12,235. (Chairman.) You are a Graduate of Glasgow University; and you were for three years an Assistant in England before you came here ?
—No, three years altogether.
12,236. Where were you in England ?
—Down in Lancashire.
12,237. Had you a club practice there ?
—No.
12,238. You have been seven years altogether in practice ?
—Yes.
12,239. You were assistant to your father ?
—Yes.
12,240. You know the conditions of the people here?
—Yes.
12,241. You have a population of nearly 7000 people. 6950 is the population of your parish ?
—Yes.
12,242. The population of your parish is not so widely scattered as some we have come across. The furthest away family from you is fifteen miles away. Is that a township?
—It is a farm up at Dalbeg.
12,243. You live in the centre of the population ?
—Yes.
12,244. And the population is up on the coast ?
—Yes.
12,245. About a fifth of the population is within five miles of you. What is the proportion within three miles
of you?
—The villages of Borve and Shader and Galson Farm are within three miles. Borve has a population of
478, Shader has a population of 1100, and Galson has a population of 19. That is about 23 per cent.
12,246. You have fairly good roads in your district ?
—Yes, the roads are being improved.
12,247. Is there any population in your parish which lives away from the public road altogether ?
—At Barvas there is one house.
12,248. The previous witness has just told us that he has to travel five to seven miles over the heather sometimes?
—I have not got to do that.
12,249. You use a bicycle and you have just got a motor bicycle?
—Yes.
12,250. You can use that on any part of the road ?
—Yes.
12,251. You have given a very interesting statement about the cost of the bicycle?
—Yes.
12,252. You have just got a motor bicycle and you don’t know what it will cost each year?
—No.
12,253. It will save a great deal of time ?
—Yes.
12,254. Do you keep a horse and trap ?
—I keep a trap, but since I got the motor bicycle I dispensed with the horse.
12,255. The house you are in is your own ?
—It belongs to the estate.
12,256. The Parish Council rates are £9, 7s. ?
—Yes.
12,257 Is that not the county rates as well ?
—No.
12,258. That is the poor rate and the school rate ?
—Yes. My rent is £17 and the land is £3, that is £20. My Parish Council rates are £9, 7s., and my county rates are £1, 2s. 8d., making a total of £10, 9s. 8d.
12,259 Your house is not at all suitable. There are no sanitary conveniences ?
—No.
12,260. The water supply is unsatisfactory and the house generally is unsatisfactory for patients ?
—Yes ; there is no waiting room for patients.
12,261 You have no means of getting a house. The Parish Council has not power to build a house for you?
—That is so. It is the only house I can get.
12,262. Your emoluments from your public appointments are £160 as medical officer, for the Parish Council of Barvas, which includes drugs ?
—No ; the drugs are extra.
12,263. From the School Board you get fourteen guineas, and from the Northern Lighthouse Board you get fourteen guineas?
—Yes.
12,264. You get a check fee of 10d. a visit from the Lighthouse people ?
—I never charge that.
12,265. You say here that the appointment cannot be terminated without consent of the Local Government
Board?
—There is a clause to that effect in my agreement.
12,266. Did your father have that arrangement ?
—No.
12,267. It is just since you came that that arrangement has been made ?
—Yes.
12,268. Have your relations with the Parish Council been quite cordial ?
—Yes, so far.
12,269. Were your father’s ?
—Yes.
12,270. About vaccinations, you fix days for vaccinating ?
—Yes.
12,271. Do you find the people are still getting their children vaccinated since the new provision for con-
scientious objectors was made ?
—There have not been so many the last year or two. It is practically dying out.
12,272. We had a doctor who said that there was no difference. That is not your experience ?
—No.
12,273. You have 221 paupers to attend to ?
—Yes.
12,274. There is no club system in this parish ?
—No.
12,275. Have you had any experience of a club system ?
—No.
12,276. You don’t know how they work in any other parts of the island ?
—No ; I know nothing about them.
12,277. You have a very large population to attend to. Is the work more than you can overtake? Are you able to attend effectively the whole of the population ?
—For the greater part of the year I am. The work is pretty heavy for the first three months of the year.
12,278. That is the time when there is a great rush of work ?
—Yes.
12,279. Do you find it sometimes difficult to overtake it all?
—Yes.
12,280. And although there may be work for another doctor, I don’t suppose there is a living for another doctor?
—That is so.
12,281. If these people were to get the medical attendance they ought to have, there should be more medical
assistance in that parish
—Yes, during that time.
12,282. As a matter of fact, the fees which you get are not adequate fees for the work you do ?
—Nothing like it.
12,283. You have no patients very far away, but even a patient thirteen miles away, if you have got to attend
that patient often, is not able to pay you anything like a fee which you ought to get for your work ?
—No. It is usually the first visit that costs the most, and then I call in when I am in the district again.
12,284. Supposing you had a case that you had to visit frequently, you could not get a proper fee for that case ?
—You cannot charge them a proper fee.
12,285. Have you many bad debts notwithstanding the fact that you don’t charge a proper fee ?
—Between 50 and 60 per cent. I never receive. Some years it is different. If it had been a good fishing on the East Coast the people are more able to pay my fees.
