Garynahine, 12 October 1912 - Dr Victor Alexander Ross

11,249 (Chairman) You are a Graduate of Edinburgh University, and you have been twelve years here ?

11,250 You had five years’ experience of practice in England before you came here ?

11,251. Had you a club practice there ?
—It was nearly all club practice.

11,252 Could you give us the particulars of it now? How many members were there ?
—I could not say. I was assistant there.

11,253. Did you like it ?

11,254. Was that on account of the character of the practice or the remuneration?
—The nature of the practice.

11,255. You might give us an indication of the extent of the territory you have to cover. Can you give us the
—About 40,000 acres.

11,256. The population is 4462 ?
—Yes, of course it varies considerably at different times of the year.

11,257 Is it very much scattered, or are the people in townships?
—In townships.

11,258. The townships, I suppose, are very widely scattered?
—Yes, the farthest off one is thirty miles off.

11,259. Is that a considerable township or a small one?
—A small one, with about 200 inhabitants.

11,260. You are unable to give the proportion of patients at the various distances from you. Are there any within three miles? Have you a township within three miles ?

11,261. What is the population of that township?
—About 300.

11,262. Have you any population between that and five miles ?

11,263. What population would you say it would be ?
—I should think a matter of 200 or 300.
(Mr Orrock.) If you give the township, I can give you the population. Callernish has a population of 257, Breascleit has a population of 391——that is between two and four miles from Garynahine—Breascleit Park 33, Tolstachaolais 219, Doune Carloway 168, Cirrabhig 105, Upper Carloway 389, Knock Carloway 207, Borraston 113, Gearranan 212. These are all on the north-east side of Loch Roag; they are all within ten miles of the doctor. The total population is 2109. The population on the south side of Loch Roag, including the island of Bernera, is 2326.

11,264. (Chairman.) How far is that off?
—Brenish is thirty miles off, but the bulk of the population is just surrounding the coast. It is ten miles by sea and twenty miles by road to Valtos.

11,265. Have you many of those townships without a road fit for.tratfic ?
—We have no townships without roads except a few small places in the Island Bernera.

11,266. Is there wheel traflic on that island at all ?
—There are no carts at all.

11,267. You have a good deal of sea work?
—My principal sea work is to the island of Bernera, which I do by motor-launch.

11,268. Is it your own ?
—No, it is a public motor-launch which goes every day.

11,269. Is it dangerous crossing to the island ?
—It is just like all the other places.

11,270. Your means of getting about the country are by motor-car, motor bicycle or ordinary bicycle. What do you use most ?
—Since March I have used my motor bicycle continuously.

11,271. Can you tell us what it costs you to run it ?
—The initial cost was £55 exclusive of petrol ; I find it costs me about £10, for the time I have had it.

11,272. Can you tell us how much petrol you use ?
—It is supposed to do 120 miles to the gallon of petrol. I have certainly done the 60 miles on half a gallon of petrol.

11,273. Would you say it would cost you £30 a year to keep the motor bicycle?

11,274. Would that include anything for depreciation?

11,275. You have not thought of getting a motor—car ?
—I have thought of it many a time, but it is beyond me.

11,276. Would it be of great convenience, not only to you but to your patients?
—Yes. A motor bicycle is a fine weather machine; a motor-car you can take out at any time.

11,277. If you could afford it you would have a motor-car ?
—Yes, certainly, long long ago.

11,278. Your house is not very conveniently situated ?
—No. It is more inconvenient for my patients. It is a very small surgery. It is only a few feet square. You have to take your patients into your kitchen. There is no convenience as regards pantry, scullery, or anything like that.

11,279. The Parish Council have no power to build a house ?

11,280. You get £200 as medical officer and public vaccinator ?

11,281. You have seventy-nine paupers and sixty—two dependents to attend to for that ?

11,282. I suppose this salary is given to you, as it is in almost every case we have come across in the Highlands, so that they may retain the services of a doctor in the district ?

11,283. So that really the paupers get better medical attendance than the very poor who are just over the line?
—I would not say that. The paupers are not much trouble.

11,284. The paupers are entitled to medical attendance, and the people who are above the pauper line are not, and they are not able to pay for it?
—Yes, of course they don’t pay for it.

11,285. What about vaccinations? Do you find that the law that was passed with regard to conscientious objectors has lessened the number vaccinated.
—Yes, considerably.

