Stornoway, 11 October 1912, W. A. Ross

11,193. (Chairman) You are a Solicitor in Stornoway and Secretary of the Lewis Hospital ?

11,194. It is the only hospital except the infectious diseases hospital?

11,195. What was the date of the founding of the hospital ?
—They commenced to found it in 1892. That was the date when the first lecture in aid of the hospital was really given. The subject was brought before the public by Sheriff Davidson, who was then the resident Sheriff-Substitute here who delivered a lecture and brought before them the urgent necessity of having a fully equipped hospital in Lewis, and he was supported by the Town Council, the doctors, and the other parties in the town. As a result, the hospital was promoted and the first patient was admitted on the 1st February, 1896.

11,196. You have twelve beds, I understand ?
—Yes. It is divided into two wards, a male Ward and a female ward, with six beds in each. Off each ward there are what we call ward kitchens where the nurses prepare the food, or rather, it is brought in there from the general kitchen in the rear of the premises. That is where the food is cooked. The wards, as I say, are six-bed wards. There is besides a matron's room and a doctor’s room on the ground floor,
and upstairs there are four bedrooms for the staff——that is, for the matron and the nurses themselves.

11,197. Surely we could see it ?
—Yes. We would pride ourselves if you would visit it. I think you will find that it is thoroughly well equipped. We have got an operating room as well ; we have also got an outside laundry block, a mortuary chamber, and all that. If you like I could
arrange for the Committee visiting the hospital.

11,198. You ‘have kindly offered here to give us the number of patients you have treated in it ?
—I give you the number that have been treated in the hospital since its inception as 1200.

11,199. That is about 100 a year ?

11,200 It is not taken so much advantage of now, we hear?
—Unfortunately it is not. The number of cases treated in the hospital within the last two years——I need not go any further back—has dropped considerably. It used to be from eighty to one hundred a year.

11,201. What is it now?
—Our highest number was in 1903, when our number was 101. The first year, in 1896,
right on to 30th Nov. 1897, there were 100 cases treated in the hospital. That is for a year. We opened on the 1st of February, 1896, and I am giving the figures down to 1897, and 100 were dealt with. For the year ending 30th November 1910, we had eighty-six cases in the hospital, and for the year 1911, we had forty-nine cases in the hospital, and up to this date we have only had eighteen cases. You
can see that it is a very serious matter. It is not being taken advantage of.

11,202. Where are the patients being treated now?
—That I cannot tell you. It may be that some of them are being treated in the Combination Poorhouse, but I don’t think they are being treated there. I candidly have it as my opinion that many cases from the parish an town of Stornoway, and from the outlying parishes, must be receiving treatment in their own homes ; cases which ought to be sent to the hospital.

11,203. Do any of them go to Glasgow ?
—Yes. I think, do go to the South for surgical operations.

11,204. Is the management conducted by a committee of ladies and gentleman without any written constitution at all ?
—It was successfully conducted by a committee until recently, when it was found that the committee were not representative enough, and adopting that view, and for the further reason that when we found we had to deal with trustees who were handing over legacies to us, we had difficulty in getting payment as we had no written constitution, and they very often hesitated paying over a legacy to us at once. Now we have a written constitution, of which I shall leave a copy with you. The main features of that constitution are that the governors of the institution have various qualifications, moneyed qualifications principally. A feature I would like to draw attention to, as showing the thoroughly representative nature of it, is that
We appoint from the public boards men as governors of the hospital. The Stornoway Pier and Harbour Commission appoint one representative; the Town Council appoint another, and each of the Parish Councillors in the island appoint a representative to the Board of Governors. Then all the medical men throughout the island are, by reason of the fact that they are medical men, on the board also.

11,205. (Dr Mackenzie.) How many of them altogether?
—Six. We have all the ministers of all denominations too.

11,206. (Chairman.) Are they on the board ex officio?

11,207. (Dr M‘Vail.) How many of them are there ?
—About twenty or twenty-five, but we have had nothing like that number at our meetings.

11,208, (Dr Mackenzie.) Are there any more besides those ?
—Subscribers of one guinea are entitled to elect a governor. I will read the ninth head of the constitution. (Reads). Those who subscribe less than a guinea, we give
them representation by allowing them to elect two of their own number. We also have appointed those who from the commencement of the hospital have paid £20. They are really life governors, and any one who now pays us ten guineas becomes a life governor. The proprietor of Lewis or the chamberlain is a governor. The governors elect a board of management which consists of twelve. The governors only meet under the terms of the constitution once a year, and the board of management meets once a month.

