DONALD SMITH, called and exmiued.
11,062. (Chairman) You are Inspector of Poor for the Parishes of Lochs and Barvas ?
11,063. And you are clerk of tlie Parish Council of Lochs and Barvas, and you collect the rates for these
11,064. The net rates in the parish of Lochs last year amounted to 15s. 5d. in the £ ?
11,065. In the parish of Lochs 12s. 10d. was payable by the owner and 15s. 2d. was payable by the occupier ?
11,066. Then there is an abatement of 45 per cent allowed off that ?
11,067. So that that works out on the gross rental, without any abatement except the 45 per cent., at a rate
of 15s. 5d. per £ ?
11,068. Then with regard to the parish of Barvas, the total rates were 30s. 7d. per .9, with a deduction of 45 per cent., which makes it work out at a rate on the gross rental of 16s. 10d. per £ ?
11,069. So that a man who is paying a £20 rent for a shop would have to pay over £10 in rates ?
—Yes, with an addition of about half of 2s. 9d. per £ of county rates.
11,070. How long have you been Inspector of Poor there ?
—For sixteen years.
11,071. What is the condition of the people there ?
—Very congested ; there is too much sub-division.
11,072. Do they do that still ?
—Yes, they do.
11,073. Are they able to pay doctor’s fees in that district?
—Well, I should say that they are. Of course, there are exceptions.
11,074. But, generally, they are able to pay fair doctor’s fees ?
—Yes. The doctors are not excessive in their charges.
11,075. Take a crofter who is a good many miles away from the doctor’s house, say ten or ﬁfteen miles, the doctor would need a fee of 12s. or 15s. for going the ﬁfteen miles, and a crofter there could not pay an adequate fee to the doctor if he had to attend for a continued illness ?
—Yes, if he had to attend regularly.
11,076. In a case like that at present I suppose the doctor must stand the expense of it himself; that is to say, he never recovers from a patient at that distance from his house a fee adequate to the services he renders to him ?
—Perhaps in cases where he makes one call only, the people cannot pay his fee, but when he makes ﬁve, six, or ten calls in the district, he can make it up that way.
11,077. There is no club system in your parish ?
11,078. Have you any idea as to how that would work ? Suppose instead of charging each patient in that way, there was a scheme organised whereby the people who never needed the doctor at all should contribute to a club, and the doctor was paid out of that club, do you think that would work well in your district ?
—It was tried on a small scale when Dr Ross was appointed. at Lochs two or three years ago, but I don’t think it worked.
11,079. Was it voluntary ?
11,080. Do you think it ought to be made compulsory, and that then it would have a chance of success?
—Perhaps it would.
11,081. Could it be, for instance, collected with your rates ?
—I don’t think that there would be any chance of increasing the rate; it is near breaking-point as it is, but if they were assisted, and that principle of a club system adopted, I believe that the money could be collected.
11,082. Somebody has to pay. Could we work it out in. a more equitable way by asking everybody for a small sum ?
—That is the principle upon which we collect our present education rate. We ask people who have no
children at school at all to contribute, and some of them object.
11,083. Suppose that is done, what do you think a family in your district could pay towards the cost of a doctor in the form of an annual sum ? Would 3d. a week be too much to ask from them ?
—That would not be too much.
11,084. That is 13s. a year ?
—I am afraid that is too high. There are no industries in the country, and even 3d. a week would be difficult to collect.
11,085. What are they in your districts ?
—Crofters and ﬁshermen.
11,086. And are these the crofters who go away to the east coast ?
11,087. What would be the average earnings of a crofter in your district from his croft ?
—About £4 or £5 or £6. .
11,088. He gets a house ?
11,089. What is the average size of a croft ?
—About two acres of arable land and ten acres of an outrun.
11,090. Will he make anything over and above that £6 out of his croft ?
—I think that he will. He will get a it a good supply of potatoes.
11,091. If he had a savings bank available what could he put into it at the end of a year on an average?
—I could not say. I don’t think he could put anything into it after supporting himself and his family.
11,092. The whole family could make a living out of that croft ?
—If the croft was well attended to, I think they could make a living out of it. We are not rearing crofters and crofters’ wives now as they used to do. They look upon other sources for livelihood than to the land Our present education system and other systems have taken away the crofter ideas out of the people. I don't think the girls would make good crofters’ wives. They go north an south and elsewhere, and take situations.
Emigration has taken a lot away from us within the last few years.
11,093. (Mr Grierson.) You say education is making them dissatisﬁed with the life of living on the land?
—Yes, they seem to go to cities and go abroad.
