HEALTH PROBLEMS IN COUNTRY DISTRICTS, 

 TRANSVAAL AND ORANGE FREE STATE. 



By Jane Buchanan Henderson Ruthven^ M.D., L.R.C.P.» 

 L.R.C.S.E., L.R.F.P.S, F.R.S.A. 



{Read, July 12, 1918.) 



The following paper has been written as a result of my 

 experience during 15 years of work as a medical practitioner in a 

 country district of the Transvaal, and from information obtained 

 in several driving tours extending into the north-western part of 

 the Orange Free State. 



Although written in general terms, it could have been 

 illustrated, had time and space permitted, by definite cases which 

 have come under my own observation. Most of the suggestions 

 express my emphatic opinion as regards what is urgently required 

 at the present moment, and what is absolutely essential as a 

 preliminary to any satisfactory permanent scheme of closer settle- 

 ment. 



There are two aspects of family life to which I wish to draw 

 attention. Firstly, the actual one of producing a family with 

 all its risks to the mother and the new-born infant. In the 

 country there is absolutely no provision made for help at such a 

 time as this. Among the farms the women are helped by an 

 elderly woman, who has gained knowledge by experience, and, 

 as nature is kind, the results are apparently fairly satisfactory. 

 In every farm-house you will find a man and his wife and 

 children. What more can you want? But look into matters a 

 little deeper and you will in many cases find that a compara- 

 tively young man has his second or third wife, and the children 

 represent mothers who have died. With a kind of comfortable 

 fatalism, or resignation to the will of Providence, they accept the 

 inevitable ; the Orphan Chamber sees to the dividing up of the 

 farm ; and the man looks round and hopes for better luck next 

 time. 



The country Boer, who lives by the traditions of his fathers, 

 or, rather, I should say his mothers, grandmothers, and aunts,, 

 may be satisfied, but a new era is approaching; it has already 

 begun. Men from overseas, tired of mining, or put off the mines 

 on account of miners' phthisis, are willing to go on to the land 

 with their wives and children. They hire a piece of ground, trek 

 out with their belongings, hire a neighbour to plough up the 

 ground, and prepare to sit in the sun while the mealies are 

 growing. The woman has another thought — a new baby is in 

 prospect. What is she to do? In former confinements she has 

 had some of the amenities of modern care and nursing. She is 

 afraid of the local " Tante," with her old-fashioned ways and a 

 language which is strange to her. Her own people are away 



