568 SCIENCE IN AFRICA 



RURAL HYGIENE 



The relative claims of towns and rural areas for special attention 

 by medical departments and missions have been discussed in 

 Chapter XV, pages 462, etc, and the existing organizations 

 devoted to improving health in rural areas are outhned in pages 

 471-503. In this section examples are selected to show how far 

 some of the major problems of rural medicine and hygiene are 

 provided for by these agencies. The need for further health services 

 for rural areas in the British colonial territories was emphasized 

 in a series of papers relating to the health and progress of native 

 populations published by the Colonial Office (193 1). 



The desirable minimum medical and sanitary service for a large 

 rural district has often been discussed, and the definition by 

 Dr. A. R. Paterson (1928b), which has been adopted as the 

 official scheme for the development of services in Kenya, may 

 be given. Paterson considers that there should be at least one 

 district medical officer, one medical officer of health, one dispen- 

 sary medical officer, two European nursing sisters, one European 

 sanitary inspector to train natives how to make permanent sanitary 

 dwellings, perhaps a European hospital assistant and storekeeper, 

 an adequately trained and disciplined native subordinate staff, 

 a hospital with accommodation for about 100 patients, and from 

 six to twelve out-dispensaries; and, as an essential part of the 

 service, good housing for the staff. This outline represents only 

 a skeleton staff compared with that which will be required to 

 destroy disease and maintain health in a quarter of a million 

 people. Accordingly it is recognized in every territory in Africa 

 that adequate provision depends on the employment of trained 

 African personnel, a question discussed in Chapter XV. 



The Pan-African Health Conferences of 1932 and 1935 (League 

 of Nations 1933b and 1936) gave special attention to the question 

 of hygiene and medical services in rural Africa. From the several 

 reports and resolutions adopted at these conferences, the following 

 general principles emerge: 



I. In countries with a large backward population the preven- 

 tive and curative functions cannot be separated in field personnel. 

 In urbanized areas and some well-advanced rural areas, where 