12,286. Do they make an effort to pay ?
—They would if they had the money at the time.
12,287. Now we are anxious to devise some scheme whereby the medical service to the people could be
improved and the public health might be better protected, and also the doctors might receive something like a fair remuneration for the services they render. At present we are convinced that the doctors in the Highlands don’t receive the remuneration they ought to have. I notice in your note that you sent us on behalf of the Medical Association, that you prefer remuneration for the actual visits and the actual work done rather than payment in any other form. But how are you going to see that you get a proper fee for visiting a patient ten or twelve miles away, perhaps two or three times a week for two or three weeks on end? How are you going to get it from the patient ?
—It cannot come from the patient.
12,288. As a matter of fact, at present the doctor bears the burden ; he does the work without being paid for it?
—Yes.
12,289. I want to ask you this: suppose we endeavour to arrange a scheme to spread the cost of the medical
service of the district over the whole of the people of the district—the expense of the medical service must be paid by somebody ; it must either be paid by the patient or by the doctor himself, or it must be paid by some other authority—do you think it is possible for us to arrange that the community itself should bear a fairer share of the cost of this medical service? That is to say, at the same time that the patient who is far away, and the patient who is often ill, might be to some extent relieved of the burden which is too heavy for him, and the patient who is near the doctor or who never needs the services of the doctor should bear a share of that cost. Supposing a scheme were presented to us providing that each household in the district should pay a certain sum each year for the cost of medical attendance, just as at present the rates bear the cost of the medical service out of all proportion to the services you render to the paupers, would you have any objection to that?
—I am afraid you could never work it on such a scheme as that.
12,290. Why ?
—Because I could not do the work. It would make too much work for me.
12,291. Would it make more work than is needed for the people ?
—I think it would. I think they would take advantage of it.
12,292. Do you think at present there are many cases in your district that don’t get sufficient medical attendance?
—Yes.
12,293. There ought to be medical service provided for these people in some way ?
—Yes.
12,294. Do you see any objection, even supposing it did make a good deal more work—while it might make
some work that was unnecessary it would get at, would not it, a good deal of the illness that at present is
unattended ?
—Yes, it should.
12,295. Do you see any serious objection to a method of that kind, further than it would make a good deal of extra woik ?
—So long as there were safeguards it would be all right.
12,296. So long as the doctor was protected against frivolous calls and that sort of thing, there is no serious
objection to it ?
—Not so far as I know.
12,297. Supposing we could devise a scheme whereby the district should provide a considerable share of it, what sum do you think each family could pay per annum into a fund of that kind? You know the circumstances of the people ?
—You mean including crofters, squatters, and cottars, and all that sort of people ?
12,298. Some of the cottars and squatters, we are told, are better off than the crofters. What sum do you think they could pay to include the whole of the medical service on the family? Could they pay 5s. a year for each family ?
—I think most of them could.
12,299. That would provide a large sum from your parish. If we could get 5s. a year out of them it would be
a large sum. If a scheme could be devised whereby we could get that from the families—it has been agreed that some safeguard should be made for the doctors, and that there should be a check fee—what fee do you think would be enough to prevent a frivolous call and yet not interfere with the patient sending for the doctor when it is absolutely necessary ?
—I should say 2s. 6d.
12,300. Would that not prevent them sending ?
—I mean for the first visit.
12,301. Would you give further visits free ?
—I would charge perhaps ls. for the further visits.
12,302. Do you think that would be adequate protection for a crofter ?
—I think beyond that ordinary messages should be delivered before a certain hour in the morning.
12,303. You would give special consideration to the messages that were sent to you before ten o’clock in the
morning ?
—Yes. All calls for ordinary visits should be sent in before ten o’clock in the morning.
12,304. There is a great deal of excitement at present on the question of a club system. Don’t you think that a
club system in a district of this kind is a different thing from a club system in the town? Don’t you think it
would be a good thing for the patient and not a bad thing for the doctor ?
—The circumstances are entirely different.
12,305. Do you think there would be many unnecessary calls if there was practically free medical attendance?
—I cannot say.
12,306. Do you get many unnecessary calls to attend the paupers ?
—No.
12,307. Of course they get it without charge. Do you think the general population would be any different from
the paupers ?
—Perhaps they would expect some return for their £53. in the year.
12,308. Suppose a scheme of this sort was devised and there was a great increase of work, I don’t suppose one doctor could undertake it ?
—I think not.
12,309. Could you still attend to 7000 people ?
—Not if the work was increased.
12,310. If it did mean any increase of work you would need assistance ?
—Yes, especially for these three months of the year.
12,311. If assistance was needed here, I suppose you would a prove of the regular doctor havin an assistant.
It would be absurd to put down another doctor in that district. Would you be satisfied with an assistant under
you if there was too much work for one doctor, or would you prefer nurses ?
—Both are needed just now. The nurses are required to carry out the instructions of the doctors.
12,312. You think if there was any extra work here at all you would need assistance ?
—Yes.
12,313. You were an assistant with your father?
—Yes, after his health broke down.