11,094. (Chairman.) Education is making them discontented with the crofter conditions ?
11,095. These ﬁsher girls are quite willing to come back and get married on the island ?
—I suppose none of us are unwilling to get married, as a rule. Many of them have not so much to look forward to. I am surprised that many of them see so much elsewhere and come back to live in this country.
11,096. You think that your poor people, the non-paupers, have not much difficulty in getting a doctor to prescribe for them ?
—No complaints have reached me about that.
11,097. Do you sometimes think that they don’t send for a doctor in time through the fear of running up a bill?
—I don’t think so. Of course they were not in the habit of having regular medical attendance.
11,098. Have you anything to say about the nurses? Do you think the number of the nurses or the quality of
the nurses can be improved ?
—I think they are doing very well in the parishes. There are two in each of the parishes, and the parishes are well served with them. Of course, with the additional claims that the Insurance scheme may bring upon the doctors it may alter the whole thing, but so far as the working of the parishes up to the present time is concerned, from my experience, there have not been many cases where the nursing service was not sufficient.
11,099. In your opinion, there are too many drugs used by some of the classes of the communit . Can you tell us if there is much patent medicine used in this place ?
—I don't think so.
11,100. Don’t they use Beecham’s Pills, and that sort of thing?
—I think there are some who use them. They get them by parcel post.
11,101. You say the district was never so well supplied with nurses and doctors as at present?
—It has greatly improved from what it used to be.
11,102. The medical service has greatly improved from what it used to be ?
—Yes, I think so. Dr Ross has a motor bicycle; Dr Cameron has a boat to cross Erisort, and he has seven miles to go to his furthest away patient after that. He motors there in about an hour.
11,103. (Dr Mackenzie.) In what way do you say the service has improved; has it improved by the increase of motors or by the increase of men, or what is it? What period are you thinking of ?
—For years after I was appointed there was only one medical officer for each parish, and no nurse at all. Now we have a medical officer in each parish, and he has facilities for travelling to his patients. There was not a nurse, and there are now two nurses in the parish, roads, and a telegraphic connection with the villages and with the town.
11,104. Do you think motors introduced here would help matters very much ?
—Our parish extends to about ﬁfteen miles. There is a piece of the west part of Barvas that it would be well to join with the parish of Uig. There is a populous district in the parish of Uig that is contiguous to a populous district of the parish of Barvas. In the parish of Barvas there are close on 7000 people under one doctor.
11,105. What do you think about increasing the size of the area to control the doctors? Instead of leaving it with the parish, would you make it the District Committee? Would that help in the rearrangement of the doctors ?
—I have not thought of that. This can well be left with the Parish Councils as before.
11,106. Has that suggestion ever been made to work those two bits of the parishes with one doctor ?
11,107. (Chairman) Who was Dr Murchison’s predecessor?
11,108. Had you many applicants for his post?
—No, not many. It was the parish of Stornoway that had to do with it. It was not our Parish Council. There were a few applicants, but the situation was a little peculiar; it is a small part of the parish, and the paupers’ allowance to the doctor was not very much of an inducement.
11,109. Is there anything else you would like to say, any suggestion you would like to make whereby things could be improved ?
—I don’t think so.
11,110. (Lady Tullibardine.) The Chairman was asking you about the possibility of starting a club system for
medical attendance. He was also asking you whether, if such a thing were started, the club subscription could be collected with the rates. Do I understand you to say that it would be difficult to collect a club subscription in that way unless there was some deduction off the rates ?
—I said if there was a fee for medical purposes on the present rates the Parish Council would have a diﬂiculty in asking the people to pay it.
11,111. You would not like to be responsible for the collection of a club subscription in addition to your present rates?
—No, I don’t think it would be easy to get them to take up that position.
11.112. (Dr Mackenzie.) In point of fact, your parishes have had great difficulty in collecting the rates, quite
apart from extra burdens being put on them ?
11,113. (Lady Tullibardine.) Supposing the District Committee of the County Council were to collect that
money, would that make it easier ?
—No, I don’t think so.
11,114, If the people could be got to understand that this collection of a club subscription was instead of the
collection of the doctor’s fees, do you not think they would pay it more willingly? They don’t like when the doctor’s bill comes in after an illness ?
—I am afraid that the people are not so sympathetic in that way, that the one should bear the burden of the expense of the doctor to the other to any extent. Something like that was more practicable in the Highlands thirty years ago.
11,115. Are the people less ready to help than they were before?
—Yes, I think so. That is experience of my district as Poor Inspector.
11,116. Can you explain why ?