11,286. To what extent ?
—Not so much in the East Ward, but in the West Ward the number had decreased considerably.

11,287. We have had evidence that there are hardly any vaccinations at all ?
—There are hardly any in the West Ward.

11,288. There is no local club ?

11,289. Has it ever been tried ?
—Not in this parish, but it was tried in the parish of Lochs.

11,290. We had evidence of a club system, one in North Uist, that is managed by the factor, and it works very well. Have you ever thought of that as a means of improving the medical attendance, not only to the people, but as an improvement on the remuneration of the doctor ?

11,291. Supposing you have a patient thirty miles away, you cannot pay a visit for less than 30s. Is not it a little hard that these people living at that distance should have to pay 30s. and those living nearer the doctor should get it cheaper?

11,292. Don’t you think the people nearer at hand should pay?
—In that light, supposing I was paid 2s. 6d. for visiting Brenish, it would pay me quite as well as charging 20s. or 30s., if I got over the difficulties of travelling.

11,293. It is the cost of travelling ?

11,294. You can never get an adequate fee from the people at these distances ?
—You cannot charge an adequate fee. It is better to charge a small sum and get it.

11,295. It is the doctors who are bearing the cost of medical service in these far-off places ?

11,296. Don’t you think there is something in the view that the charge should, as far as possible, be spread over the whole population ?
—Yes, as nearly as possible.

11,297. Do you see any objection, from your experience of the practice here, to an arrangement whereby each family should pay a certain sum, and that that should be put into a central fund which would enable the doctor to visit the distant patients at thesame rate as those near at hand. It would provide the cost of his travelling?
—Would you make it a family matter ?

11,298. Yes ?
—I have a rooted objection to a club system

11,299. Does not it appeal to you as being rather a fair method of getting over the difficulty ?
—Yes, certainly

11,300. There are many households that us? have a doctor ?
—My experience of club systems was that as soon as that system was introduced the demand were greater.

11,301. There_must be some protection for the doctor?
—It would work all right if there was some protection for
the doctor.

11,302. Supposing that was provided for in this way that there should be a fee, a check fee, for each visit; how would that do ?
—Yes, I certainly would approve of that

11,303. Or of a considerable sum for the first call, so that the doctor might see whether it was a frivolous one or not ?
—Yes, that is so.

11,304. You think that might work well enough if that were part of the scheme ?

11,305. Supposing that a scheme of that kind was arranged, what sum do you think the crofters could pay; per family as an annual contribution ?
—I could hardly say.

11,306. Could they pay 3d. a week ?
—Yes, easily.?

11,307. 3d. a week is 13s. a year ?
—They can easily pay it.

11,308. You think in this district they can all pay it?
—Yes ; I mean the household, not individually.

11,309. There are certain families who cannot pay it just the same as there are some who cannot pay rates and they would have to be relieved ?
—I don’t think so.

11,310. Roughly, what proportion do you think could afford to pay 13s. a year ?
—90 per cent., I think.

11,311. Can you tell us what the livelihood of the crofters is? They have their crofts?
—They cannot make much of their crofts. Of course, they have their stock

11,312. Their crofts give them milk, potatoes, and that sort of thing ?

11,313. They are fishermen besides ?

11,314. We have had. evidence that they make from £10 to £20 a year out of that?

11,315. We are told that most of them are either Naval Reserve men or Militia men?

11,316. A doctor told us that practically every man the island was a trained man?

11,317. And they bring home a sum with them?

11,318. Are the home industries in a good state just now ?
—The home industries within the last twelve months or so got a set back. I find now it is reviving. Before that they were making a considerable income out of home industries.

11,319. So that you think they could afford to pay 13s a year ?
—Yes, certainly.

11,320. Do you think they would pay it ?
—I think they would if they were shown the benefits they would derive from it. ,

11,321. You charge ls. per mile for your fee, but if you hire a motor you have to pay more than that ?
—Yes. Of course, I have to pay 1s. 9d. a mile. '

11,322. That is including the return journey ?

11,323. Do you think there are many people who don't get medical attendance at present—I mean people who are above the pauper line ?
—I don’t think so.

11,324. Do you think there are many of your patients who hesitate to call you in at anearly stage of their illness because of the fees they will have to pay?—Of course you will find exceptional cases in all practices. It is just the want of judgment ; they don’t hesitate very much.

11,325. You don’t get cases presented to you the that you would like to have seen sooner ?
—One would see that in any practice.