12,314. The people in your district are mostly crofters and fishermen, and they get certain sums from the Naval Reserve and the Militia. Practically every able-bodied man in your parish is either a Naval Reserve man or a Militia man ?
—Practically every one.
12,315. With practically every man in the island a trained man, compulsory service would make practically
no difference here ?
—I think so.
12,316. What sort of income do you say comes into a household in your parish ?
—It is very difficult to say; it varies according to the fishing.
12,317. Your experience is very much like the experience of other doctors in the Highlands, that there are a good many cases presented to you that you ought to have seen sooner ?
—Yes.
12,318. Do the people delay because of the fear of running up a. bill ?
—I don’t think so, because those near at hand do it in the same way as the others.
12,319. You send your serious cases to Glasgow or to Stornoway Hospital ?
—Yes.
12,320. Do you deal with them at home sometimes with a helpful colleague ?
—Yes.
12,321. How do you manage to perform a serious operation ?
—We cannot do it in the houses. If there is a serious operation they must be sent to Glasgow or Edinburgh.
12,322. Are the houses being improved in your district at all?
—Slowly.
12,323. Has any effort been made by the public authorities to improve them ?
—The improvement is very slow.
12,324. Could anything be done to accelerate it?
—I think something ought to be done, if possible.
12,325. Why is it impossible here if it is possible in other parts of the Hebrides ?
—I don’t think in Inverness shire there is a single house with cattle in it, and in this place it seems to be the rule rather than the exception?
—Yes, it is the rule.
12,326. What is being done by the public authorities?
—So far as I know, nothing is being done so far as the houses are concerned.
12,327. It is illegal, of course, to have the houses in that condition, and steps might be taken to cure them in
that way. Take this case alone: it is now illegal, as you know, to have children in a room with a fire without the
fire being protected?
—Practically every fire in our parish is in the middle of the room.
12,328. I suppose there are a good many accident cases of that kind ?
—There are wonderfully few.
12,329. You sometimes have very serious outbreaks of epidemics in your parish ?
—Yes.
12,330. You had one here, I see, last year. Was that a serious one ?
—It was typhus fever.
12,331. Where did it break out ?
—In the village of Borve. .
12,332. Are the houses very bad ?
—Just the ordinary houses.
12,333. That means that they are just about as bad as they can be ?
—They are no worse than in the other districts.
12,334. Were the cows in the house?
—Yes.
12,335. And was there a collection of manure at the end of it?
—No. At the time the fever broke out the houses were practically clear of manure.
12,336. Is it the case that they allow the manure to accumulate in their houses for nine months of the year?
—Yes, practically from one end of the year to the other.
12,337. How is it you escape having a great deal more typhus ?
—I suppose nature helps us.
12,338. Do you know anything about Ireland? I don't think there is anything as bad as this in Ireland?
—I don't think so.
12,339. I know that in Ireland the Congested Districts Board gave £5 to every small holder who removed the
cows from his house. The local authorities never tried anything of that kind here ?
—Not so far as I know.
12,340. You are very anxious to have this condition of affairs improved ?
—I think it is the first thing that ought to be attended to.
12,341. Do you agitate for it?
—I am agitating for it always.
12,342. You had about 153 births in 1911?
—Yes.
12,343. And you were only called to about 40 of them ?
—Yes, at the most.
12,344. You were only called to the serious ones ?
—Yes.
12,345. They are mostly attended by certificated nurses or uncertificated midwives ?
—Yes.
12,346. . About 90 were attended by the certificated nurses?
—Yes ; that is an estimate.
12,347. And the number attended by uncertificated midwives was about 20 ?
—Perhaps more.
12,348. Were these uncertificated nurses?
—Crofters’ wives.
12,349 Of course you are very much against maternity cases being attended to by uncertificated women of that kind?
—I think they are a social danger.
12,350. You say in answer to question 24 that there was a case of puerperal sepsis. When the births are
attended by a doctor there have been no such cases, and very few when they have been attended by certified nurses, but more when they have been attended by uncertified midwives ?
—That is my experience.
12,351. The nurses are doing good work in your district?
—Yes.
12,352. How many have you got ?
—Three. One of them does mission work.
12,353. Does she do nursing too ?
—Yes, in ordinary cases.
12,354. You have not got much pulmonary tuberculosis in your parish ?
—In one village there are a number of cases.
12,355. Non-pulmonary tuberculosis is fairly common?
—Yes.
12,356. You tell us in your statement quite frankly that it is a struggle and a worry for you to make ends meet in your practice ?
—Yes.
12,357. It is not a very brilliant prospect for a young man to feel that in ten years he may not be any better off
than he is now ?
—No.
12,358. There is no hospital in your parish ?
—No.
12,359. Have you any trouble in having your patients removed to the hospital here ?
—Yes.
12,360. They are trying to get an ambulance in connection with the hospital ?
—Yes.
12,361. Is there an ambulance in connection with the fever hospital ?
—There is an ordinary fever van. In some parts of the parish they are twenty-seven miles away from
the Stornoway hospital.
12,362. If you have a serious case you want to get operated on, you will have some difficulty in getting it in
to the hospital?
—The case can either be taken in a cab or a car.