—The race for life is becoming very keen. They go out into the world and all they have is considered to be sufﬁcient for themselves. The circumstances have not improved to any extent.
11,117. Are there many houses where the doctor is not called in in the course of a year ?
—I should say there are a good many of them.
11,118. And therefore the heads of these houses would not be expecting to pay a doctor’s bill in the course of a year ?
—That is so. I don’t think that they would willingly undertake to pay for their neighbour.
11,119. Are there not some houses in your district where there is illness and they don’t call the doctor in because of the distance he is away from them ?
—No such case is known to me. Although the doctor lives a distance away from them he is in the neighbourhood of the village or of these families at some time or other. The better off people in the neighbourhood send for the doctor, and the other people would have the opportunity of calling him in when he was passing their door.
11,120. That sounds as if they were ready to help each other. I don’t quite understand that ?
—The people in the parish who are well-off send for the doctor when they require him, and if there is a poor person who needs the doctor at the same time he will call the doctor in when this better off person is calling him in, and in that case the doctor will call for 2s. 6d. or 1s. 6d. Now that the doctors have motor bicycles there is not a week passes but a doctor is passing the most of the doors of the people in the parish, because we are not now so isolated as we used to be. On calling the doctor he can be at most of the houses within an hour and a half after being called.
11,121. Can he manage that all through the winter ?
—Well, there are exceptions.
11,122. For several months in the year lit would be very difficult ?
—In the case of a snowstorm it would be; but with his motor-bicycle or with his trap he can usually reach his patients either eight miles to the one side of his house or seven or eight miles to the other side. The villages are all on the public road. I think I am safe in saying that the doctor passes every door in the parish once in every week in the year.
11,123. (Dr M‘Vail.) I think the general effect of this paper that you have put in, if read by the man in the
street, would be to suggest that there is no medical problem whatever in Lewis. You say that the people are invariably able to pay the doctor’s fees, and that, in your opinion, the district was never so well supplied with nurses and doctors. You say, “ So far as Lewis is concerned, the medical service ‘is in a very improved condition.” Does that really represent your mind? Should this Committee report to the Government that in Lewis there is no medical question requiring to be solved, and can we move on to another part without making any recommendation ?
—Well, that is putting it in another direction. I would be far from saying that there is nothing further to be said on that question.
11,124. If that is not your view—what is it? What is the medical problem ?
—Although we had medical attendance we would require something else for Lewis. There is a. lot of consumption in Lewis, and we would require better treatment for these people. I don’t think that a consumptive person has much chance of improving under the present conditions.
11,125. Is that the whole problem in Lewis? You told us that the crofter can put nothing in the Savings Bank ;
is that the average condition of the crofter at the end of the year ?
—Well, considering all his outlays, it is.
11,126. That is your opinion ?
11,127. Don’t you think that the crofter’s condition of life should be improved by making medical service more available to him without excessive expenditure? The very fact that they cannot put anything in the savings bank for many years speaks for itself. They may not need medical attendance for some years, but if there is a bad illness in the house during one year and there is a big account for the doctor, the doctor either does not get the money or the crofter has less than nothing at the end of the year ?
—In that case it certainly would be hard. That is an extreme case. There are such cases, but it is not the general rule of life. It is not our general experience.
11,128. You said that when a doctor is called in to a well-off person in a village, that very often a poor person takes advantage of his visit to the well-off person and gets a visit that is required to be made at a cheap rate ?
11,129. Do you think it is right that a poor person requiring a visit at a cheap rate should wait the chance of the doctor coming to a well-off person to get it?
—It depends on the nature of the trouble. There are urgent cases where it would not apply. For instance, these parishes are very much indebted to the paupers of the parish for their medical service. It is not the crofters nor these people who pay for the doctors at present, except in so far as they contribute through the rates. The doctors are in the parish at the expense of the paupers—at the expense of the poor rate.
11,130. That is hardly the point. If it is the case that a poor crofter often requires to take the chance of the doctor being called to visit a better-off person in order that he shall have a visit to his sick wife or child, do you think that that is a condition of things that requires no remedy ? Don’t you think there should be some medical provision to prevent such a mere accidental way of getting the doctor ?
—I don’t say that that is the rule at all. I said that, generally, there was no district or village where a medical officer was not passing through the village once a week or once a fortnight, and although a person had not much money to pay for him coming a distance, there are very few who could not pay to call him in on these occasions.
11,131. If a crofter has to wait till the doctor is passing through the village once a week or once a fortnight before calling him into the house of a sick person, do you think that is satisfactory ?