11,326. No more here than anywhere else ?
—Not in my experience.

11,327. How is the telephone and telegraph system developed here ?
—I should say there are telephone offices in every township.

11,328. No telephones ?
—They are all telephones.

11,329. Will the Post Office allow you to speak over the telephone ?

11,330. Do you see any reason why they should not?
—Not a bit.

11,331. Would it be of great convenience to you if you could consult patients over the ’phone?
—It would be a convenience if we could consult with the nurses with regard to a case over the ’phone.

11,332. Have you nurses at these distant parts?
—Yes, there are three nurses in the parish.

11,333. They are pretty well supplied with nurses?
—We would like more. I consider that nurses are very much more more valuable than medical service. I think they have had more educative influence in Lewis than the
medical men.

11,334. You attend very few confinements ?
—Yes, very few

11,335. They are mostly attended by nurses ?

11,336. They only send for you in bad cases ?

11,337. Has that always been the case in Lewis ?
—The nursing system has only been introduced since I came here. Before then it was done by local women.

11,338. About tuberculosis, have you very much of that?
—Yes, very much.

11,339. Is it increasing ?
—I think it is.

11,340. Can you give any reason for it ?
—I suppose insanitation and infection.

11,341. Some doctors have told us that they find a good many cases have either contracted or developed the disease in the South and come home with it ?
—There has been a great deal of that—servant girls going South,—but there has always been a taint in the family.

11,342. If they come home with the disease in an active condition, does it affect the other members of the family readily?
—Yes, almost invariably. I have known a single family to be cleared out in a few years by phthisis.

11,343. What about the housing; has that anything to do with it ?
—Undoubtedly. They are living in a constant atmosphere of smoke.

11,344. Supposing a family is cleared out with consumption, will another family go into that house ?
—They are fighting shy of it just now. They are fortunately not so much frightened of the house as they are of their furniture, and that sort of thing. They take a great interest in burning up the furniture.

11,345 You don’t burn up the house ?
—No ; I disinfect it well.

11,346. We find all over the country that doctors are disgracefully underpaid. I suppose you are no richer now than you were when you began ?
—I am not.

11,347. Are you married ?

11,348. You have three nurses in the district ?

11,349. They are the nurses supplied by the Association in Edinburgh ?
—Yes ; they are partly paid by the Association in Edinburgh and partly by the local Committee of the District County Council.

11,350. The nurses are trained by Miss M‘Phail’s Committee?

11,351. As to the training of the nurses, would you have proper hospital—trained nurses ?
—They are all trained.

11.352 They only have a few months’ training ?
—No ; some fo them have been trained for four or five years.

11,353. Are they Jubilee nurses ?

11,354. They are good ?

11,355. Are they native girls ?

11,356. They are sent South to be trained ?
—One of them had been South before. She was not trained by the Association.

11,357. In the case of maternity cases, do these nurses live in the houses of the people ?
—They live in the houses for the first night or two. They sit up all night.

11,358. Do they do the household work when they are there?
—Yes, they do a little.

11,359 Do they milk the cow and that sort of thing ?
—No, they do not milk the cow.

11,360 They do it in some places. I suppose there is always plenty assistance among the neighbours ?

11,361 You approve very highly of the importation of these nurses?

11,362. And if you had a telepone system it would be of great help?
—Yes. I often send wires if I am anxious about a case just to ask how the patient is, reply paid, and that sort of thing.

11,363. At your own expense ?

11,364. You have an hospital at Stornoway ?

11,365. It is quite satisfactory ?

11,366. How long have you been here ?
—Twelve years.

11,367. You think there should be a central authority in Scotland?

11,368 You say a central medical authority. Is that sort of Scottish British Medical Association ?

11,369 I think the question has more reference to a central authority ?
—With medical representation.

11,370 What do you say as to fixity of tenure for doctors?
—I have had very pleasant relations with the Parish Council.

11,371. You think the doctor should have some appeal to the Local Government Board?

11,372. Would you approve of the authority for arranging being the District Committee instead of the Parish Council?
—I think so, withthe right of appeal to the Local Government Board.

11,373. You would be likely to get a broader view taken of your case ?
—Yes. You might get justice.

11,374. Supposing they did an unreasonable thing, We have been told that the British Medical Association insert an advertisement along with their advertisement for a new doctor, and it prevents a doctor replying ?
—It does not prevent him replying, but it advises him about the thing.