12,363. You find, as a great many doctors do, great difficulty in getting a holiday when you need one. In
this way, you will agree, that the public health suffers because you are not able to rub up your knowledge and
visit hospitals and so on ?
—That is so.
12,364. Your suggestions for the improvement of the medicaI. service in the Highlands you have embodied in a memorandum, and you wish it put in the notes ?
—Yes. I now hand in a copy of the memorandum.
STATEMENT ON BEHALF OF THE MEDICAL PRACTITIONERS IN THE LEWS
Borve, Stomoway, 12th Aug. 1912.
M. BEATON, Esq.
Dear Sir,—
At a meeting of the Lewis section of the Ross shire division of the British Medical Association, held at Stornogway on the 8th inst., uestions 33 and 34 of your Committee’s Schedule were under consideration, and I was instructed to forward to you the findings of the meeting, which were as follows :—
33: . That, considering the medical requirements of the people; the convenience of telegraphic communication;
the enormous saving in time which modern methods of travel, and improved roads, allow; the eneral freedom
from acute illness for the greater part of the year; and the limited means of the people, the number of medical
men already practising in Lewis is sufficient. That, in order to make the present service more efficient,
additional nurses, fully trained in medical, surgical, and maternity work, and working under the control of the
doctors and not of nursing associations, would be most helpful. Such nurses could see to it that medical instructions were properly carried out, and that a proper dietary was prepared or the patient. In short, they would carry into the homes of the people the benefits of skilful nursing and the elements of hygiene.
34. That much general improvement could be effected on the lines laid down in the Lord Balfour Committee
(Lewis) Report, 1903, and that, as more immediately concerning the needs of the doctors, the following recommendations are urged :—
(1) Reasonable security of tenure.
(2) Adoption of finding of special meeting of the medical practitioners of Ross and Cromarty, held on the 3rd August 1912, as follows :—that remuneration should not be per capita but per attendance, and that the fee should be 2s. 6d. per visit—mileage at the rate of 1s. 6d. per mile, and that visits taking some hours should be at the rate of 2s. 6d. per hour.
(3) Provision for payment of substitute during a month’s holiday each year.
(4) Provision made for suitable dwellings for doctors and nurses.
I am, Yours faithfully,
(Sgd.) JOHN M. Ross, Hon. Secretary.
12,365. At present you think there are enough medical men in the Highlands if the means of communication were improved, and telegraphs and telephones extended, and possibly a rearrangement of the districts ?
—I know that the people cannot support the doctors.
12,366. Whether they need more or not, there is no room for any more to make a living unless a fund was
provided for them ?
—That is so.
12,367. Supposing there was a chance of doctors making a living, do you think that more doctors could be profitably employed ?
—During certain parts of the year when the work is heavy they could.
12,368. You want reasonable security of tenure; it is just, I suppose, an appeal to the Local Government Board ?
—Yes.
12,369. And that your remuneration should be not per capita but per attendance ?
—Yes.
12,370. A man who lives a long way from the doctor- a poor man who lives ten or twenty miles away from the doctor—cannot pay an adequate fee ?
—The man himself cannot provide an adequate fee.
12,371. Unless some means is found for providing it, the doctor must bear the cost himself. At present there is no other way of providing it ?
—That is how it is done at present.
12,372. You advocate suitable dwellings for the doctors and the nurses ?
—Yes.
12,373. You do think that there should be an extension of the supply of nurses ?
—Yes, I think it is necessary.
12,374. Would you like hospital-trained nurses, or is the kind of nurses that is at present in Lewis quite good
enough for your purpose ?
—I think they would need to be specially trained in surgical and medical work, and in maternity work.
12,375. I suppose you would like them to be more directly under the control of the doctor than they are at
present ?
—Yes.
12,376. (Lady Tullibardine.) Do you find that the population in your area, other than the crofter and fishing
population, can pay you a fair fee ?
—There are very few of these.
12,377. I notice that you mention others, such as merchants, farmers, and teachers ?
—Most of the merchants are crofters.
12,378. There are not many teachers ?
—There are seven schools in the parish.
12,379. Can the farmers pay fairly remunerative fees ?
—Yes, but there are only two or three in the whole parish.
12,380. My point is that supposing a club system such as the Chairman has outlined was recommended, would you wish it limited to the crofters and fishermen, or would it also be as well to include the merchants and farmers ?
—A number of the merchants would come under it as being crofters, but I think the teachers and farmers ought to be excluded.
12,381. They can pay you more than the crofters and the fishermen ?
—I think they ought to be expected to pay reasonable fees.
12,382. Are there many single people living alone ?
—Not many.
12,383. You say you wish safeguards for the club system. Would you wish to have confinements and operations excluded from the proposed club subscription of 5s. ?
—I think they should be extra.
12,384. Would not something in the way of a small cottage hospital of a simple kind be of great advantage in
your neighbourhood?
—It would be.
12,385. I mean not so much an hospital as possibly a couple of rooms added to the nurse’s house, where a patient could be nursed ?
—It would be a great boon, I should think.
12,386. Even if it were not elaborately fitted up, just a couple of nice clean rooms to which serious cases might be taken ?