11,209. Who are the medical men who manage it—the operations, and so on?
-Hitherto that has been done by the medical men who were resident in the town of
Stornoway, and they also are entitled to be adopted, I should mention, as extra members of the board of management. Since the beginning of the hospital patients sent to the hospital were attended by the doctor who sent them. In the case of the country doctors it was impossible for them to attend cases that were sent to the hospital, and they were allowed to select their own doctor here who should attend to cases that they sent in, and that arrangement worked quite comfortably for many years, in fact, it has worked all along; it has really never been altered. It is
the standing arrangement still. But I am bound to say that there is now growing up a feeling—I don’t know why it should be so, but it is there; but it has never come
officially before the board of management—that the town doctors should not attend the cases that are sent in from the country doctors.

11,210. Could the country doctor attend himself ?
—He could not.

11,211. Where has that feeling grown up ?
—I cannot say. Nothing official has come before the board of management to that effect, but we hear outside that the town doctors feel having to attend these patients.

11,212. Are they paid ?
—No, they are not paid.

11,213. Not even a nominal fee ?
—No. It becomes a serious matter now. We have heard of cases that have been refused admission to the hospital because there was nobody who would attend to them there. There are two cases in the hospital at present that are being attended by one of the town doctors, but cases have been refused and have gone to Glasgow, Edinburgh, and Aberdeen for operations that should have been treated here. But what the
reason is we, as board of management, are not aware, and we cannot understand it.

11,214. It was suggested that you might put in a resident surgeon and let him practise in the town ?
-Yes, that might be done, and I think that looking to the population of the parish of Stornoway there would be a practice for him.

11,215. The patients are not being sent in. Is that because the country doctors have changed their minds as to the desirability of sending their patients to the hospital?
—-No. It is this way rather: I heard of a case that was recommended to the hospital, but the country doctor said that there is no town doctor going to the hospital just now, and they did not know what to do.

11,216. Did not the town doctors manage it before the board of management was formed?—No; there was always a committee of management. They really attended
as they required.

11,217. (Dr M‘ Vail.) I wonder if there is any feeling on the part of the doctors that they have always done the work in the past, that they had at the same time been
allowed to manage the hospital themselves, but now that it is under a constitution they ought to be paid for their attendance at the hospital on the patients of other doctors. You say you have no idea of the explanation of the difficulty ?
—I know nothing about it. So far as any operations since the drawing up of the constitution are concerned, it really has not altered anything with regard
to the dignity and general management of the hospital, because that has gone on, so far as the new board is concerned, the same as before. We keep the staff at the hospital and we say to the doctors, “The hospital is there ; send your patients—all are welcome.”

11,218. Formerly the town doctors attended for nothing the cases sent in by the country doctors. Now they are not attending them. They have not indicated whether it
is because of attendance without remuneration or that the general hospital management is altered—presumably alteration of the management might be the explanation?
-It might.

11,219. Has anybody asked them why they don’t attend?
——There have been discussions at the board of management meetings with regard to differences over particular things, and some of these discussions have been rather
wandering. Apart from the hospital, there is the nursing aspect of it. We have had a Jubilee nurse as matron at the hospital for several years. She does the district
nursing for us from the hospital. How comes it within quite a recent period that the Jubilee nurse does not get district cases sent to her by the doctors ?
—She gets very few contrasted with what she has had in recent years.

11,220. (Lady Tullibardine.) Does the nurse not do as much district nursing as she did before ?
—Not nearly as much.
11,221. Is there as much illness ?
—Yes, I am certain of it. I find on looking back to the year 1909 there were seventy-five out-patients, or district patients, nursed from the hospital by the Jubilee nurse, which involved 2000 visits; in 1910 there were 64 district patients nursed by the Jubilee nurse, involving 1328 visits; in 1911 they dropped to twenty-eight patients, involving 841 visits.

11,222. (Chairman.) Who is nursing the patients now?
—That is what I want to know. There must be several poor people who used to receive the administrations of the nurse who are not getting them now.

11,223. Does she do the pauper work as well ?
—If a pauper was brought to her notice she would do it.

11,224. So that the inference is that they—the two medical officers of the parish— are not even sending the the Jubilee nurse pauper patients to nurse, and therefore the patients are not being nursed ?
—That is so.

11,225. (Mr Lindsay.) There seems to be a boycotting of your institution, for some reason ?

11,226. Surely, as Dr M’Vail has pointed out, there seems to be a great mystery about it. Why don’t you ask them why they are boycotting your institution ?
—One of the doctors is on the board of management, and he has heard the discussion at the board of management meetings He was at the board of management when the question was put, “What is the reason that we are not getting patients at the hospital now?” but we have had no answer.

11,227. Don’t you think that this is unreasonable treatment of the institution by the doctors ?
—Yes. Assuming we were appointing a salaried medical man there as house surgeon, and allowing him to practise in the town, there is the risk that it would give umbrage to the doctors and they would not send cases to the hospital. Accidents, at
least, would have to be sent to us, and I have no doubt that in time it would pass off.