11,375. We have been told that they refused to take an advertisement in, and that when the Journal appeared there was an advertisement advising the doctors about the advertisement appearing in other papers ?
—I never heard of anything like that.

11,376. You never got a holiday unless you supplied a locum for yourself ?
—No, that is so.

11,377. Do you find that a great disadvantage, not only to yourself but also to your patients ?
—I certainly think it is a great disadvantage,—a great hardship. My idea is that a man should get a month or six weeks to attend some hospital or post-graduate course to advance his knowledge.

11,378. Have you any other suggestions to make whereby the medical service could be improved in the Highlands, as to how the conditions of the doctor could be improved,
and how the general public could get medical service more easily and more readily?
—Increased facilities for travelling is the great thing here.

11,379. If that is to be done the doctor has to be helped?
—Yes, that is so.

11,380. He cannot do it himself ?
—That is so.

11,381. You also want an increase in telephonic and telegraphic communication ?
—We are well supplied with telephonic communication here. It would be very convenient to be able to speak to a nurse or patient through the telephone.

11,382. You also wish an increase of the number of nurses ?
—Yes, certainly. The style of living has improved through this means.

11,383. (Lady Tullibardine.) Could you tell us a little more particularly about the training of these nurses ?
—One of them has been three or five years in some Glasgow hospital.

11,384. She is a fully certified woman ?

11,385. Then with regard to the others, what training have they had ?
—I am not quite sure of the number of years she has been in Glasgow.

11,386. Would she be from the Govan Home ?
—I could not say.

11,387. She has less training than the others ?
—She is less confident, anyway.

11,388. Do you find that there is much difference between them, between the value of the two?

11,389. Do you find they have both an educative influence as regards hygiene in the house ?

11,390. Do you find that the fully trained nurse is less adapted to the conditions she finds in the houses ?
—Probably she is.

11,391. Less ready to give a helping hand in the house?
—Yes ; she is more of a “lady.”

11,392. Do you think there is any preference for the less highly trained nurse ?
—I would not say that. I would rather have a highly trained nurse. The people would not take to her so readily ; they would not understand her so readily. '

11,393. Did you find that with the more fully trained nurse ?
—They were shy of her for a bit.

11,394. Has that worn off?

11,395. You don’t find that they prefer the less highly trained woman because she can make herself more useful ?

11,396. (Dr Mackenzie.) You have no difficulty in keeping them in full employment?

11,397. They get plenty to do ?

11,398. (Chairman.) Are they Gaelic-speaking Women?

11,399. (Lady Tullvlbardine.) They nurse without a fee ?
—Yes. They make a charge for maternity cases, which goes to the funds of the association in Edinburgh.

11,400. They do a certain amount of preventive work. If there is any person bedridden or delicate they go in without being called in ?

11,401. Does that tend to diminish your work ?

11,402. Are you called in after that ?

11,403. You have more work in this parish than you have time to do?
—I have only had two messages in a fortnight. We are never hard worked except for three months in the year. I am worked hard from the middle of January to the latter end of March or so.

11,404. Is there any reason for that ?
—The people get poorer and their liability to respiratory diseases is greater. The children get bad then.

11,405. Is the money that they have made at the fishing running short by that time? —Yes. That is to say, they get poorer and they are probably without milk. Fish is scarcer, and food materials are scarce. For three months in the year I am kept pretty hard at it, with just quite sufficient to do. If I had not the nurses it would be more than sufficient.

11,406. For the other nine months in the year you have not enough work to do?
—No. We have just sufficient to keep us going.

11,407. You would be glad to have more work to do ?

11,408. Then I suppose that if the medical service here were subsidised so as to make it cheaper for the people you would expect greater demands on the doctor’s services ?
—I would.

11,409. In that event, would one man be able to overtake the work ?
—I think so ; with travelling facilities.

11,410. He would be able to attend to a population of over 4000 people ?
—Yes, serious cases I mean. I don’t mean to say that he would be able to attend to the small cases, the results of teadrinking and that sort of thing.

11,411. You want more nurses ?

11,412. How many do you think you require ?
—The nurses just now are rather overworked ; especially the West Uig one. I think there should be one extra in West Uig, and probably one in the East Ward. In the Middle Ward of the parish—that is the island of Bernera—she has a pretty easy time of it. There is a population of 700 there.

