Lochmaddy, 16 October 1912 - Archibald Alexander Chisholm

14,292. (Chairman.) You are Procurator-Fiscal at Loch Maddy, for the Long Island district of Invernessshire?
— Yes.

14,293. You have been here for a long time?
—For over thirty-one years.

14,294. You know the conditions very intimately, the social conditions of the people?
—Yes.

14,295. The main sources of livelihood are crofting and fishing?
—Yes,

14,296. Is there the tweed industry here?
—Yes, there is the tweed industry.

14,297. It does not amount to so much as it does in Harris, I suppose?
—No, but it is considerable in North Uist as well as Harris.

14,298. They derive a considerable income from the Lovat Scouts and the Militia?
—About £1000 a year.

14,299. Are there any in the Naval Reserve?
—No.

14,300. The crofters don’t have very much ready cash, but they have a home and milk and potatoes and that sort of thing?
—Yes, generally. Some few have means.

14,301. And generally the population are able to pay a fair fee?
—The crofter population, yes.

14,302. The crofters are not able to pay an adequate fee to a doctor for the services he renders, especially if he lives far away from them?
—A single crofter might not be.

14,303. A crofter living ten or fifteen miles away from a doctor could not pay a fee, an adequate fee, for the doctor’s attendance?
—No, assuming that the doctor had not much practice; but here the doctors wander about from morning to night, and in the course of the day they visit many patients.

14,304. But if a crofter has sent for the doctor and the doctor had to drive to him a good few miles, and had to drive often, most of the crofters could not pay adequate fees?
—Yes.

14,305. And, as a matter of fact, when a case comes up like that they don’t pay an adequate fee to the doctor?
— In North Uist the doctor is appointed by the estate on a sort of club system.

14,306. If you had not that club system here in many cases the doctor would have to render services for which he would never get paid?
—Yes, and he does that still.

14,307. You describe here the advantages of the club system?
—Yes.

14,308. It is generally that 5s. a family is taken from the crofter and the cottar class, and a larger sum is taken from the farmers?
—Yes.

14,309. And the doctor gives them free medical attendance and charges medicines extra?
—Yes.

14,310. But the doctor explained to us that he had these fees when he came here about twenty-five or twenty-six years ago?
—I do not know what he said. I take it so.

14,311. He tells us that in that time the work he has had to do increased very largely?
—I suppose for any extra work that has fallen to him he gets extra pay. So far as the crofting and cottar classes are concerned, there has been no extra work, but less—they are now fewer.

14,312. He tells us that since the introduction of the telegraph system he has had to pay a good many more visits than he had to pay before, and he gets no more for them?
—That may be so. The North Uist doctor lives in the most inaccessible place.

14,313. Why does he live there?
—Well, I don’t know. I suppose the reason is obvious. He lives in almost the most inaccessible place.

14,314. Do you think that there should be more than one doctor here in this parish?
—Most certainly, but each independent of the other. I don’t think there should be two doctors, one under the other, because if so, individual responsibility would be destroyed. All the work would be thrown upon the junior, and all blames.

14,315. Do you think that there is a living in this district for two doctors?
—South Uist supports two doctors, and I should think the income of the North Uist doctor is equal to that of the two in South Uist, and more than equal.

14,316. Do you think it would help you to get good doctors to divide the living?
—I don’t say that it might or it might not, but two would be better than one obviously.

14,317. Do you think it would improve the medical service in the district if the income of the doctor were divided between two?
—Yes, certainly, if two could be got for the same money, as might be got in North Uist.

14,318. Do you think two could be got for the same money?
—I should think they could be, very likely.

14,319. Apart from having two doctors, do you think the service in this district could be improved by the addition of fully qualified nurses?
—We have two nurses in North Uist.

14,320. Is that enough?
—No.

14,321. It would improve matters if you had more?
— Yes, a good many more, because of the difficulty of getting at some parts of the parish.

14,322. Do you think the public would prefer these nurses put under the control of the doctor or independent to him?
—To a certain extent they must be under his control, and to a certain extent they must be independent.

14,323. Have you had any experience of both?
—The nurses here are worked by a Nursing Committee.

14,324. Yes, but they are under the control of the doctor?
—A nurse must be under control of a doctor.

14,325. In some cases they practise on their own account pnd charge fees?
—Yes; they practice, but do not charge fees.

