Stornoway, 14 October 1912 - Dr Allan Cameron

11,856. (Chairman.) You reside at Keose, by Stornoway ?

11,857. You are a graduate of Glasgow University ; an M.B. and C.M. ?

11,858. You were assistant for fifteen months at Invergordon ; you were over two years Medical Officer for South Uist, and nearly four years Medical Officer for the
parishes of Lady, Cross, and Burness in Orkney ?

11,859. You were for six months in charge of a parish in Dumfriesshire, and you were for four months in charge of a colliery and general practice in Cambuslang?—Yes.

11,860. ln what part of South Uist were you ?
—Dalibrog. I was Medical Officer for the whole of South Uist at the time.

11,861. When was that ?

11,862. How does the condition of the South Uist crofters compare with the condition of the crofters here ?
—They have better stock there.

11,863. There are no other doctors practising in your district ?

11,864. How far are you from Stornoway ?
—Thirteen miles.

11,865. How far is the nearest part of your parish from Stornoway ?
—Six miles.

11,866. It has a population of 4750 ?

11,867. Do you find any difficulty in overtaking all that population ?
—Occasionally one gets too much work.

11,868. It seems a lot for one doctor to do. You are busy at certain seasons of the year ?

11,869. What seasons have you the most pressure work—from January to about March?
—Yes, the usual winter season.

11,870. We had evidence of that already. Why should you be busier at that time than at other times of the year
—There are more sick.

11,871. Why ?
—Because of the weather conditions.

11,872. Is there anything in the fact that the people are poorer at that time ?
—The people are poorer from March till the spring fishing commences in June.

11,873. Will they have less milk at that time ?

11,874. Does that affect them to any extent ?
—Yes, the children.

11.,875. Is condensed milk used to any extent ?
—Not very much.

11,876. What do they do when the cows are all dry ?
—They use a lot of tea, I suppose. .

11,877. You give us in our statement a very complete note of the population, and so on ?
—Yes. At Keose there is an approximate population of 139, and it is central; at
Laxay there is an approximate population of 200, from one to one and a half miles from my house; at Balallan there is an approximate population of 493, from four to five miles from my house; Aribruach is eight miles from my house; at Luirbost there is an approximate population of 671, five to seven miles from my house ; Achmore is eight miles from my house ; at Crossbost there is an approximate population of 312, seven to eight miles from my house ; at Ranish there is an approximate population of 468, eight to nine miles from my house; at Grimshadder there is an approximate population of 226, eight to nine miles from my house; Cromore is three miles from my house ; at Mariveg there is an approximate population of 206, four miles from
my house; at Calbost there is an approximate population of 187, five miles from my house; at Gravir there is an approximate population of 468, four to five miles from my house; at Limerva there is an approximate population of 339, eight miles from my house ; Caversta and Habost and Kershader are a half to three miles by boat from my house ; and my house is fourteen miles from Eishken and Aline by road. There is a keeper’s house at Kenmore, but I am never there; there is also a keeper’s house at Mulliagary, but I am never there either ; and there is a keeper’s house at Valamus, and I have only been once there in ten years. Within five miles of my house there is about 20 per cent of the population. Between five and ten miles there is 75 per cent. ; and at twenty miles there are none.

11,878. You say 20 per cent. of your patients are within five miles of your house. How many would you say are within three miles, which is supposed to be the distance
a doctor goes without charging mileage ?
—About 5 per cent.

11,879. You have none beyond twenty miles ?

11,880. They are much more compact than many of the country practices ?

11,881. The roads are fairly good, you say ?
—The Lochs roads are not bad.

11,882 You must have a good deal of sea work ?

11,883. Is it dangerous sometimes ?

11,884. How do you get across? Just by an ordinary fishing-boat?

11,885. The crews take you themselves ?
—Yes, very often

11,886. You have not a motorboat ?

11,887. Would that be of any service to you ?

11,888. Would it need to be very big ?
—If the whole of the sea work was to be overtaken by motor-boat it would require to be big.

11,889. Whether would a motor-car or a boat be of most service to you ?
—A motor-car.

11,890. A motor-car would be of great service to you, I suppose?
—My distances are not great; they are usually within eight miles.

11,891. How far have you to walk sometimes ?
—Up to seven or eight miles.

11,892. Are these townships or isolated houses that you have to call at ?

11,893. How did you manage to get the houses improved at South Uist ?
—We took them before the Sheriff of Lochmaddy.

11,894. Was there any assistance given to the crofters to put the cattle out of their houses?

11,895. In Ireland the Congested Districts Board gave £5 to every crofter who put his cattle out of the house. You keep two horses and a trap ?

11,896. Have you a boat of your own also?

11,897. You say it costs you ls. a mile to keep the traps and horses or do you mean to say it costs you Is. a mile when you hire?
—Yes ; the latter.

11,898 What does it cost you to keep your horse and trap?
—It costs me £30 for each horse.

11,899. And you have a lad besides, I suppose?
—Yes, a lad or boy.

11,900. It costs you the best part of £100, I suppose ?

11,901. Have you a good house ?

11,902. Is that a difficulty in the Highlands very often?

11,903. Doctors often have trouble in getting suitable houses ?

11,904. I suppose you would support the proposal that the Parish Councils should have power to build a house for the doctor ?
—Yes. The Parish Council have to do with my house.

11,905. Yes, but they have no power to build a house for you ?

11,906. It is not a sufficient house for you ?

11,907. Are you married?

11,908. Have you any children ?

11,909. You get £192 as parish medical officer and medical officer of the School Board ?

11,910. You have 204 paupers to attend to?