11,413. Are there many cases that you can attribute to over-tea-drinking ?
—Yes ; many cases, especially on the female side.

11,414. Do they not take much porridge ?
—No, unfortunately it has gone out.

11,415. They give the tea to the children too ?
—Yes. It is not tea ; it is a sort of bark. It is that sort of tea that constricts your tongue when you take it.

11,416. We gather from a paper sent in by the secretary of a local medical committee that the doctors as a whole in Lewis are opposed to a club system. Do you think the idea of a check fee to safeguard the doctor from trivial calls would meet their objections?
—I think so.

11,417 You don’t think they would prefer a system by which the fees could be reduced to a certain class of the population supposing the doctor were subsidised?
—Yes, I think that would be certainly the better scheme.

11,418. To a payment of 2s. 6d. ?
—Very little certainly be preferable.

11,419. Would that be more popular, do you think ?
—I don’t say it would be more popular.

11,420. We gathered from some witnesses that the club system might not be regarded as very popular ?
—One cannot answer that question very well. It has not been tried.

11,421. You cannot express an opinion as to the payment of a limited fee or a club system ?

11,422. But you think the doctors would prefer the limitd fee per visit ?
—I think so.

11,423. (Dr M‘ Vail.) Has school medical inspection brought you much work ?

11,424. School medical inspection is going on ?
—That is so.

11,425. And no doubt parents are notified when defects are found ?

11,426. And no doubt defects are found, but they don’t come before you ?
—They came at first with a note from the School Medical Inspector, but they have dropped it.

11,427. There is no system of school nurses to follow up the cases or to see that they do go to you ?

11,428. When they came at first did the system reveal to you the existence of conditions in a good many children requiring attention ?

11,429. There is a great deal of good medical work to be done if the children were brought to you ?
—Yes, or by trained nurses. For example, the nurses could see to running ears, and things like that.

11,430. And there are also adenoids and defects of eye-sight and hearing and glandular conditions, and even general anaemia and defective digestion that need to be seen to ?

11,431. Will these defects to some extent exist beyond school life ?
—I don’t see much of it in adult life.

11,432. But among the young people ?
—You don’t see much glandular enlargement.

11,433. Do you not see much tubercular disease, independent of phthisis ?
—Very little.

11,434. There is very little bone tuberculosis, and other forms ?
—Very little.

11,435. When you say that one medical man is able to look after this population, and, as a matter of fact, you are busy only three months of the year, is that because there are no conditions requiring attention or because the people are not alive to the conditions requiring attention, or if they are alive to them, is it because they are not able to afford to call you in ?
—I don’t think it is because of that they are quite able to afford it. There is a wonderful improvement here in the summer ; even really bad phthisical cases in the winter, cases that you think will shortly die improve remarkably in the summer.

11,436. Diseases among children are very much lessened in the summer ?

11,437. But they are there in the winter ?

11,438. It is not usually assumed that even in the city a medical man can attend a population of 4400 successfully; and I wonder whether the reason that you are not fully occupied with the crofters in the year is not that the conditions don’t exist requiring attention, but that they don't send for you. They have got into the habit of not sending on account of not troubling you, or is it on account of not being able to pay you ?
—I don’t think that troubles them very much.

11,439. Is it ignorance, or what is it ?
—There does not seem to be very much disease. Of course you cannot compare a practice in the centre of Glasgow with the nature of the practice here. In Glasgow the doctor’s existence depends on how many visits he makes. There may be a matter of
over-doctoring in the centre of the city.

11,440. The feeding conditions that you mentioned are likely to have effects on the children ?
—They look puny, certainly.

11,441. Would not the prevention of anaemia and that sort of disease afford a considerable field for medical work?
—Yes, or instruction from nurses for proper dieting.

11,442. Assume for a moment that it were possible to devise a scheme for medical attendance by which a medical man in a locality like this would have a net income that would not result in his being worse off at the end of twelve years than he was at the beginning, an income that would result in his being able to save something, and that that income would not fall as a burden on the people or prevent them from sending when occasion existed for sending; don’t you think that in that way there would arise a good deal more medical work than at present exists?
—You could make a great deal more medical work if you liked.

11,443. There is material for work if the condition were favourable?
—Yes; you could make a great amount of work. I am judging the amount of work by the calls I make.

11,444. The standard here is the number of calls that they think are necessary. It is the standard from their point of view, and they are not able to judge ?
—You can make work.

