Although the county health officer is necessary for the administration of the technical aspects of public health administration, the most important gains in the health of the rural community will come through the personal education of its people on matters of hygiene and sanitation. This is the field of public health nurses, and I believe that the records of their work in rural communities will show that they have done more for health education than any other one agency. A decade ago trained visiting nurses were practically unknown in rural communities. In 1914 the American Red Cross first organized its Town and Country Nursing Service and coöperated with a few rural communities in supervising the work of trained public health nurses, but relatively few places employed rural nurses prior to the war. The county tuberculosis societies also employed visiting nurses who worked throughout a whole county and whose work inevitably created a demand for visiting nurses for a more general service. The shortage of physicians during the war and the influenza epidemic of 1918 revealed the need for rural nurses and since the war the local chapters of the American Red Cross, which is devoting much of its attention to public health work, have employed hundreds of rural public health nurses.
The success of school nurses in the cities has led to their employment in the smaller towns, and now county school nurses are being employed in individual counties in several states, and in other states school nurses are employed by townships or jointly by several rural school districts. Wisconsin and Ohio have recently enacted laws compelling every county to employ at least one public health nurse, and a dozen or more states have passed legislation making the employment of county or local nurses optional. Under whatever auspices they are employed, rural public health nurses have found that their most effective work may be done at first in connection with the schools. Medical examination of school children is now required in many states, but unless it is followed up by some one who will see the parents and encourage them to secure the necessary medical or dental treatment, the results of these examinations are often disappointing.