11,911. That is not quite £1 a head ?

11,912. We found some doctors that were paid £12 a head for the paupers ?
—I daresay.

11,913. I daresay this sum is given to you so that you will remain there. It is a big fee for attending paupers, but unless it was given I suppose there is not a sufficient income for a doctor to make a living there?

11,914. In regard to medical attendance, the pauper is better off than the poor who are just above the pauper limit?
—Practically the same, except that so far as medical attendance is concerned they all get it.

11,915. Your tenure is terminable by three months’ notice on either side ?

11,916. I suppose you are in favour of doctors having an appeal to the Local Government Board ?

11,917. You have never had trouble with your Parish Council ?

11,918. It is the same sort of thing that teachers have that you want ?

11,919. What about vaccinations? Do you find that the poor to avoid vaccinations have become conscientious objectors? Has that provision led to fewer vaccinations ?
—No; there have only been two or three conscientious objectors since I came to the parish.

11,920. There have been no cases where to save the trouble they have become conscientious objectors ?

11,921. We have had some doctors who told us that since this power was given there have been hardly any at all. That is not your experience ?

11,922. Do you fix special days for vaccinations?

11,923. Have you special days for visiting your districts ?

11,924. Have you ever thought of adopting that ?
—Yes, when I came to Lewis I did.

11,925. Have you ever tried it ?

11,926. Sometimes it works and sometimes it does not work. Some doctors do it and have to give it up, and others find it works very well. How do you think it would do with you? Your distances are not so great; it is not the same as if you were twenty-five miles away from some of your patients ?
—No, that is so.

11,927. In one case in Lochaber we found that the doctor did that. He was able to give a patient who called on him on these occasions a visit at 2s. 6d., whereas otherwise it would have cost him 25s. ?
—That is so.

11,928. There is no club in this district ?

11,929. Is there any on this island at all ?
—They had a club system in my district at one time.

11,930. Did it break down ?

11,931. Was it a voluntary system ?

11,932. Was that the reason why it broke down ?
—Every member of the house was supposed to be a member, but they were not.

11,933. (Dr Mackenzie.) Was that before your time ?

11,934. How much were they able to collect ?
—I don’t know. The doctor who began it had to stop it.

11,935. (Chairman) On principle, I suppose you would agree that it is a fair thing that the cost of the doctor should be more equally distributed than it is just now
over the population. That is to say, you will agree that it is to some extent a hard thing that a crofter, in every other respect equal to the other crofters, living twenty-five miles from the doctor should have to pay £1 or 25s. a visit,
whereas the crofter near the doctor gets a visit for 2s. 6d.?
—The distances are a hardship.

11,936. The medical service to the man in the distance cannot be suflicient so long as he feels he has got to pay a large fee if he calls in a doctor ; at least he would be liable for a large fee?
—No, it cannot be so constant.

11,937. Would you a prove of a system, if one could be devised, whereby every family in the parish would pay a sum per head, and it would go to a fund to enable the doctor to equalise his charge. That is to say that every family whether they needed the doctor or not should pay a certain sum per year, and that would go to the doctor, so that he might be able to visit his patients, making a uniform charge to each ?
—I have tried the club system in South Uist, and Strath in Skye for six months, and I did not find it satisfactory at all.

11,938. Why ?
—They did not pay and they wanted me too often.

11,939. Unless it was made compulsory you think it would not work. Supposing it was made compulsory, and that this was a charge which could be legally exacted from
every household, do you think there would be anything unfair in it?
—The regulations would need to be very stringent.

11,940. You see no objection to a system which would work as the North Uist one works, and it seems to work very well, that each family should contribute a sum—whatever it could afford—and that thereby the doctor would be able to pay a visit to a distant patient at a small fee ?
—So far as my experience of them goes, they have been very unsatisfactory.

11,941. First of all, because the payments were irregular, and secondly, because they gave you too much to do ?

11,942. Supposing we got over the first difficulty by making it compulsory, would it be sufficient protection in the other case that there should be a check fee on each visit ?
—I should like a check fee on any club system.

11,943. You think that would be necessary ?

11,944. What form would you like it to take? Would you approve of a charge of 2s. 6d. for the first visit and a smaller charge afterwards ?

11,945. Or would you prefer a small fee of, say, 1s. for each visit ?
—I don’t mind the amount as long as it is fixed.

11,946. I want you to tell me which would have the most effect on the people. Which do you think would be the best ?
—I see it would be a difficulty if the people could get a doctor without feeling that they were running up a fee. I think there is something to be said in the view
that 2s. 6d. should be charged for the first visit?
—Yes, I would go in for that.

11,947. You think that would have an advantage over the 1s. a visit?
—Yes. I think there should be a fixed fee for the club system, and for the first visit a fee of 2s. 6d., and 1s. for any further visits.

11,948. You would not be so particular about the fee so long as the doctor was properly remunerated ?
—It would not matter.

11,949. But in the interests of public health, what would you say ?
—I think it would be in the interests of the people to charge a fee for every visit.

11,950. You would not mind if you got 2s. 6d. as a fee, or anything like that, so long as you are paid otherwise. It is merely for your protection. So long as you were guaranteed a sufficient income, you would not mind attending the man so long as it was a case of serious illness, but you would mind being called out of bed for a gumboil ?

11,951. Suppose it was arranged that there should be a payment per family over the whole parish to provide for a doctor, what sum do you think they could afford without really crippling their ordinary resources ?
—The whole thing depends very much on the patient. With us here it depends entirely on the fishing.

11,952. Some years they would be able to pay more and some years less ?