11,445. And useful work ?
—I don’t say it is useful; you could make it. I say the nurse could do more good than a medical man in many cases.

11,446. Do you think you would welcome a scheme of that sort, by which through compulsory local contributions possibly with check fees, subsidised from a central fund and mileage provided for you, you were guaranteed a reasonable income ?
—I would welcome it.

11,447. Would a small hospital be of great benefit to yourself and to the locality?
—I think so, provided there was a dispensary near it.

11,448. If there was an hospital, would it be better for you if it was in the centre of the population than if it was near you ?
—Yes, it would be better for my attendance.

11,449. (Mr Orrock) Where would you think would be a suitable place for an hospital in your parish ?
—Of course the bulk of the population is on the east side of Loch Roag

11,450. (Dr M‘ Vail.) You think that tuberculosis is increasing?
—Yes, I am afraid it is.

11,451. Don’t you think that affords a field for medical work ?
—Yes, public health work. If the public health matters remain as they are we cannot hope to battle with it. I

11,452. (Dr Mackenzie.) You don’t consider it is, a matter of private medical work here ; it is primarily public health work ?
—That is so. What I see here is too hopeless a matter for medical attention.

11,453. (Dr M‘ Vail.) What do you mean ?
—I mean how dissatisfied one is with what headway one makes the district.

11,454. But all you have really asked is the telephones?

11,455. And you point out the great conveniences these would be ?

11,456. You have spoken about the feeding, that children get porridge hardly at all?
—No. They have got an unfortunate system at home; that is sending them away to the school with one of these hard cabin biscuits and a cup of tea.

11,457. That is their breakfast ?

11,458. Why is that? Is it ignorance or laziness on the part of the parents ?
—I am afraid it is both. It is easier to make a cup of tea and give them a biscuit than to make porridge..

11.459. Has the nurse any effect in changing that ?
—They are continually preaching it.

11,460. With any good result ?
—I am afraid it is very little. Of course the woman here is really the hard-worked
member of the household.

11,461. What does the man do ?
—The man works a certain amount of time in the year. The woman has the household duties to do, peat—carrying, and all that sort of

11462. Could not the man carry the peat ?
—They do in some cases.

11,463. (Chairman) How many ministers have you in the parish?
—Only two ministers, and any amount of lay preachers.

11.464. How many churches and congregations have you?
—Ten churches.

11,465. (Dr Mackenzie.) How many sects ?
—About three sects. There is only one Catholic in the parish of Uig.

11,466. (Dr M‘Vail.) Where were you born ?

11,467. Where were you in practice in England ?
—In Darlington.

11.468. Would you rather have the work here with all its disadvantages if you had a decent living ?
—Undoubtedly I would.

11,469. Have you thought of leaving ?
—When one gets settled down in a place with a family, it is difficult to think about leaving.

11,470. How can you educate your children here ?
—The schools are very good here. Schools are exceedingly well provided in Lewis.

11,471. (Dr Mackenzie.) Better even than in other parts of the county ?

11,472. (Mr Lindsay.) I have heard it said that these sheilings are a good influence in maintaining the health of the people ?
—It is an extraordinary improvement one sees in these sheilings.

11,473. What are these sheilings ?
—They are just shelters on the moor. They go in the month of June and stay out for two or three months. They are confined and restricted there to a purely milk diet.

11.474. (Dr Miller.) It is a very deplorable state of matters that this hospital in Stornoway which was provided for the benefit of the people should not be utilised to any great extent ?

11.475. Do you think that Dr Mackenzie, if his influence is not exercised on the hospital, would prevent the hospital being much used, even if other arrangements were made?
—You mean, if there was a resident doctor there he would also have to rely on a local practitioner, especially in cases of operations?

11,476. You don’t think if they introduced a resident man with a retaining fee of £60 or £80 a year, that that would help? I mean, would you outside practitioners have much hesitation in sending your patients to a young graduate from Edinburgh?
—I would not send them. I always send cases that require dieting to the hospital, but the more serious cases of operations are sent to Edinburgh, Glasgow and Aberdeen.

11,477. You do that in any case, even although Dr Mackenzie is there ?

11,478 (Dr Mackenzie.) I want to say I have been equally impressed by your evidence, but I am not surprised about it because for years we have known of your splendid work in this parish ; in fact, recently you and your nurses have been overwhelmed with epidemic work which should have been the work of the Public Health Authority. What is the population of your West Ward ?