14,326. They don’t charge fees here at all?
—They are not supposed to do so. Any payments that are made are supposed to be paid into the funds of the Association.

14,327. You don’t approve of a nurse practising on her own?
—I would if she was a good nurse.

14,328. You mean, of course, nursing work, not medical work?
—Yes, including such as attending cases of confinement.

14,329. Now, while we are on that subject, have you any cases here of uncertified midwives attending these cases?
—I have no case in view, but I have no doubt that lots of uncertified midwives do attend these cases. Till recently here none were certificated.

14,330. Now, if anything happens, if the patient dies or if the child dies, do you, as Fiscal, take any notice of that?
—Not unless there are any circumstances inferring blame against any person.

14,331. Is not it an offence for an uncertified midwife to attend a case?
—Not in emergency for anyone.

14,332. And to take fees for it?
—I don’t see any harm.

14,333. Is not that the law of the land?
—I don’t know. For a long time there were no certified nurses here. The custom has grown among the people, and women of very slight experience used to do it.

14,334. Supposing a death under these circumstances occurred, it would be no part of your duty to inquire about it?
—Not unless there was suspicion of blame.

14,335. You are not able to say what the proportion is of cases among the non-pauper poor who are not medically attended, but you know there are a certain proportion of them?
—Yes, there must be.

14,336. What do you think the reason of that is?
—Do you mean to certify their death causes?

14,337. Although they don’t die, if they suffer without medical attendance, what is the reason?
—It is obvious on the face of it that in a parish of this extent, and broken up as it is by water, one medical man cannot give medical attendance to the whole place.

14,338. He goes if he is sent for?
—He does his best. I have no doubt some must suffer.

14,339. Do you think they always send for him when they are ill?
—I don’t know. I suppose he will say himself that. Very probably they send too often.

14,340. Do you think there is any large proportion of the people of this district who don’t receive the services of a doctor because they hesitate to send for him on account of the trouble of getting him and the cost of getting him?
—I don’t know. In a bad case, I think, they almost always manage to get him.

14,341. Of course here they have no fees to pay except the 5s. That is to say, they have practically free attendance?
—Yes, most of the people.

14,342. And in the case of uncertified deaths, they are usually the deaths of old people?
—They are cases where death has been due to natural causes, and there is not even suspicion of blame in connection with death.

14,343. Do you think there are many cases where a doctor is not sent for in time: that is to say, if he ‘had been sent for sooner the results would have been better?
— I don’t know, but probably a few cases.

14,344. You cannot give any instances in your own experience of difficulties of getting doctors?
—Yes. I have had difficulty in getting doctors myself for official duties.

14,345. You might tell us about that?
—In May last, in connection with an old woman in Benbecula, I wanted two medical men to attend. By wire I first of all communicated with the local man, Dr Macauley, and he was absent in some out-of-the-way place in South Uist, attending to his medical work, and he could not attend. I asked the North Uist doctor to attend; but he could not attend; he being laid up with cold. I asked the Harris doctor to attend, but he was otherwise engaged. I asked the Obbe doctor to attend and he gave the same reply. Eventually I wired to the doctor in Barra and he was able to go, with Dr Reardon from Dalibrog.

14,346. What was the case?
—A case of assault upon an old woman.

14,347. Are there any other cases you care to tell us about?
—That is the most recent one, but I have often had trouble in getting doctors where they knew they could get substantial fees. It was not a question of fees at all. In the case of the old woman nurses did all that was necessary. She was too far gone to benefit by a doctor’s attendance. The situation was that all those doctors knew they would be paid, but they could not go. At certain times, no matter whether they could otherwise go or not, weather might prevent them. The only way out of that difficulty is to have more doctors for the islands, and have the whole lot of them supervised by some independent central authority.

14,348. You think it would be an advantage to have a central authority to control the doctors?
—Certainly, and that they should be properly looked after.

14,349. Do you think the present parish area too small for an efficient service: would you view with favour an extension of the area of control from the parish to the District Committee?
—Yes, and beyond that to some central authority in Edinburgh or London.

14,350. Yes, but as a local authority?
—Well, local authorities here are very local, and open to suspicion of local prejudices.

14,351. If the area was made the district, would that be an improvement, taking it generally?
—No, I would say the control ought to be put into the hands of a more independent body than even the district of the County Council. Parish and district areas here are identical.

14,352. Who is going to pay them?
—I don’t know. The Government must find funds, if that is established, no doubt.