11,953. Do you think that 3d. a week would be too much for them to pay?
—Is that to cover the whole household?

11,954. I have said to a great many people 3d. a week and they say yes, and then I have said “ Could they afford 13s. a year?” and they have said they could not. 13s. a year does seem a big sum. Would 5s. be an unreasonable amount?
—I think it is small enough.

11,955. I daresay there are some who really could not pay anything at all ; there might be some means of exempting them ?

11,956. You have about 1000 families. That would give you £250 as a sort of fund. That, I daresay, would improve your present remuneration?

11,957. You say you prefer payment by visit, but to the sort of scheme I have outlined you have not the same objection ?
—I have no particular objection to a club system provided it is properly managed.

11,958. We want to improve the position of the doctors in the Highlands. We are convinced their position is not satisfactory just now. At the same time we want to devise a means of providing funds so that the service may be made more efficient in the Highlands and this has occurred to us as a reasonable method by which we could arrive at that, and you see no objection to it ? You see, we have crofting and fishing?
—Yes, plenty of work as it is, and I naturally would prefer payment for work done, but I have no objection to a club system if it is properly managed.

11,959. Under certain circumstances the people in the district should have practically free medical attendance as they have free education. That is practically what they have just now. You must do a lot of work without getting paid for it ?
—That is so. Were it not for the fixed salary the private practice is not worth anything.

11,960. We are trying to devise a scheme whereby that should fall on somebody else. That is a scheme that is
been suggested to us, and I am asking you if you would be quite willing to fall in with such an arrangement. I don’t want to commit you to say you will fall in with this system of a club practice. A doctor in a parish here has control of the whole parish, and he is responsible for the health of the parish just as the teacher is responsible for the the education of the parish. You are in a different position than the doctors competing with each other in the town. Whatever the objection in the south to a club practice is, I don’t think there is the same objection in the Highlands ?
—My experience of club systems has not been very satisfactory, but I am quite willing to agree your proposal to have a club system, provided it is properly managed.

11,961. You supply medicine?

11,962. And you have no difficulty in getting fresh medicine?

11,963. You have a very good service here—a steamer every day ?
—Yes, and mails every day.

11,964. The means of livelihood of the population are crofting and fishing?

11,965. Can you give us any indication of the income of a household in your district ?
—The average income will be between £20 and £30, and with the woman at the weaving industry they can keep the house going.

11,966. Do the girls go fish-curing ?

11,967. They will make £10 or £20 ?

11,968. The croft only gives them a house and milk, and that sort of thing ?

11,969. We were told by Dr Mackenzie the other day that practically every able-bodied man in the island is a
trained soldier or sailor. That is to say, that either they are in the Naval Reserve or the Militia ?
—A great many of the young men are.

11,970. And the old men likely were in their day. It is rather a remarkable thing that practically every able-bodied man in the island has been trained in His Majesty's service ?

11,971. Practically speaking, compulsory service would not make any difference in the island?
—Practically. It is only the unfit that are not in the service. The first thing they do when they leave school is to try to get into the Militia.

11,972. The average ability of the people in your district to pay doctors’ fees is not very high, and I daresay you often get a very inadequate fee for the work you do?

11,973. Then you have to go a long distance?
—Yes, if I have to cross the moor for seven or eight miles my fee is 5s. or 7s. 6d.

11,974. It is quite an inadequate fee for you, and it is often as much as they can pay?

11,975. You charge 1s. a mile, including medicine?
—For continued medicines I charge differently.

11,976. You think that 10 to 15 per cent. of the non-paupers don’t get medical service when they ought to have it. That is to say, that there is from 10 to 15 per cent, roughly, of illness among the non-pauper poor which is not attended by a doctor when a doctor ought to see them?
—Yes, about that.

11,977. Due, I suppose, to the patients hesitating to incur a doctor’s bill which they feel they cannot pay?

11,978. And I daresay to the difficulty of getting a doctor, and so on ?
—Yes, and other risks.

11,979. Have you any suggestions to make as to how the means of communication between you and the people could be improved? You say a motor-car is not of much importance ?
—No, but when the road system is completed the motor-car would come in for the longer journeys.

11,980. At present your practice could not afford it?
—At present it is not much use.

11,981. Do you send many of your serious cases south to Glasgow, Edinburgh, or Aberdeen ?
—Yes, sometimes.

11,982. What about the Stornoway Hospital? Do you send them there sometimes ?

11,983. How many do you send in a year ?
—An average of one or two.

11,984. How can you attend to the people in the kind of houses we see here—it must be difficult ?
—It is difficult.

11,985. I should think there is no part of Great Britain or Ireland where an hospital is of more use than in Stornoway. Would you say that ?
—The hospital has been of great use in Stornoway.

11,986. There is no place where it would be more necessary ?
—I should think not in Scotland.

11,987. It is not fair for people to expect a doctor to treat serious cases in the houses here ?
—We have to do it.

11,988. Have you to do operations in these houses sometimes?
—Yes; sometimes.

11,989. And your death-rate is not high after all ?

11,990. Have you many uncertified deaths ?
—Over 70 per cent. of the deaths are certified.

11,991. That is to say that 25 per cent. are uncertified ?
—Yes. I am not quite sure about the exact percentage.

11,992. 25 per cent. is a large percentage, is not it, of uncertified deaths ?
—Yes. There was not a single death uncertified last year under sixty-five years of age.

11,993. It is the usual thing; the people don’t think it is necessary to send for a medical man when it is old age?
—That is so.

11,994. About telegraphs and telephones, is the telegraph pretty well developed in your district ?
—Fairly well. There are three telegraph offices.