11,479 Are you often in that ward ; do you go periodically?
—If there is any urgent case I am there almost daily.

11,480. Is there much pneumonia in these two wards of the parish?
—No ; very little.

11,481. Is there much catarrhal condition in children?
—There is a tremendous amount of that. Of course you cannot help having that if you live in these houses with the smoke.

11,482 Do you think that is a large factor in the incidence of phthisis ?
—Yes, I think it has a great deal to do with it.

11,483 Is there much catarrh and broncho-pneumonia among the children ?
—A great deal.

11,484. And among the school children ?
—Yes, in spring there is.

11,485. Is there a great deal of chronic bronchitis among the middle-aged people?—Yes.

11,486. Are you called in to treat these cases ?

11,487. Perhaps with that rheumatism and dyspepsia will be the bulk of your practice ?

11,488. Dyspepsia is probably brought on by the large amount of tea drunk ?
—Yes, and their way of cooking.

11,489. What is their food apart from tea and bread? Do they consume much fish and mutton ?
—Yes, I must say they go in for a good deal of that, but it is salted and dried.

11,490. Is there much Braxy mutton in this district, and is it salted ?
—Yes. They lay in a stock here. They perhaps kill five or six, and they prefer to salt the mutton rather than keep it fresh. Another fault here is they don’t
go in for vegetables, except potatoes.

11,491. They can grow vegetables in Lewis ?
—Yes ; they can grow anything.

11,492. Of course your zeal in that kind of thing you feel to be pretty hopeless. It is hardly a practitioner's work ?
—I feel it hardly a practitioner’s work.

11,493. How many cases of phthisis have you to attend to in the course of a year ?
—I could not say the exact number.

11,494. Would it amount to twenty or thirty ?

11,495. Do the nurses attend many phthisical cases ?
-Yes, they always look after them.

11,496. Would you consider that a big proportion of your houses here are fit places for phthisis to be treated in at all ?
—I don’t think there is one place suited for the treatment of phthisis. There have been several sent to the sanatorium at Conon Bridge. One was sent five years ago, and he is still living. Of course it was wonderful the educative influence that had on him. He erected a shelter here for himself.

11,497. Has it induced the local people to do the same ?

11,498. You would have difliculty in getting them to do that ?
—That is so.

11,499. It would be a benefit to get them into an institution for only that sort of thing ?
—It would greatly benefit.

11,500. How often can you visit them on the average-acute cases ?
—I try to visit them two or three times a week.

11,501. For as long as you can? How often will you visit a case like that on your hands in the early stages, or in the serious stages, I should say ?
—Two or three times a week.

11,502. You have an exceedingly small amount of glandular disease from what we found elsewhere. Is the amount of milk consumed here less or more than it is, from your experience, elsewhere ?
—I think it is.

11,503. Do they consume much condensed milk here ?

11,504. They must use the milk of their own cows ?
—It is very little. The cows are not good milk producers. The under-fed Highland cow gives very little milk, but the little they do give is good.

11,505. There is not much tuberculosis among the cattle in the Highlands ?
—That is so. Another great evil here is that their eatables are all stored in the eating room—milk included.

11,506. The living room is the animal room in many cases ?

11,507. You say that you are no better off to-day than you were when you began—rather worse if anything? Have you any explanation why your emoluments should
go down? Are the people growing poorer or is the nursing system robbing you of your practice? Has the population decreased, or what is it ?
—The population has gone down, certainly. My income has not gone up. Of course I was a bachelor when I came here first and my expenses were less than they are now. Of course the demands on my time are greater now.

11,508. It is not a progressing practice, and it ought to be if people were getting sufficient enlightenment to demand sufficient medical attention ?

11,509. As to medical inspection, how many schools are there in the parish, roughly?
—I think there are nine.

11,510. And about how many children—about 500 to 800 children ?
—At Carloway there are about 200 children.

11,511. Do you mean when you say with regard to medical inspection, that they have ceased to come to you now, that they have absolutely dropped coming, and that it
is only an occasional child that comes to you as the result of school medical inspection ?
—That is so.

11,512. Is there any treatment done at all ?
—Yes : there is treatment for a bit. They come perhaps for a day or two ; for example, in cases of discharging ears.

11,513. Of course that is very little use ; they might go on for weeks or months ?
—I tried to tell them that the would have to come for a long time to have them cured, but if they did not see the cure taking place at once they did not come back.

