, with its chiefly unsanitary conditions. Here the leaky cesspool still exists, close by the family well, or by the neighbor's well. The absence of any system of collecting garbage and miscellaneous waste shows itself by the littering of the yards, the alleys, streets, and even stream beds with all kinds of refuse. In some towns the premature introduction of a water-supply system causes the ground to become still more thoroughly saturated with diluted sewage, so that the wells of those households not yet connected with the water-supply are a continual source of danger. In such communities, appreciation of the necessity for a public control of sanitation has not yet made much headway. The acts of each family violating the laws of health not only react upon itself but upon the immediate neighborhood, often with disastrous results. When typhoid fever has once gained a foothold in such communities it is apt to develop into an epidemic.

The tendency of our population to concentrate in villages and towns makes the sanitary improvement of such communities a most important and vital condition of national health and prosperity. The following pages are not intended for these communities, for they need, in most cases, the advice of sanitarians and sanitary engineers, acquainted with local conditions. Still, they may be of service in pointing out the dangers which may and do actually beset the population that neglects to dispose of refuse and waste in a manner which does not clash with the laws of health.

The chief dangers which threaten rural inhabitants are those arising from polluted drinking water. This is infected from the household excrement and barnyard drainage, as will be described farther on, and its use leads in the main to bowel disturbances, typhoid-fever, and dysenteric affections. It might be claimed that in an isolated homestead the danger is absent because the night soil from the healthy household can not contain the germs of typhoid-fever, and, therefore, the well water can not receive them from leaky cesspools and surface drainage. This would be true if the family lived secluded from other human beings. As the case stands, there is much more communication than is at first thought supposed. There is more or less coming and going of farm hands and other hired help, of tramps, peddlers, etc. The farmer travels more than formerly. He frequently visits neighboring communities. The children go to school. As it has been shown that there may be mild cases of typhoid-fever passing unnoticed, in a farm hand, for example, who leaves on account of ill health, perhaps, and who has meanwhile, in his discharges, deposited the germs of this disease on the premises, it is evident that isolation nowadays does not exist except in remote, thinly settled regions, and that disease germs may make themselves suddenly felt in an unexpected manner in any farmhouse.

There are other important reasons, however, why rural sanitation should not be neglected. The health of the large communities of people who draw their food supply from the country is in a measure dependent on the health of the farming community. There is scarcely a city child who is not, in a degree, dependent for its health on the sanitary conditions prevailing in the house of the dairyman. Milk has been repeatedly shown to be the means of distributing typhoid-fever and other diseases. Any vegetable foods from the farm eaten raw are liable to become carriers of infection under unsanitary conditions.

In many parts of our country other causes operate in making the health of many people depend on the proprieties of country homes. The thousands of city people, who flock every summer to the country and bring to the farming community considerable sums of money, should be properly protected against the dangers of polluted water and infected milk by the adoption of suitable methods of sewage disposal. Too frequently those who left the city for the purpose of gaining strength by breathing pure air, drinking pure water, and eating pure food, only return with the germs of an often fatal disease within them to swell the typhoid statistics of our large cities.