11,995. Have you any other telegraph offices on the other side of the loch?

11,996. Are these telegraph offices operated by telephones?

11,997. Would it be an advantage in your parish if you were allowed to speak over the telephone to a patient ?
—Yes, or to a nurse.

11,998. How many nurses are there in your district ?

11,999. Are they the Govan nurses — that is Miss McPhail’s?
—Yes, both are assisted by Miss M‘Phail.

12,000. Where are they situated ?
—One at Luirbost and the other at Limerva.

12,001. There are about 140 maternity cases in the course of a year in your practice ?

12,002. You attend about thirty of them?

12,003. I suppose you are only sent for in serious cases?

12,004. It is quite satisfactory, is it—the nurses are quite satisfactory?
—Yes, the maternity nurses. They are certified nurses, but they have no hospital training; still they are quite satisfactory for maternity work.

12,005. But not for the other work ?
—I would like a better trained nurse for the other work.

12,006. Are these local girls who have been sent away to be trained ?

12,007. Their relations are in the district?
—In Stornoway.

12,008. In some ways, I suppose, that is an advantage, because they are more useful about the house than a trained nurse would be ?

12,009. Do they do work in the house ?
—Not very much.

12,010. They don’t milk the cow, and that sort of thing?

12,011. You have had several cases of puerperal fever through your midwife ?

12,012. Was she a trained nurse ?

12,013 That, of course, is a very dangerous thing ?

12,014. Is tuberculous disease increasing with you?
—It is very prevalent.

12,015. Is there much of it brought from the South? That is to say, natives who go South and come back with it developed ?
—No, I did not notice that particularly. It is quite prevalent enough without being brought from the South.

12,016. Has the housing anything to do with that ?
—I think so

12,017. You say there is a nurse almost in every township. You mean one that attends maternity cases ?

12,018, Are they employed very much, these uncertified nurses?

12,019. What do the nurses charge ?
—5s. a case is what the district nurses charge.

12,020. By the district nurses you mean the nurses we were speaking of ?
—I don’t know what the local women charge. It is the district nurses I am talking of.

12,021. Would you like to have mofe trained nurses ?

12,022. With your population you have surely work for more nurses?
—Yes. For the distances they have to travel the supply seems to be quite inadequate.

12,023. Do they not work under your control?

12,024 Do they undertake cases on their own account?

12,025. You want a central medical authority, but you would not expect a medical authority to have power over a Parish Council ?
—No, but the Parish Council have power over me just now.

12,026. Do you want a medical authority to decide questions between the Parish Council and you? Would not you be satisfied with the Local Government Board ?
—Yes, quite.

12,027. You have no facilities for getting a holiday or getting South to rub 11 your knowledge ?

12,028. We have have evidence that that is a very great hardship in the Highlands ?

12,029. And that the public health suffers in consequence?

12,030. That is to say, the doctors would be more efficient if they got a chance of attending postgraduate courses ?

12,031. You want the roads improved ?

12,032. You refer us to the report which we got from Dr Ross as to the suggested improvements in the medical service. You have nothing else to add ?

12,033. (Lady Tullibardine.) I think you told the chairman that even under a club system you would prefer the system of a small fee per visit to a larger fee for the first visit only. Was one of your reasons this, that it might be difficult to say exactly what was a first visit ?
—It might be, when you were called in when you were in that district. It would be a first visit, but it would not be the same as if you were called from your home.

12,034. The idea of a club system would be to equalise the payments per visit to people living all over the district. You would not suggest the charging of a higher fee for those living further away from you ?
—No. Under a club system the fee would be uniform, I should think. It would
not matter what part of the district the patient was in.

12,035. My point was that supposing it was a fee for a first visit only, would it be sometimes difficult to state what the first visit was? Supposing you were attending one member of the family and you thought that was the first visit, and you went afterwards to that member of the family and somebody else in the family was ill, would it be difficult to charge a first visit for another member of the
family ?
—I would charge a fee of some kind, but not to the extent of the first visit.

12,036. We are presuming some allowance for the distance should be given ?
—I should charge for each case equally. In that case I would have to consider my expenditure.

12,037. You would see no difficulty in fixing a higher fee for the first visit and a fee for later visits ?
—I don’t think it would be a hardship for them to pay 2s. 6d. for the first visit.

12,038. Supposing you had not seen a patient for a month and you were then called in again, would you consider that a first visit ?
—If the patient had been better in the interval I would.

12,039. Would there be any difficulty in defining a first visit?
—There would be some difficulty with chronic cases. For all chronic cases I would charge the original fee.

12,040. You lay stress on the regulations that would be necessary if any club system were enforced. One witness suggested that a higher fee should be charged for visits which were not asked for before ten o’clock in the morning. Do you think that would be a necessary regulation ?

12,041. It would enable you to plan out your day better ?

12,042. Would you have a special fee for confinements and operations under a club system ?
—Yes, confinements especially, and operations, too, if you have to do them.

12,043. I am assuming that you have a special fee for operations at present?
—A slightly modified fee for operations at present, and a special fee for confinements.

12,044. For confinements you would wish to make a special charge under a club system ?

12,045. And operations too, perhaps according to the nature of the operation ?
—Yes, the severity of the operation and the preparations I would have to make for it in the way of special appliances.

12,046. Would you object to operations being included in the club subscription ?
—I think it would be better altogether to exclude them.

12,047. On the ground that they entail much more responsibility on you than the work of an ordinary visit?
—Yes. If you are going to include them under the amount you stated, I don’t think it is sufficient.