14,353. At present the doctors are paid partly from parochial appointments, partly from fees, and partly under a club system?
—Yes, and Crown appointments and private patients of means.

14,354. And School Board appointments, and all these appointments. Manifestly, if there is local money used to pay the doctor, there must be local control. That is to say, if the Parish Council contribute a large sum, as they do, in these Highland parishes for the doctor, the Parish Council should have some say in the matter?
—Yes, so long as the Local Authority is responsible for the payment or the engagement of the doctor.

14,355. It does not apply in North Uist, but in some districts we find that the doctors overlap a bit. That is to say, that part of a doctor’s practice might be much nearer his professional brother in the other parish than himself, and one way of getting over it has occurred to me, and that is that the District Committee should have the control over them?
—And the appointing and disposal of them. I think that there should be an central body, but it is more the local control of them I am talking about.

14,356. You don’t think there would be much advantage with a larger area?
—No.

14,357. What we want to get from you is your view as to how we could make practice here more attractive for doctors. There is no doubt it is very difficult to get good doctors in the Highlands?
—Give them smaller districts and more pay.

14,358. Has it ever occurred to you that perhaps a system of promotion or change might be adopted, whereby a man might not be settled down here for his life; you would get a good man to start here for a year or two if he was sure of getting a change?
—Yes. We have some good men just now. It is only fair that such men should have a chance of getting promotion to something better. They should have a change on to the Mainland after serving here.

14,359. On the other hand, there are men who prefer this country?
—There are not many.

14,360. How do you think we are going to get better remuneration for these doctors?
—Well, I don't suppose much more can be got out of the local rates. The local rates, I believe, might be slightly raised if the annual valuation of shootings were properly assessed. They appear to be on the face of them undervalued in some places. Of course that would not be a complete cure by any means.

14,361. I don’t think there is much more to be got out of the rates, but at the present moment I don't think any of the doctors have such an income as an educated man ought to be expected to get. A few are making a good income, but a good many are not?
—I think North Uist ought to be a fairly good living.

14,362. In every case we have come across the sum paid by the Parish Council to the doctor for his services to the paupers is out of all proportion to the services he renders to them?
—Compared with the Mainland, yes.

14,363. You get them getting £2, £5, £10, and as much as £12 per head per pauper, and that is given so as to induce them to stay?
—Large parishes in the Mainland may be paying only £10, whereas here they may be paying £100 salary for paupers alone.

14,364. That sum that is given to them is a great deal more than a fair sum for the services they render, but it is given so as to have a doctor in the parish?
—Yes. We have parishes in the Highlands where the rate for poor-law is very much higher on account of the cost of attending to the paupers. That is taken out of the poor rate to induce a doctor to remain there.

14,365. In that case the poor rate is bearing the expense of providing a doctor for the non-paupers?
—Yes, indirectly, I suppose that is so.

14,366. Is there any other way whereby the community could bear part of this cost themselves?
—Not that I know of, except by individual payment by people who are having the doctor’s services.

14,367. Could not a development of the system you have got in North Uist be devised whereby a sum might be raised, contributed to by the rates, by the School Board appointments and the Government appointments, and the sum that is collected in this way, along with the club subscriptions and perhaps a Government grant, might secure for the medical men in the various parishes a decent salary. Do you think this club system could be developed in this way. I mean, to pool the funds in each parish into one fund and augment that by a Government grant and also by contributions from the locality?
—It would depend on the Government grant.

14,368. It is the contributions from the locality I am speaking of?
—I don’t think it would be good.

14,369. What sum do you think could be contributed per family; could you get any more than 5s. per family out of them?
—I think on the average 5s. per family or 7s. 6d. per family could be paid.

14,370. If it was all collected it would amount to a good deal?
—No doubt.

14,371. I think we discovered that in the case of a voluntary club there is a great deal of it never collected; a great many people never pay?
—I believe that is so, but that is a point upon which Mr Wilson, if he is here, could speak from actual experience.

14,372. Do you think from your point of view that there would be any objection to it being made compulsory?
—I would have objection; I would prefer to pay the medical man or the nurse for myself.

14,373. Do you think there would be any hardship in asking the crofter who never needed the doctor in his house to pay that sum per year? At present the doctor has to be paid by somebody—partly by the doctor himself?
—I may be wrong, but I think they pay pretty well generally for the doctor.

