“Priest-doctors” as a rural health service in the age of Enlightenment

Tim ExTNSION ofmedical care and health education in remote and sparsely populated rural areas has now become one of the main objectives in the plans for the development of health services throughout the world. Rural health services are receiving, deservedly, a high place in the order of priorities of development planning.1'2 In some countries rural health schemes have already been successfully established on a large scale as, for example, in Russia and China.4 It has been generally realised that any extension of medical care on a large scale cannot, for various reasons, be achieved by creating a large additional supply of fully trained doctors in rural areas. It has been found necessary to build up a cadre of auxiliary health personnel to deal with the primary health care of the population. The great interest in schemes of this nature is by no means confined to those who are entrusted with the improvement of the health of developing countries. In the U.S.A. a number of schemes employing auxiliaries are now on trial,5 and in Canada6 and Great Britain7 the possibility of creating health care teams relying primarily on para-medical personnel is being explored. The attention given to rural health problems, especially in developing countries, and the proposed means to deal with them may seem novel to us at the present time. However, the importance of adequate medical care in agricultural areas had been recognized long ago and measures to relieve the plight of the rural population have been proposed from time to time in different European countries. The suggested methods to deal with the problems of under-doctored countries then differ remarkably little from those which are expected to remedy the lack of suitable health personnel in similiar locations in our time. In the eighteenth century the main deficiencies which were then thought to merit