12,048. You say you would like some fully trained nurses. Could you give us any idea as to the proportion that confinements bear to the number of ordinary cases that require nursing ?
—With the nurses at present or with myself?

12,049. Well, as matters stand, you have told us you have 140 confinements in the district in the year. Will there be 140 cases requiring a fully trained nurse to treat them in the year ?
—Surgical treatment?

12,050. Not specially surgical treatment, but requiring a trained nurse ?
—I should expect the nurse will have 140 cases in the year of ordinary visits.

12,051. Do you think it would be possible to have both kinds in the district ?
—I don’t think they would work together.

12,052. I am assuming that the maternity nurse would only go to confinements ?
——She does it just now. Every nurse that is placed there at one time or another will have a good deal of ordinary nursing as well as confinements.

12,053. Have you had reason to complain of the nursing of ordinary cases?
—When they began after coming from the Maternity Home they were not so good for ordinary cases.

12,054. Do you not find that after a few months they get to know a little more about it ?

12,055. Do you consider a maternity nurse would be sufficient for general cases in the district ?
—Within a limited extent. Let her pick up as much as she likes at her work, she will never become such a competent person as a nurse who has been trained.

12,056. (Dr Miller.) Do you find that there is a tendency to physical degeneration amongst the people here ?
—Yes, there is. My experience of them only extends over a period of ten years.

12,057. But in that time do you find that that is the case ?
—I don’t think they are a particularly robust lot.

12,058. Would you attribute that to the housing conditions or the conditions of living ?

12,059. What is the state of the teeth ?
—Pretty fair.

12,060. Is there much lunacy in your district ?
—Not much on the whole.

12,061. You cannot recall how many lunatics you are called upon to certify Within a year, on an average ?
—One or two.

12,062. Have you any resident lunatics, registered lunatics ?
—I think it is within half a dozen.

12,063. You are called upon to visit those every quarter ?

12,064. Do you get a separate fee for that, or is it included in the Parish Council remuneration ?—I get a separate fee.

12,065. Of 10s. 6d. per visit ?
—3s. 6d. per visit.

12,066. You refer to infantile trismus. You have cases of tetanus at present. What is it due to ?
—It is supposed to be due to special treatment of the infant, improper nursing of the infant. They had it in St Kilda until they sent a proper nurse, and it is not there now.

12,067. According to the scheme that the Chairman has sketched out for you, I take it that you would have about 1000 non-pauper families in your parish—takiIrg it very
—I don’t know the number.

12,068. At a very modified rate, at the minimum fee that has been considered by this Committee, it would mean a sum of £250 that would accrue to you per annum in addition to your parochial salary ?

12,069. You would consider that a fair fee for attending those 4000 people ?
—I would consider I was a little better off than I am now.

12,070. And that would be, I presume, exclusive of travelling allowances which would be probably provided on a well-considered scheme ?

12,071. With an income of £500 a year you would be fairly well off in attending to these 4000 people ?
—Yes ; I would be considerably better off than I am now.

12,072. With this club system, of course, there would be strict regulations issued. As medical officer to the School Board what are your duties?
—When I came here the other doctors in the rural parishes, in Lewis and in Lochs parish, were appointed as superintendents of schools before the last Act was passed, for which they got a guinea for each school, an for which they issued a certificate in the case of epidemics, and so forth.

12,073. That is not for treatment of school children ?

12,074. Then with regard to this question of fixity of tenure, you are quite satisfied that that ought to be conceivable ?

12,075. An appeal to the Local Government Board, at least?

12,076. (Dr Mackenzie.) About these school certificates, how many have you given within the last ten years, since you came, for the closing of schools? How many schools have you in the parish ?

12,077. How many certificates have you given, roughly?
—I could not tell you.

12,078. Have you had any one school closed once or twice a year ?

12,079. In fact, the closing of schools is looked upon in Lewis as the only remedy for dealing with epidemics among the children ?

12,080. Do you think it is possible to disinfect the houses in Lewis where you have cows and human beings all jumbled up ?

12,081. You have never disinfected a house like that?
—Never in my life.

12,082. Disinfection is looked upon as a farce by the people ?
—Except the immediate disinfection of the patient

12,083. You would not undertake to extirpate typhoid without cleansing the whole place and clearing out cows and everything else for the time being ?

12,084. You have never had that to do. You don't think it is impracticable ?
—I think it would be absolutely necessary.

12,085. About certification, it is practically the only method that has been used up to date ?
—No, there have been several houses that have been uninhabited after fever.

12,086. Have you any idea what this certification amounts to ?
—There is a medical officer of health for the school now.

12,087. Still the School Board continue the twelve guineas ?
—The matter is not just now settled whether we are going to continue to receive that sum or not.

12,088. Do you examine any junior students at all?

12,089. Nor any of the teachers ?

12,090. Have you to certify anything to the School Board apart from the closure of schools ?
—We were in the habit of givin certificates to the children for that as well as for
absence from school for ordinary illness.

12,091. You said that you had tried a club system in three places, and you found it unsatisfactory. Tell us exactly how you found it unsatisfactory in South Uist,
Strath, and Skye. Take South Uist ; what led you to consider it unsatisfactory ?
—They did not pay their club subscription.

12,092. To begin with, how many families had you in the club in South Uist? What population was there there?

12,093. That, roughly, would be from 600 to 900 families. Would you have 600 families ?
—I cannot say

12,094. How was it organised ?
—Mr Wilson, the District Clerk, undertook the collecting of the subscriptions from each crofter, and he never did it.