14,374. I don’t think you can produce a crofter who lives at say ten or fifteen miles from a doctor who pays fees to a doctor sufficient to cover his expenses. I think we have got evidence pretty well to that effect?
—Most of them are far away from the doctors here.

14,375. Is it fair to ask a doctor to bear the expense of that?
—No.

14,376. And is the doctor not very apt to be unwilling to go when he knows it is to be a losing concern for him?
—Naturally.

14,377. As a rule we have found that they have almost never refused to go to a case. It is not right that a doctor should have to charge a poor man a fee that that poor man cannot manifestly pay without hardship. Do you think it would be an unfair thin to ask that the man beside the doctor should bear some of the cost of keeping an efficient doctor for the whole district?
—To levy an assessment?

14,378. Yes?
—On principle it looks all right at first sight.

14,379. Do you think there is anything wrong in it?
— There may be some men who don’t need the doctor all their lives.

14,380. Do you think it is fair to ask a crofter ten or fifteen miles away to pay 15s. or 20s., and that the other man near the doctor should get a visit for 2s. 6d.? You asking the invalid to contribute the whole cost of keeping the doctor there. What do you think the people in this district would think about it?
—I think they are perfectly content with the present system as a system, which amounts practically to that. That is the North Uist people.

14,381. You think there should be another doctor here, could be more nurses?
—Yes.

14,382. To give an efficient medical service?
—Yes.

14,383. You think that the local doctors and local Parish Councils should be controlled by a body in London?
—I would like the medical service to be controlled from London.

14,384. The only authority you could have in London would be the English Local Government Board?
—I presume some special authority could be established for dealing with a new situation—some Central Medical Board.

14,385. To deal with the Scottish medical service?
—Yes, certainly. Why not?

14,386. You would have this London Medical Board dealing with Scottish cases, and you would have that Board situated in London. What would you imagine the Board would be composed of —Englishmen or Scotchmen?
—It is immaterial.

14,387. Who do you think would be likely to be appointed?
—I should think there would be a large sprinkling of Englishmen on it. They would go more on general lines and broader principles than a Scottish Board. They would be more above local prejudices and pettinesses.

14,388. Why?
—Being in London.

14,389. Why?
—I suppose they would also be controlling the English public health on the same lines.

14,390. No; this is for the Highlands and the Islands alone?
—Still, I would rather have it done from London for the Highlands and the Islands. The English Board of Agriculture controls diseases of animals here, and does it well.

14,391. The next point you have here is that decent houses should be provided for the medical men. That is rather a serious difficulty?
—Yes, independent residences.

14,392. Who should build them?
—That is a matter for the Commission to solve. I would have independent residences, because if they don’t have such there may be trouble. Take the case of a young man appointed by a Parish Council: if he does not get into, and keep in, the good graces of a proprietor he may get no good place to live in.

14,393. Don’t you think the Parish Council is the proper authority to build a house for the doctor?
—They ought to have powers.

14,394. Anybody that takes their place should have power to build a house, which they have not got at present. You know that they have not the power at present?
—They have not.

14,395. You suggest that superannuation should be provided for doctors and nurses?
—Yes, certainly, those who served long here.

14,396. It would have the advantage of superannuating an old man, whose usefulness was done?
—Yes.

14,397. You suggest that assistance should be given to the doctors so that they could have a holiday which would enable them to rub up their medical knowledge?
—No, I did not suggest that, but personally I have no objection.

14,398. You also say that the system of locum tenens should be discouraged as tending to destroy individual responsibility. Will you explain what you mean exactly?
—He may be a man attending classes for one year. I saw years ago such a man taken out here and attending cases. He might get all the work and any blame.

14,399. Before he was qualified?
—Yes.

14,400. (Dr Mackenzie.) You know that is illegal?
—Yes, now.

14,401. (Chairman.) You say illegal locum teams should be discouraged, but you would not say that the doctor should not be allowed to put a locum in to allow him to have a holiday?
—I don’t say that.

14,402. Why should you discourage him?
—He could put in a locum tenens and go away for a very long time himself, and the people might not be nearly so well pleased. He might get too many holidays if he found he could get them cheaply and readily.

14,403. Have you had experience of that?
—I don’t like to say so.

14,404. Why should you object to the doctors having an assistant?
—If a place can support a doctor and an assistant it can also support two doctors, both are doctors equally.