—Yes, that would be a great improvement.
12,387. (Dr Miller.) You are a native of the parish of Barvas ?
—Yes, I was born at Lochs.
12,388. You have resided there for a large part of your life ?
—Yes.
12,389. And naturally you are interested in the people and the locality ?
—Yes.
12,390. And that has had something to do with your going to stay in the place ?
—Partly, and partly owing to my father’s illness.
12,391. Is your father staying with you now ?
—No ; he stays with my sister down in England.
12,392. The Chairman has elicited from you that during part of the year the work is really too heavy for one man and that you would be the better of some assistance. You could not provide that out of your emoluments?
—That is out of the question.
12,393. If, from other sources, the emoluments were forthcoming, you would be willing enough to have an
assistant in the parish ?
—Yes, if I could afford to keep one.
12,394. Would you prefer to have him resident in your centre or would you place him, for the convenience of the work of the population, at some outlying point of the parish ?
—It might depend if there were any epidemics. My house is situated right in the centre of the parish.
12,395. You think it might be as convenient to have the assistant staying with yourself as to have him planted
outside somewhere ?
—There would be hardly a place for him outside.
12,396. Your present house, I think you have said, is very small for your purpose ?
—Only the waiting-room part of it. The family portion is big.
12,397. The water supply in your house is inadequate?
—Yes.
12,398. Is it the habit of the patients to come to consult you in the house every day ?
—Yes.
12,399. When you are away in the country do they come notwithstanding your absence and stay there for hours at a time ?
—Yes. They sit in the kitchen and they are fed in the kitchen.
12,400. How are they fed ? Does your cook feed them?
—Yes.
12,401. All that comes out of your pocket and out of your purse ?
—Yes.
12,402. That is a usual kind of occurrence ?
—It is an every-day occurrence.
12,403. I suppose you are unceasingly employed amongst that population. You have very little time for your
leisure ?
—Except for a few months in the summer-time when the people are away.
12,404. What are your duties under the School Board ? I see you receive a certain fee from the School Board ?
—It is in connection with the sanitation of the schools and the certificates for the closing of the schools in the case of an illness among the children.
12,405. But you have got nothing to do with the treatment of school children as such under the School Board?
—Not for this fourteen guineas.
12,406. I see that the Northern Lighthouse Board give you fourteen guineas a year. How many families do you attend for that sum ?
—Three.
12,407. How far distant are they from you ?
—Between eleven and twelve miles.
12,408. Do you find that the work is considerable in connection with these people ?
—Not for the last two years.
12,409. They happen to be healthy families ?
—Yes, and their requirements are not great. They are small families.
12,410. I think you have said that the people are really unable to pay you an adequate fee—those above the
pauper line ?
—Yes.
12,411. What is the average rental per household in your district ?
—35s. per croft ; 8s. 9d. per head.
12,412. What sort of persons would you be inclined to exclude from the general public service system that is
under contemplation ?
—Practically those I rmentioned—the farmers and the teachers.
12,413. And the merchants?
—Perhaps some of the merchants. The most of the merchants are really crofters or squatters.
12,414. I fancy it is recognised that some system of regulation in addition to a check fee would be necessary to protect the doctor and to enable him to carry out his work methodically under the proposed public medical
service. You would think that would be necessary ?
—Yes.
12,415. A regulation as to times when messages are to be sent in to the doctor, and so on ?
—Yes, and hours for the people to come to the doctor.
12,416. Might I ask, have you had experience—at any rate your father will have had it—but have you personally had experience of such cases as strangulated hernia?
—Only one. I was able to reduce it.
12,417. Have you had cases of diphtheria ?
—No.
12,418. So that you have not been called upon to do tracheotomy ?
—No.
12,419. Would not it be a great advantage if you had a bed attached to one of the nurse’s dwellings where you could convey a patient to when needed ?
—Yes.
12,420. With regard to this awful state of the housing do you think that it is due to local conditions, or is it just
a survival of barbarism? Do you think the Highland people two hundred years ago were subjected to this kind
of living in houses? Do you think it was the normal condition of the Highlanders two hundred years ago?
—I suppose it has been the same always in this island.
12,421. You cannot conceive anything more dreadful than exists here. It is a blot on civilisation ?
—Yes.
12,422. Do you know any other part of the civilised world where worse, or even as bad, conditions exist? —No.
12,423. Don’t you think it is rather often more incongruous that most of the people living in these places are
people who have travelled and have seen respectable methods of living ?
—Most of the young people have travelled.
12,424. And yet they are content to come back and live under these conditions ?
—It is very strange.
12,425. You don’t see much non-pulmonary tuberculosis. Do you attribute that in part to the condition of the milk supply ?
—Yes, the milk supply is very unsatisfactory.
12,426. Are the cows healthy on the whole or are they an unhealthy breed ?
—They don’t look healthy.
12,427. And the housing is bad ?
—Yes, and also the places in which they keep their milk.
12,428 Where do they keep their milk, as a rule?
—In chests sometimes, and in presses in the living room or in the bedroom.
12,429. Open to all the contamination that is possible?
—Yes. .