12,095. What proportion was collected? How long were you there ?
—Three and a half years.

12,096. Did you get it for the first year ?
—I never got it clear.

12,097. You never got anything ?
—Yes, I got something.

12,098. Will you tell us, roughly, what proportion of the crofters in South Uist did actually pay their subscription in the first year ?
—Between 70 and 80 per cent.

12,099. And how much would you have got through Mr Wilson in actual coin ?
—He came on the scene the last year I was there.

12,100. Would you have got £10, or £20, or £30, or £40 ?
—At the least £100. 1 think it ought to be that at least. It is fifteen years ago.

12,101. What about Strath, in Skye? Why did it break down? At South Uist it broke down, you suggest, because the collection of the subscriptions was not really made?
—I am not quite sure that it has broken down now.

12,102. I wanted to know why it was unsatisfactory. There is nothing essentially unsatisfactory in the idea?
—No, certainly not, provided that the work is not too much.

12,103. I was wondering whether it was on that account it broke down ?
—My main reason was that I never got them to pay properly and they had no feeling about Working you to death.

12,104. In point of fact, you did not get the promised amount in South Uist, and as the result of its being collected you got more work that year.

12,105. Then as to Strath, what have you to say about it ?
—I was only six months there.

12,106. It was in existence when you went ?

12,107. Who made the collection ?
—The poor inspector

12,108. He collected all that was due ?

12,109. How much did he collect; what proportion did he collect ?
—It was not far off the whole amount ; he would collect about 90 per cent.

12,110. That is a good deal. How much would that amount to in coin ?
—The total club in Skye was a little over £100.

12,111. Then what did you get from the parish?
—The parish salary was £100. The total would be about £250.

12,112. Then you would have some private fees as well?

12,113. Why was it unsatisfactory? Did you consider that that was too small a sum ?

12,114. What was the club subscription ?

12,115. Supposing it had been 7s. 6d., would it have been fair remuneration for the work ?
—Not for the number of people in the parish.

12,116. In fact, you would consider it would need more than 7s. 6d. even to make it a reasonable paying account ?
—Yes, for the household. For the head of the family I think 7s. 6d. an ordinarily low fee.

12,117. What proportion of the families would you have attended in the year? How many families would you
—The population was 2200.

12,118. Divide that by five. That is nearly 500 families?
—I was only six months there.

12,119. Was there anywhere else that you had a club system?

12,120. Your grounds of dissatisfaction with the club system consist of three elements; first, you considered the subscription too low ; secondly, the collection was not very satisfactory; and thirdly, the amount of work was too much?
—The people when they get under a club system are liable to take the doctor out often.

12,121. You think that, as a matter of fact, you were taken out more frequently without any reason in South
Uist and Strath than you are in Lochs ?
—Yes, I do. I have travelled twenty miles to a girl with toothache, and when I got there she was not ill.

12,122. You have never had trivial calls and that sort of thing put upon you in Lochs. You have no complaint
whatever to make of trivial calls in your present practice?
—One is taken occasionally out to people when they don’t know what is wrong with them. You don’t complain.

12,123. You do think a club system does encourage trivial calls ?

12,124. In the matter of drugs, have you a special allowance outside your £192 you get as parish medical
—The sum for the drugs is included in that sum.

12,125. You have 200 paupers ?

12,126. What amount would your drug bill for them specifically be ?
—£8 is included for payment for drugs for paupers.

12,127. It includes appliances as well, dressings and so on if you need them ?
—No, just medicine.

12,128. You are paid specially for appliances ?

12,129. Do you think the £8 covers the medicine adequately ?
—It is a small sum.

12,130. Do you prescribe much medicine for paupers, in point of fact ?

12,131. Have you any cases of leg ulcers or chronic cases needing repeated dressing ?
—I have not many cases of leg ulcers.

12,132. How many cases have you needing dressings just now?
—I have one of tubercular disease in the spine just now.

12,133. Of the 200 paupers, how many cases have you at the present moment needing surgical attention among the paupers?
—That 200 includes.the paupers and dependents.

12,134. How many paupers in chief are there ?
—About 90 paupers, without the dependents.

12,135. Along with your 90 paupers, of course, you have got to attend the dependents as well. If you count the 200, how many cases have you needing surgical treatment in the 200? Have you any bone tuberculosis, hip-joint and bone diseases ?
—I have one case of bone tuberculosis—spinal disease.

12,136. Any hips ?
—I have two or three just now, but they are not among the paupers. I had none before.

12,137. Have you many surgical cases among your general practice ?
—There is not much. These tuberculous cases take a great deal of dressing when they do come on.

12,138. Among your general practice what amount of tuberculous cases have you ?
—Bone cases and pulmonary phthisis?

12,139. Among the bone cases you said there were one or two hips ?
—I have three cases of disease of the hip just now.

12,140. Discharging ?

12,141. How often do you see these in the course of the year? How many visits would you pay to these cases ?
—I would pay a good number of visits—perhaps half a dozen, until I fixed them up, and after that I would visit them when in the district, perhaps every week, or every ten days, to keep them in view.

12,142. You say there is from 10 to 15 per cent. of the population not medically attended. What do you base
that estimate on ?
—On the death certificates.

12,143. You mean that you are making your estimate purely on the death certificates ?

12,144. You say there is 70 per cent. of the deaths certified. That leaves 30 per cent. uncertified. You
consider that practically 30 per cent. must go without medical attention ?

12,145. Have you any idea what sort of diseases go unattended ?
—Apoplexy. There was one case the other day of a man who was working, and he had an apoplectic fit, and he died shortly afterwards. For the last year or two the majority of them are over sixty-five years of age. It is very apparent that none of them were uncertified under sixty-five years of age.