—It was not so satisfactory in the past experience of the island. In the district that I have pointed out to you, the congested end of the parish of Barvas, if there were facilities for getting medical service there without increasing the present rates, there is room for a doctor.
11,132. I am wondering what is really in your mind. Is it the fear that any improved service would be a burden on the rates ? If you assume that there might be an improved service without its being a burden on the rates, would you tell us that no improved medical service is required? If you had been told that we were coming here to consider the possibility of providing a medical service without burdening the rates, would you say that there was no improvement needed ?
—I am really quite frank in my opinion that the doctors might have improved communication or motor cars or motor bicycles.
11,133. Then you think there is room for improvement there ?
—Yes. I think that would be an improvement.
11,134. Surely it would be desirable that the crofter twenty miles from a doctor should be able to get the doctor when he needs him without ruining himself, or else without imposing on the doctor? The crofter, in the meantime, at a distance, a poor man, if he has a doctor’s bill to pay, it means that he goes behind with his annual accounts, or else he does not pay the doctor ?
—That may be his experience, but I don’t hear that said by the people. I don’t hear
11,135. There are only two alternatives ; they may have been so long in a condition of inability with regard to medical attendance that they have come to think it is
almost normal. Don’t you think that the medical attendance in Lewis is open to enormous improvement ?
—Yes, to my mind, on the lines I have suggested.
11,136. (Dr Miller.) Do you reside in Stornoway ?
11,137. And are you secretary to the hospital we have been hearing about ?
11,138. (Dr Mackenzie.) You are Poor Inspector for Barvas ?
11,139. Is not it the fact that a year or two ago your rates were in such a condition that you were not able to pay either the paupers or the medical officer?
11,140. And that you were not able to give the medical officer his salary for the half year, or something like that?
11,141. And in order to get you over the difficulty for the time, through the Local Government Board, the Treasury had to come to your assistance ?
11,142. Do you consider that with a condition of rates such as that you can possibly have an adequate medical service in the parish? Surely the first condition of having a doctor at all is that you are able to pay him the salary that you have undertaken to pay him ?
11,143. And in this year that I am talking of you were not able to do it ?
11,144. That has been practically the condition of that parish for the last four or ﬁve years ?
11,145. You have always been more or less in difficulties, and at this moment you are only beginning to emerge from your difficulties ?
11,146 Would you consider that that is a satisfactory medical service for a parish to have—that you are liable at any moment not to be able to pay your medical man ?
—It is not satisfactory.
11,147. So that there is some room for improvement of your medical service ?
—At any moment should that happen again we will be in the same difficulty.
11,148. So that there is room for going into the whole question of your medical service, evenfrom the pauper’s point of view, quite apart from the point of view of your general population ?
11,149. You are quite liable to be again in the same position of having no money either to let your doctor live or to provide food for your paupers?
11,150. How many paupers have you in the parish as a rule ?
11,151. And these are scattered up and down the whole range range, from the border of Ness village to the border of Barvas ?
11,152. Of course there are a great many people on the border line, who might quite possibly be on the roll if the standard of living were considered a little higher?
—Yes. Even the paupers are more discontented with their allowance than they ever were. They are more dissatisﬁed with our smaller aliment.
11,153. Taking the medical service for those poorer people just above the border line, are they getting sufficient medical attendance at the present moment ? Can they pay the fees that you say the general mass of the people pay? Does the doctor not attend scores upon scores of these people without ever getting a penny for it?
11,154. You have also had large epidemics within the last year or so ?
11,155. Within a few years you have had fifty cases of typhoid in the Ness district?
11,156. You had to do something for their nursing
11,157. The District Committee would be primarily responsible. Your medical ofﬁcer is the only doctor in the locality. Do you think that one doctor is able to attend all the infectious diseases that you have had within the last three years ?
11,158. Does Dr Ross’s son ﬁnd it possible to overtake the work ?
—He is young and active.
11,159. What is the population of your parish ?
—From 6000 to 7000.
11,160. What is the length of Ness ?
11,161. You know, of course, there is something like 2.5 or thereabout dying of consumption in every 1000 of your population. That is 12 or 13 every year die of consumption. You will ﬁnd that that will give you the number suffering from pulmonary phthisis in the year. Add to that the amount of other tuberculosis, such as joints and hip-joint disease, and so on. Do you think that one doctor can possibly look after all these cases over such a big area? Do you think that adequate medical attention? That is 6000 people to one doctor. In the South we have about one doctor to every 2000 of a population, while you assure us that one doctor to about 6000 is sufficient. Are you not really overstating the case a little ?
—I must say that our medical service has improved.
11,162. That is, from the condition it was in thirty or forty years ago?