12,430. You have told us about the nurses, that the number of nurses is, in your view, insufficient ?
—Yes.
12,431. And you would favour nurses with the best training possible ?
—Yes.
12,432. And with more direct control by the doctor?
—Yes, to work under the doctor.
12,433. (Dr Mackenzie.) In Dr Murray’s report for the Lewis district, we ?nd an account of the outbreak of
typhus that you had last year. You had some twenty one cases to handle with three deaths ?
—Yes.
12,434. The work was practically all done by yourself and the local nurse ?
—There was a nurse got from Stornoway.
12,435. Dr Murray says in his report, “I should like to repeat here what I stated in my special report upon the
Borve outbreak, that Dr Ross deserves great credit for the unremitting care and attention which he gave to all
the cases, and for his efforts to prevent the spread of: the disease. The nurse was in attendance upon all the cases and disinfection was carried out as thoroughly as the circumstances would permit.” I presume whatever was done from the hygienic standpoint was practically done by yourself and the nurse ?
—Of course the sanitary inspector was out too.
12,436. You had all the active work arising out of the treatment of the cases ?
—Yes.
12,437. What was actually done in the disinfecting of the houses? They were all black houses, I presume?
—Yes.
12,438. All with cows in the houses and a considerable quantity of manure and excreta of other kinds?
—Not at that time. It was at a time of the year when the houses were practically clean.
12,439. What was done with regard to disinfection?
—All the woodwork was washed down with ordinary disinfectants, Jayes fluid and carbolic acid, and a good deal of wool and clothing was destroyed.
12,440. Didn’t you think of burning the house?
—Where were the people to go?
12,441. Was the thatch removed ?
—Not on that particular occasion.
12,442. Then the straw on the beds, was it removed?.
—It was all burned.
12,443. And the clothing ?
—It was swabbed.
12,444. And how were the floors dealt with?
—In some cases lime was applied to the walls. The rooms were fumigated again.
12,445. In any case, you had a great deal of extra work thrown on you by that outbreak ?
—Yes.
12,446. You and the nurse had special management of it right through ?
—Yes.
12,447. How long did it last ?
—Practically for three months.
12,448. You also had an inspection of contact cases. Dr Murray says that along with you he visited all the
infected houses and examined a number of the children at school. Do you give certificates for the schools—for all the children at school ?—Yes (i.e. for those excluded from school).
12,449. Did the local authority for public health recognise your service in any way after this outbreak by
say extra remuneration whatever ?
—Nothing whatever.
12,450. Of course you were doing largely their work. If they had had an hospital all these cases would have
been removed to hospital ?
—Practically the whole thing was done at my expense.
12,451. In fact, as a private practitioner, you were asked to do what the local authority ought to have done ?
—Yes.
12,452. Have you had much typhoid since you began to practise here ?
—Very little (i.e. apart from epidemics).
12,453. You have had it occasionally. Some years ago, during your father’s time, there was an outbreak in the Ness district ?
—That would be six or seven years ago.
12,454. It was a very considerable outbreak ; there were something like fifty or seventy cases. He did the same ?
—Yes.
12,455. He devoted himself to the treatment of the cases, and as far as possible limited the outbreak ?
—Yes.
12,456. Once more doing the work of the local authority ?
—Yes.
12,457. Did they offer, to your knowledge, to remunerate him for his services ?
—No.
12,458. Was he medical officer of health for the parish ?
—Local medical officer of health.
12,459. What salary did he have ?
—£20 a year.
12,460. And for that he had to take charge of all epidemics ?
—Yes.
12,461. You are not medical officer of health ?
—No, but I am assistant to Dr Murray.
12,462. Do you get any money in respect of that ?
—£20 a year
12,463. Is that understood to cover all this special outbreak work ?
—I don’t think it should.
12,464. At any rate they have given you nothing but that?
—Nothing.
12,465. In the matter of the improvement of the houses, do you, who know the district perfectly, recognise any serious improvement in the last ten years ?
—Yes.
12,466. What form has it taken; are they building a few houses, or is it the improvement of the old ones ?
—Mostly the building of new houses.
12,467. Is there any tendency towards building new houses among the crofters themselves or the others? Is
there any desire to have better houses ?
—Yes, with some, especially those who have been away.
12,468. Has it made any serious improvement in the district?
—Not so far.
12,469. As a medical man, and being familiar with civilised housing in the south of Scotland, you would not
call these houses suitable places for nursing diseases ; it is a test of the capacity of human endurance in the midst of the worst surroundings. Is that putting it too strongly ?
—I think so.
12,470. (Chairman.) Has any house been built deliberately to contain both the cattle and human beings?
—Yes.
12,471 Within recent years ?
—Within the last two or three years.
12,472. (Mr Orrock.) Did this epidemic break out in one of the improved houses ?
— No.
12,473, I refer to the Shader epidemic ?
—It broke out in a very bad house in Shader.
12,474. Was it not in one of the improved houses ?
—Not at all; one of the worst houses in the place.
12,475. (Chairman.) Have many of these houses been built within your knowledge recently ?
—Not so many.
12,476. More than one ?
—Yes.