12,146. We have had some evidence from other parishes that a fair percentage are uncertified between the ages of nothing and sixty-five, and a fair proportion over sixty-five ?
—That is so.

12,147. About nursing, is it the case that the nurses in your parish are really doing medical work ?

12,148. Supposing you did not have these nurses, you would be called to more cases ?

12,149. So that in reality they are doing the work that a doctor would normally be doing ?

12,150. You are quite clear about that point ?

12,151. Have you any relation to these nurses ?
—None whatever.

12,152. Can you ask them to nurse a case under your direction ?
—Under the Parish Council.

12,153. The nurse is bound to carry out your instructions?
—Yes. They are partly paid by the Parish Council. Usually they go to any case that I ask them to go to.

12,154. In such a case they go at your instance and they act under your instructions ?

12,155. Normally, for the majority of the cases, they act on their own independently ?
—One of them does. No, I don’t think so. I think probably they get advice in most cases from me.

12,156. In the majority of cases you really give the primary instructions with regard to treatment and they
carry them out ?

12,157. You have no responsibility for them except in regard to parish cases, and you have no difficulty really at all ?
—That is so.

12,158. You think that is a satisfactory step in a parish like this ?

12,159. What would you consider as an improvement? Don’t you think that a nurse is a sort of subsidiary oflicer in a medical service, and that she should be under the direction of a medical man ?

12,160. As to these unqualified midwives, you say that approximately 70 cases out of the 140 confinements are attended by uncertificated nurses ?

12,161. Do you consider that satisfactory ?

12,162. What would you have ?
—Trained nurses.

12,163. Would you consider the same arrangement as is in England satisfactory ?
—I have had no experience in England.

12,164. At any rate, you would not consider that the births were properly attended to in another parish where
they were superintended by unqualified people ?

12,165. Since you came here ten years ago you say that tetanus has been the cause of the deaths of one or two infants yearly. How many cases come under your notice yearly ?
—I probably put that a little high, but I have seen two in a year and one in a year since I came here.

12,166. Quite so. Of course, that is an enormous proportion compared with anything that happens in the
worst town in Scotland ?
—Yes. There is practically none there.

12,167. So that this condition of the new-born is almost, so far as I am aware, absolutely confined to the Hebrides ?
—That is so.

12,168. Are there any cases in South Uist ?
—No, I don’t think so. It was not so common there.

12,169. In Skye, did you ever have a case ?
—I do not think so.

12,170. Are the housing conditions in Skye any better than the housing conditions here ?
—They are better.

12,171. Do they have the cows in the houses to any extent ?

12,172. You are quite satisfied that this condition of tetanus is mainly due to the fact that the animals are in
the same house; at any rate, that makes it much more liable to happen. You would say that is a reasonable
suggestion ?
—Yes ; the presence of filth.

12,173. And the conditions are aggravated by the cattle being in the houses ?

12,174. Have you any other explanations to offer why it should be so common in Lewis, and so uncommon elsewhere ?
—I never saw any cases where the confinement had been attended by in self or by the trained nurse. It only
occurs when the midwife, the local midwife, has the case.

12,175. It is due to qualified midwifery ?
—That is so.

12,176. Such a thing should not happen in a decent practice ?
—That is so.

12,177. What kind of operations have you actually done in the houses? Give us one or two illustrations?
—I had one operation on a tuberculous bone.

12,178. What other kind of operations do you do in the houses ?
—I cut cancer in these houses, and tumours of the breast, and bone conditions.

12,179. You do a fair amount of minor surgery ?

12,180. How do you find your cases do ?
—Very well.

12,181. Even under these bad conditions ?

12.182. You would not consider them ideal conditions?

12,183. In fact, you would consider them very much to the contrary. How do you account for your cases doing so well ?
—I have no special theory.

12,184. You publish no statistics?
—No, none whatever.

12,185. In fact, it is only a general impression ?

12,186. (Lady Tullibardine.) Do you regard the peat as in any way antiseptic ?
—No ; it is possible, but otherwise it is harmful. I think it is bad for the lung conditions, —the throat and the lungs.

12,187. One wonders that there is not more disease than there is, considering the presence of the cattle and
the lack of ventilation, and so on, in some of the houses.

12,188. (Dr Mackenzie.) Do you think the peat smoke contributes to phthisis?
—Yes. It keeps up a lot of irritation in the bronchial tubes.

12,189. You have had some cases of puerperal fever. Have you had many cases ?

12,190. Taking the ten years you have been here, have you seen any serious improvement, or any recognisable improvement, in the housing conditions ?
—A good number of new houses have been built.

12,191. There is a huge number still of the old houses ?

12,192. With these local district nurses who charge a fee of 5s. a case when attending confinements, how many days do they stay in the house and superintend the case ?
—About nine days or ten days. They don’t stay in the house during that time. They leave the house as soon as they can.

12,193. Do they sometimes stay overnight ?

12,194. (Mr Lindsay.) In regard to question 33, your Medical Association say that considering the medical requirements of the people and the general freedom from acute illness for the greater part of the year, they consider that the number of medical men already practising in Lewis is sufficient. That arises out of the question you answered to Dr Miller. You say that the population are physically degenerating ?
—The population might be counted as degenerating although there is no acute illness.

12,195. You say that the men are almost all Naval Reserve men or Militia men ?

12,196. You have no knowledge of what percentage of recruits were rejected ?
—No. They are all examined in Stornoway.