11,163. (Dr Lindsay.) You say here the district was never so well supplied with doctors and nurses, and you also say that so far as Lewis is concerned the medical service is in a very improved position. You don’t mean to say it could not be better ?
11,164. Your point is simply this, that the medical service should be improved if it can be improved without an addition to the rates ?
11,165. You don’t say it is as good as it ought to be?
—No, I never said that.
11,166. You don’t object to it being improved further ?
11,167. Especially if it can be improved without an addition to the local rates?
—Yes, certainly. My point is that they cannot increase the rates, but in the light of these statements the medical service is in need of being improved.
11,168. In answer to question 3, you say they can invariably pay doctors’ fees. Don’t you think it would relieve the rates if this 5s. was paid for a club subscription to some other body ?
11,169. (Chairman) What difference would that make to the people?
—Perhaps they would pay sooner to another body.
11,170 I understood you to say that the collector of poor rates could not get the money out of the people, but that they might pay it to somebody else-—the club subscription?
—Well, I don’t know. They might pay it to somebody else, but my point is, if the rate is to be increased the people will demur, but if the rate is not to be increased, probably they would agree to the club subscription, to pay it to some other party. What I said was that the county rate was being collected now by a central authority. Perhaps they would be more willing to pay the medical rate than the other rates.
(Mr Orrock.) Mr Smith said that he was asked to undertake the collection of the consolidated rates. The collector of the consolidated rates lives in Dingwall, and
therefore, Mr Smith being on the ground, it was thought he would have better chance of collecting the consolidated rates as he goes through the district.
11,171. (Mr Lindsay.) Is it in your mind that by paying 5s. a year they will get rid of all other medical fees, except a check fee?
—Yes. They would not need to pay anything except the 5s.
11,172. They would not have any objection to paying that 5s.?
—I could not say.
11,173. They would get free medical service that they have not got just now?
—I could not say whether they would be willing to pay it or not.
11,174 Have the old age pensions improved the conditions in the island of Lewis ?
—It has reduced the number of paupers on the roll by about eight or ten in each
11,175. How many paupers had you?
—200. I may say that the roll was never higher than it is just now. The paupers, rolls in the parishes have not been as high as they are just now for thirty years.
11,176. In spite of the old age pensions ?
11,177. How do you account for that fact? Are the people losing the old pride that was characteristic of the Highlander?
—There is something in that. We carefully revise the roll and each person that can be struck off we strike them off. They are all really needing relief.
11,178. You are quite satisﬁed that every case you have on the roll is a thoroughly tested case that you could give relief to?
11,179. We know that out of one parish, out of 200 paupers, seventy became, old age pensioners on the passing of the Act ?
—Is that so? It was only eight or nine we got off the roll.
11,180. What is the age of the paupers at death here? They are long lived, are they not ?
—They are just much the same as the rest of the people. The lunatics live longer
than any other class in the country.
11,181. (Lady Tullibardine.) Are the lunatics included in your number of paupers?—Yes.
11,182. Is that what accounts for the increase in the number of paupers ?
11,183. Can you account for it ?
—There were accidental drownings, and we have a lot of widows left with large
families. For instance, there was a boat lost with a crew of five, leaving widows with five or six dependents.
11,184. So it is just on account of some special circumstance like that that the number of paupers is high ?
—Yes, it may be down again in a year or two.
11,185. It is not any general depreciation of their earnings ?
11,186. (Mr Orrock.) I think you said by throwing the Shawbost end of the parish of Barvas along with Uig, and putting a doctor away to the principal heights of Uig, that that would improve the medical service. That is giving three doctors where there are two at the present moment?
—Yes, that is my opinion. Dr Ross is sufficiently near Ness at present. We could do with another doctor joining the two parts of Barvas and Uig. The present doctor for
Uig is at Garyanhine, and you would have to move him across to the Brenish end.
11,187. With regard to the parish of Lochs, Dr Cameron lives at Keose ?
11,188. The south side of Loch Erisort is a populous district and a very difficult district to work ?
—Yes. It was roadless till this year.
11,189. Do you think that another medical officer is required on that side of the loch, seeing it is so badly off for a doctor?
—Well, it would be an improvement.
11,190. Would it not be as reat an improvement to have one there as to have three or the parishes of Barvas and Uig ?
-There is a nurse in the district, but it would be an improvement if a doctor could be there too.
11,191. You have got two nurses in the district ?
11,192. And the Parish Council contributes what?
—Their salary is £50 each. The Ladies’ Highland Association contributes £25 to each of the nurses, and the County Council and the Parish Council contribute £12, 10s. each.