12,477. I presume as a trained medical man, what you mean when you say you would not do serious operations in these houses, you mean that you would not do any such work in these houses if you could avoid it. Of course there is a great difficulty and danger in doing it there ?
—Yes.
12,478. You cannot do honest and sound work without an hospital?
—That is so.
12,479. As to the nurses, you are also clear that it is necessary that they should be correlated with the medical
men in the parish ?
—Yes.
12,480. About the births, how many have you in the parish in a year ?
—153.
12,481. And of these about twenty are attended by uncertificated maternity nurses ?
—Yes.
12,482. You have had experience enough of puerperal fever alone to show that the existence of all this mass of uncertificated medical attendance is really enough to discredit that system ?
—Yes.
12,483. You say that many cases go unattended that ought to be attended. Have you any remedy as to how to get at this? What is the percentage of uncertified deaths in the parish, do you happen to know ?
—There were 37 uncertified deaths last year out of a total of 93. That is 40 per cent. They are mostly old and young people.
12,484. What do you think the want of certification is due to? Is it that they don’t think death is worth trying
to ward off ?
—A great many of these cases are chronic cases.
12,485. You may have seen them a short time before death, but not in a time that you would be justified in
giving a certificate ?
—That is so.
12,486. You get a greater number of calls to old people than you used to get ?
—Yes.
12,487. You have reason to think that since the old age pensions came into force that the attendance on the older people has gone up ?
—Yes.
12,488. Now they can afford to pay for it ?
—Yes.
12,489. Could you tell us why you made the agreement that you could not be dismissed without the consent of the Local Government Board ?
—I knew it was done in Stornoway before, and I thought it was as well to have the safeguard in my case.
12,490. The relations between your father and the County Council were quite pleasant and cordial ?
—Yes, so far as I know.
12,491. How many ministers are there in your parish?
—There are ?ve. There are over twenty churches in the parish, and a new mission house.
12,492 How many manses are there ?
—Eight.
12,493. You could get one of these manses, could you not ?
—One of the old ones?
12,494. I had the byelaws in my hand this morning, and they are dated 1900. You actually say that the houses
were built under the byelaws. The Local Authority state that the houses must not be built for the accommodation of animals under the same roof ?
—I know. Some of the houses were built within the last few years.
12,495. Has any attempt been made to prevent such houses being put up ?
—They tried to prevent them putting them up as much as possible. Sometimes they don’t know
about them.
12,496. Do they not see that the site is a good one and the building conform with the requirements of the bye-
laws ?
—I think so.
12,497. Was your Parish Council quite willing to give you this clause in your agreement? They did not object
to your having it ?
—No.
12,498. You find them a body of reasonable men, don’t you ?
—They don’t interfere very much with me.
12,499. (Dr Miller.) I think the people in your own parish—it is practically your native parish—ought to be
friendly towards you on that account as well as on your father’s account ?
—Yes.
12,500. Nevertheless you thought it desirable to have this clause of protection inserted into the agreement ?
—Yes. It was really through my father’s suggestion that I got that in.
12,501. (Mr Lindsay.) Were these crofters or cottars that put up these buildings ?
—They were mostly squatters.
12,502. Are you aware of the sanitary inspector paying a visit to that part when the buildings were being put
up ?
—He pays occasional visits.
12,503. How often does he visit ?
—I could not say.
12,504. Once a month ?
—I don’t see him once a month.
12,505. (Mr Grierson.) We have had it that a large part of your population leave the island, say, from the 1st of June to the end of November ?
—Yes.
12,506. What is the proportion of your parish that leave ?
—Practically all the able-bodied population.
12,507. They will be away for five or six months ?
—Yes.
12,508. So that you would not require to attend them, of course, during these five or six months ?
—No. I think that is one of the reasons why the work is harder afterwards.
12,509. That population goes away round to Shetland and elsewhere, when they get ill while they are away, of course, they will be doctored in the district in which they are ?
—Yes.
12,510. If you had 5s. as a capitation fee, would not it pay you pretty well seeing that for five months of the
year a large number of your patients are away? Would not a 5s. fee per family pay you very well seeing you
are not having to treat these people ?
—It is mostly the families of the able-bodied people that require treatment.
12,511 Here in this town of Stornoway we had evidence of a society of Oddfellows. I am sure that they required, to my mind, a considerable amount of treatment ?
—They require the least treatment in any case.
12,512. Have you any idea what kind of salary you would get if you got 5s. per family for a population of
7000 people. That is nearly 1400 families, which would be £350, and you have already £160 from the Parochial Board, and 28 guineas from other sources, so that that would be £529, 8s., which would be the salary if you got 5s. per family. Taking off £200 odds, that would leave you the £300 that we have been struggling to get at '?
—Yes.
12,513. What objection could on possibly have to a club system of that kind ?
—I would have no objection to it.
12,514. Would you rather have a modified fee than a club system ? Is it an objection to the club system only, or would you prefer to have a modi?ed fee? If we could subsidise or arrange it at any rate that your outlying
patients could be treated for 2s. 6d. fofi the first visit, an for every other visit ls. each, or something like that, would you prefer that to the club fee ?
—I think it would be more desirable.