11,514. Do you keep in touch with these cases in your occasional visits to the localities ?
—Yes. Of course I took that example—an ear trouble. If the child stays at a long
distance from my house I give the nurse the loan of my ear syringe to syringe it daily.

11,515. Do you think if you had a place near the more populous parts of the parish where you could attend periodically that you would have more children sent to you?

11,516. That could be done, and a little organisation that way would certainly improve a number of the people?

11,517. It is chiefly because you are a little bit out of the way, and it is a serious thing to go to the doctor ; but if the doctor happened to be there they would come with less pressure ?
——If course they look upon school medical inspection as a sort of infringement—and as a doctor’s fad.

11,518. (Mr Grierson.) We have had some suggestions through parishes in Sutherlandshire, that the supply of medicine was not always very fresh. I suppose you keep a good supply of medicine here ?
—Yes, I think so—the best I can procure. I fancy it is very much easier to procure medicine here than it is in the outside parts of Sutherlandshire.

11,519. I suppose you will keep as good a supply of medicine as a doctor keeps in a club practice in England?
—In a place like this you ought to keep a chemist’s shop. I keep everything.

11,520. There is nothing in that suggestion that the drugs are not of the very best quality ?
—I get the best it is possible to obtain.

11,521. What I want to bring out is that the supply of medicine is good that is kept on this island ?
—Yes; it is the best procurable. It is one of the biggest expenses to me in this parish. It is an awful drain on my purse.

11,522. I see you said here that after a serious illness you had to be off duty for seven months. Did your Parish Council not pay for your locum tenens?
—Not a sixpence.

11,523. I suppose you are aware that they can pay for a locum tenens while you are away?
—They won’t do‘ it. I asked them privately, and they would not do it.

11,524. With regard to security of tenure, one of the doctors in Stornoway gave me to understand that the idea of the doctors in the island was to have security of tenure ad vitam aut calpam. You don’t suggest anything like that ?

11,525. You would be quite satisfied if you simply had the right of appeal to the Local Government Board ?
—Yes, that is on the same footing as the Poor Inspectors here. They cannot dismiss a Poor Inspector for, any triviality. They can dismiss a medical oflicer at will.
Let us have a Court of Appeal at any rate.

11,526. You think the Local Government Board would make a satisfactory one ?

11,527. (Mr Orrock.) I think you said you approved of a check fee ?

11,528. What would you fix the fee at ?
—2s. 6d. or 2s. for the first visit. As long as there is a check free, it would not need to be too much.

11,529. Do you think each family in your parish would be able to pay 13s. a year ; that is 3d. a week ?

11,530. The population in your parish are mostly crofters and fishermen, with a few shooting tenants and ministers and schoolmasters ?

11,531. There are five shooting tenants in your parish?

11,532. I suppose sometimes you are called in to the lodges ?

11,533. On the island of Bernera there is a population of 730. They do a large lobster-fishing trade there?

11,534. They would be quite able to pay in Bernera?

11,535. Could you tell what would be their earnings from lobster-fishing in Bernera?
—I could not say, really. They are very well off ; they have good returns.

11,536. (Lady Tullibardine.) I see you mention the presence in the district of a few farmers. Can you give us any idea of whether they are large farmers or small
ones ?
—They are not large in comparison with Mainland farmers.

11,537. Have you any idea of the acreage ?

11,538. Do they show the same conditions of living as the crofters ?

11,539. Have they the same insanitary conditions in the houses ?

11,540. They have much better houses ?

11,541. Does the same apply to the gamekeepers ?
—They are very well housed.

11,542. The difficulty arises in the case of the people who own the houses in which they live ?

11,543. They cannot afford to build good houses ?
—They are improving. Of course the Lewis estate is exceptional among the estates in the North of Scotland. They grow their own timber, and I understand the proprietors
advance them the lime.

11,544. (Chairman) In Skye where there is neither lime nor timber there has been a tremendous number of houses built ?

11,545. (Lady Tullibardine.) The people could do more to better their houses ?
—Yes, they may be miserable-looking things from the outside and yet clean and tidy

11,546. Would you put that down to the influence of the nurses ?
—I must say I see a great improvement as the result of the nurses.

11,547. (Mr Grierson.) What is your experience of club practice ?
—We have so much to do. That is one of the annoying features of a club practice—every one is a patient and wants the doctor for the most trivial and temporary ailment, or fancied ailment.

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