11,228. (Dr M‘ Vail.) Even then if a bad accident occurred you would need someone to give chloroform?
—That is so.

11,229. (Dr Miller.) There are one or two things that occur to me that have been referred to by some of my colleagues on the Committee; that if Dr Mackenzie was
largely the founder and originator of this hospital, you, as a new board, might, out of courtesy, have given him a definite position on the staff. It would have been within your power to have appointed him, say, as superintendent of the institution. That would not prevent the other doctors in the place attending. How does that strike you? Give him an honorary position to begin with ?

11,230. And then certainly the question of salary comes in. I don’t think that it is quite the thing to expect doctor in a country district to act in a purely honorary capacity in connection with an institution of that sort. Every moment of his time is valuable and the attendance upon cases in a small hospital is not of sufficient training or of professional value to him that he can afford to accept
an appointment of that kind on an honorary basis. Does it not strike you that it might be fair to remunerate the men to attend the hospital, perhaps not on a very great scale, but still on an appreciable scale—give them a salary of from £50 to £60

11,231. And they would be under your control, that you speak so much about. At present they can snap their fingers at you. They are giving gratuitous services?
—Yes, I agree with you. In the past we have fully acknowledged the services which Dr Mackenzie, Dr Murray, Dr Macdonald, and Dr Macrae, and all the doctors have given to the hospital. We have gladly acknowledged them both publicly and in. our reports, and in every way. They have given excellent services to the hospital. So far as appointing him as superintendent to the hospital, I must say it has never come formally before the board of management.

11,232 Does it not strike you as a solution of the difficulty?
—We would like to carry Dr Mackenzie along with us. We felt after taking an interest in the hospital, that by appointing him to an appointment such as you indicated there was a risk, which we avoided, that he might run away with it.

11,233. Run away with the hospital ?
—No; with the management of it.

11,234 What I suggested was that you should appoint him to be superinten ent of the hospital, and the salary comes in, which might be divided or shared with the other
men in the place ?
—Yes. Personally my view is that the place could stand a third doctor.

11,235. You have twelve beds in that hospital, and your staff is a Jubilee nurse, a staff nurse, and probationer ?

11,236. And you expect the matron to go into the neighbouring district and attend outdoor cases ?

11,237. And leave the twelve patients in the twelve beds to the care of the junior nurses ?
—And the staff nurse, who is a trained nurse.

11,238 You are putting the matron out into the country is attend outside cases when she, as matron, ought to be there managing the hospital and attending to the patients inside?

11,239 It strikes me that there is a flaw there. Have your second nurse, if you like, affiliated to the Jubilee Institute, and working outside when she could be spared, but that the matron should be the outside nurse seems to me a fault straightaway ?
—It has worked well in the past. The number of cases shows that.

11,240 Are you tied down by any endowment to have the Jubilee nurse going out?
—Throngh the Ashburton Bequest £1000 was left for district nursing, and after being
administered by its trustees for some years it came to be administered by the hospital committee, and that money was to be devoted to district nursing, so that we are bound to see that the district nursing is done.

11,241. (Mr Lindsay.) District nursing means nursing in the town, and not away out in the surrounding districts?
—For a radius of two or three miles ; not very far out.

11,242. (Dr Miller.) Does not it strike you that possibly you are quite willing to carry Dr Mackenzie with you if he will come ?
—Yes, it is desirable.

11,243. You have not really constituted your medical staff on the usual basis of hospitals, as far as I understand. Don’t you think that you might, without any loss of dignity whatsoever, invite Dr Mackenzie to accept this post as superintendent, and define his duties as much as you like and give him a salary, and give Dr Murchison or anybody else a salary, and define their duties also? If he refuses to
do that, then advertise as much as you like ?
—Would you pay both the doctors?

11,244. Would your finances stand giving retaining fees of that sort ?
—Not very well at present, but our endowment, I am glad to say, is increasing very well. We are up to over £5000 now, and I hope that in time we will be able to meet such a thing. Certainly, if any funds are going to be given from public services that would help us.

11,245. (Mr Orrock.) Is Dr Mackenzie a trustee ?

11,246. Would it be competent for him to take remuneration, holding the office of trustee ?
—That might be a question.

11,247. (Lady Tullibardine.) Do you think the objections of certain members of the board which you mentioned would be limited to giving Dr Mackenzie the office of superintendent of the hospital; would they be willing to give a retaining fee to all the medical officers in Stornoway, without putting one in a position over the other?
—I am not very sure about that. For a long while Dr Mackenzie, though not formally appointed, did do the duties of medical officer.

11,248. Now that it is a more strictly constituted board of management, do you think that he now feels he has not got as much control as he had before ?
—I think there is something in that.

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