12,515. In whose interests? In the doctor’s or the patient’s interests ?
—I think in the interests of both.
12,516. You think it would be more desirable in the patient’s interest because the patient would be more ready to call you ?
—Part of my salary would be coming from people to whom I give no attendance in the year.
12,517. You think that in the club system there would be a lot of people paying to whom you give no attendance, whereas if you had a modi?ed fee only people would pay to whom you give attendance ?
—Yes.
12,518. I see you say here when you supply your medicines they are usually included in your charge for
the visit ?
—Yes.
12,519. If there was any club fee, would you expect to get your medicines paid out of that club fee—your medicines and dressings. With the £350, would you consider that you would require to be paid for your medicines and dressings over and above that sum, or do you think you could throw in your medicines and dressings for that sum ?
—It is difficult to answer that question.
12,520. We had it from one of the doctors that he thought such a fee as 5s. would not pay for more than
medical attendance, and that you would probably require to be paid for your medicines and dressings over and above that. Have you the same feeling ?
—I would think so.
12,521. I think you said here that you would re uire an assistant to work this parish. You say that it is on y three months that it is really hard work. What would you do with the assistant doctor for the nine months? Is it your idea just to have a temporary assistant for the three months, and that you could overtake the Work during the other nine months ?
— It is only for three months I would need him.
12,522. You would prefer an assistant, I suppose, to any increase in the nursing system, because, I suppose, like all other medical men, you look upon nurses as practising as qualified medical men. Is that your feeling ?
—No. My feeling is that if the nurses are properly trained they do very little unqualified practice. The more highly trained the nurse the less she is inclined to take things on her own account.
12,523. The untrained nurse is more inclined to do it than the fully trained nurse ?
—Yes, I think so.
12,524. You lay stress on the nursing, if it is properly organised ?
—It is the only way the doctor’s instructions can be carried out.
12,525. You really would be better to have all these unqualified midwives and people cleared out of your parish, and have two or three well-trained nurses to take their place under your supervision ?
—Yes.
12,526. You say here “They work under a local committee and attend a number of cases I do not see at all.
If they consider a case to be serious they advise the people to call in the doctor.” What committee is it they work under? Is it the Parochial Committee ?
—No, it is a committee of ladies representing the Edinburgh Ladies committee.
12,527. Your feeling is that they should be entirely under your supervision ?
—Yes.
12,528. I mean that would be to the advantage of the nursing of your district if they were entirely under your
direction ?
—Yes.
12,529. That is to say, all these nurses are managed outwith your control, still you ought to have certain nurses to work under you to make the medical service efficient in your parish ?
—My opinion is that the treatment cannot be carried out without t e help of nurses, especially with regard
to dieting and poulticing, and these things. The people cannot do these things.
12,530. Don’t you think it would be a great advantage if hygiene were taught as part of the curriculum in the
schools at Borve ?
—I think so.
12,531. Do you not think that to teach the elementary points of hygiene and health are really more important
than teaching gardening ?
—I should think it is.
12,532. From the health point of view of all the people you live amongst, don’t you think so?
—Yes.
12,533. I see you object here to your housing accommodation. Is it the case that your father objected to a water closet being put into the house? Did he prefer the earth closet? Is that the reason why the accommodation was not put in ?
—It is possible.
12,534. The reason he preferred it might be because he thought that the Highland servants would not be able to look after it ?
—I don’t think he would object to a bathroom in the house.
12,535. (Mr Orrock.) With regard to the population your district, there is practically 7000 of a population.
That includes the district of Shawbost ?
—Yes.
12,536. Which has a population of 913 ?
—Yes.
12,537. We will assume that two out of every family goes to the fishing in your district. A very large number go from Ness and Shawbost suppose more than from any other part of Lewis?
—Yes.
12,538. Both men and women ?
—Yes.
12,539. And it is supposed in a season that they care a lot ?
—Yes.
12,540. Would they not be able to pay per family fully 5s. for each household?
—No doubt some of them would be able to pay more.
12,541. On the average, seeing that so many go to the East Coast ?shing in your district, would they not be able to pay 5s?
—I think 5s. would be within the reach of all.
12,542. So that in your district a very large sum would be derived from that source ?
—Yes.
12,543. Then you speak of a check fee of 2s. 6d. for the first visit and 1s. afterwards. Do you mean to suggest that that would be over and above the 5s. ?
—I have not considered it in relation to the 5s. at all. A check fee is necessary if such a system is introduced.
12,544. Over and above the 5s. ?
—Yes.
12,545. I think when we were at Garynahine a witness referred to a rearrangement of the Uig parish, and that
Shawbost, which is the end of your district, might be thrown in to the Uig district. Would that be a good arrangement? It would make your parish more compact Of course, it is not intended with the view of of reducing your emoluments. That is not the idea at all. There would then be work for two doctors at Uig ?
—If the place could support the three doctors, or if the funds were available, it would be all right.
12,546. You think if funds were available it would be a good proposal ?
—Yes, for three men could work there.
12,547. There is work for three men so long as they could make a reasonable income out of it ?
—Yes.
12,548. So that that would leave you with 6000?
—Yes.
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