12,197. You are asked the question “Do you think it would be advantageous to the profession and the public
to have a central authority to whom questions affecting medical service generally might be referred ?” and your answer is “Yes, a medical one.” Do you say you would have an exclusively medical Board to manage the affairs of the medical service of the island, or a Board composed of medical men ?
—I probably would say that I would like a medical Board along with the present conditions. We are
under the Parish Council alone.

12,198. Do you mean that that Board would be exclusively a local one, a Board of medical men, to manage the medical affairs in this island ?
—I think it is not likely that it would; it would likely be in Edinburgh. I think they would like it far better.

12,199. Did you altogether grasp what Sir John Dewar meant when he said that there was to be a fee per family per year, and then instead of you having to collect that yourself there would be a public authority  responsible for that to you ?
—I did not understand that he said that.

12,200. You will understand this, that in connection with this big question which has arisen with the doctors,
this central authority, which would necessarily require to be an authority representative of the district interests as well as the medical interests, would be responsible for the collection of that money. You understand that they would guarantee you a net salary, after paying all your travelling expenses and providing a house for you. If they guaranteed to you a net income each year of £350 or £400, don’t you say that a fee would be unnecessary other than a check fee for the first visit ?
—It would depend upon the total amount, except the first visit.

12,201. Don’t you think it would be a better system if you had a check fee for the first visit, and it depended on yourself whether there was a fee for the subsequent visits?
—It would depend on the amount. Yes, that is quite satisfactory system. It is better than charging a fee every

12,202. This Committee is here in the interests of public health and to see that the doctors get justice done to them. In that case if you are paid a net income of £350 or £400 a year, or whatever it might be, don’t you say that a check fee along with that amount would be quite sufficient without fees for subsequent visits? That would satisfy you, would not it ?
—Provided the net income was sufficient. I don't mind supposing it is one fee.

12,203. If they guaranteed you travelling expenses leaving you in hand a net income of £350 or £400, that
would satisfy you?
—Provided the net income was sufficient.

12,204. If that were enough, you would consider the one fee enough ?
—Yes, I think so.

12,205. Most of the other medical men we have come across were quite satisfied with the check fee of 2s. 6d.—one fee for the first visit ?
—Taking an ordinary case of a club system with a subscription of 5s. or 7s. 6d,, and and 2s. 6d.for the first visit and Is. for the rest, I don’t think it would be too much of a hardship on the patient if he had to pay
that fee of 1s.

12,206. It would almost make you a State servant. You would be responsible for the health of this parish, and a central authority would be set up, I suppose, composed of representatives of different interests. They would be responsible to you for a net income. Don’t you think that the one check fee would be sufficient?

12,207. (Mr Grierson.) You think that the club system would tend to the doctors not supplying good medicine?

12,208. Any fee would be held to cover the medicine they would not charge medicine to the patients over and above that ?
—It depends upon the total amount.

12,209. This check fee and the subsidy would be to raise your salary up to what we hope will be an adequate salary for the valuable services you gentlemen give in the Highlands and the Islands. Would these fees cover your dressings and medicines and that sort of thing ?
—They would.

12,210. Would it not be better if the question of dispensing were taken out of your hands and put into the
hands of the chemist?
—Not in Lochs; it could not be done.

12,211. It is really necessary that the doctor should keep drugs and bandages and so on. When you were
talking of 2s. 6d. for the first visit and 1s. for the others, had you in mind that that would not cover medicines?
You had in mind that they would be charged over and above that ?

12,212. (Mr Orrock.) I think you said you considered 13s. per year per family was rather much, but that 5s.
could be easily paid by them?
—I don’t think 13s. would be too much, but I don’t think they could afford it.

12,213. It would depend largely on whether the people were successful or not. Some years they would be able to afford it and others they would not ?

12,214. Then there would be a tremendous proportion who could not pay it near the pauper line. Your district is divided into two parts ?

12,215. In winter it is difficult to get to the far part of the southern parish ?
—Yes. It is difficult to get across the ferries sometimes.

12,216. Before you go across you have to cross moorland?

12,217. What distance have you to go before you get on to the main road ?
—Two miles.

12,218. And it is all boggy land between the loch and the road ?
—Yes, but there is a road sketched out, and it is to be made.

12,219. It is not made yet ?

12,220. On the south side of Loch Erisort the population there is less than on your side of the loch ?

12,221. I think the population of the south side is 1931 and the population on this side is 2843. At present
dealing with the south side of Loch Erisort, do you think telephonic communication would be of great advantage?

12,222. You are pretty well off at present for telegraphic communication ?

12,223. But you think telephones would be a great advantage ?

12,224. The doctors could speak over the telephone to the nurses ?

12,225. Which would mean that you would not be called away except to very urgent cases ?

12,226. (Lady Tullibardine.) Can you tell us what the uncertificated midwives charge for attending a case?
 —I don’t know.

12,227. What are the teeth like in your neighbourhood?
—Very good. The school children’s teeth are very good.

12,228. And the women—have they good teeth ?
—Fairly good. There is not much decayed teeth among them.

12,229. (Chairman.) Have you many calls for trivial cases from the paupers ?

12,230. They get free medical attendance ?

12,231. What makes you think you would have a large number among the general population ?
—Because I think there is a little difiiculty in getting a messenger to go for the doctor among the paupers.

12,232. And there would not be the same difficulty among the general public ?
—I don’t think so.

12,233. Is it your experience that the paupers don’t send for you very often for trivial causes ?
—That is so.

12,234. You don’t think the general public would be the same to you ?
—It would run through the whole district that there would not be unnecessary calls, but there is always the risk.

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