14,405. You can get a good assistant for a much smaller sum than you can get a doctor to come for. I would be inclined to take the view that an assistant should be encouraged if you want to improve the medical service?
— Not here. My view is distinctly that they should be discouraged. Let there be individual responsibility.

14,406. Where will you get pay for individual responsibility?
—I am speaking of a case where money is available.

14,407. I would like you to explain why you think it is better that we should have men who are not assistants?
—You think it would be a better thing to have two men, but if you cannot get two first-class men—if you have not the emoluments—rather than having a first-class man and an assistant, would you rather have two second-class men? It seems to me that this is a typical case where they could have an assistant. It is your opinion I want?
—I have stated my opinion, and I won’t change it either.

14,408. You support the view here that I have given that doctors ought to be moved about—doctors and nurses, would you say?
—Yes, certainly, and that they ought when they do good work to receive some recognition. That would be an encouragement for a young man to come out here, because really only young men can overtake the work, especially in the winter, properly. We ought to have young men altogether.

14,409. Of course this would induce them?
—Yes. They suffer great hardships from exposure and want of proper food and lodgings when they are away from home.

14,410. (Mr Lindsay.) From your remarks about the young men and your remarks about the desirability of having a superannuation fund—putting it all into one—I think the point is, you want a State Medical Service, controlled as the army and navy are controlled from London?
—At least supervision from London.

14,411. Do you think it would be a desirable thing to do away with local control altogether?
—No.

14,412. How are you going to arrange it?
—Some local authority might have power to look after things in the locality and report to the central authority.

14,413. The point is that you lose local interest if you lose local control?
—I think the local people would often be glad to shift their interest on to the shoulders of some other authority, and to shirk disagreeable duty.

14,414. I am putting this from the local authority’s point of view. Hitherto we have heard from many doctors that security of tenure is desirable for the doctors. From your point of view, it is in the interests of the parish and the public that there should be some other authority outside?
—Decidedly. A good doctor has nothing to fear from control of local authorities. I look to the public good.

14,415. Of course this is a new view to us altogether. We have heard all along that it is on the part of the doctor that there should be that protection. You state here clearly that outside supervision is absolutely necessary for protection for the public?
—Yes. I have seen a great many doctors leave here, and I never knew of a case of harshness towards them by the local authority.

14,416. They were always lenient with the doctor?
—Yes.

14,417. (Dr Mackenzie.) Your point is that your local authorities have not really taken cases in hand that a central authority would take in hand?
—They might be stricter on them than the local authorities are. I always say that we have a lot of very good men here, but I have known others.

14,418. (Mr Lindsay.) I think there is a great deal in what the Chairman said about an assistant. What would you consider a reasonable wage for a doctor after deducting travelling expenses, etc.?
—If you give him a piece of ground where he could keep a pony and a cow or two; if he had that and free of rent and rates, you could give him £200.

14,419. Would you consider that enough?
—I would, for a young man for a few years, and then you could shift him on to something better.

14,420. I see that your question of a State medical service would meet that difficulty, but short of State medical service you are at once thrown into the idea of a larger area for the management of the doctor?
—I would prefer a State medical service.

14,421. There has been no prosecution under the Public Health Act, has there?
—Yes.

14,422. What for? Have you had any for having cattle in the houses?
—Yes, and we had prosecutions for the adulteration of food, failure to mark up margarine, etc.

14,423. But more particularly with regard to the dwellings, have you had any prosecutions with regard to the sanitary conditions of the houses?
—Mr Wilson knows about the sanitary conditions of the houses, he was a clerk to local bodies.

14,424. (Chairman.) There are no cattle in the houses now?
—I believe not. There were a few prosecutions a few years ago. A few people were prosecuted from different islands and the practice has ceased.

14,425. (Dr Miller.) There are some very good points you have put forward, and among them your idea of raising the medical service in the Highlands is very good. That is your point in wishing to have the service controlled from London?
—Yes.

14,426. It would raise the tone and the level of it, you think?
—Yes, and give us a more efficient service, and a more ready means of getting rid of undesirables.

14,427. That is your idea—to raise the level of the profession and the service in the Highlands?
—Yes.

14,428. I daresay you recognise, as matters are, we cannot very well get past the Local Government Board in Edinburgh for local matters such as we are referring to here?
— I recognise that things must be dealt with as they are unless there is a radical change.

14,429. Along with that high control that you speak of, you would naturally wish to remunerate the officials of the service as high as possible?
—Yes.

14,430. You would give us two doctors, say, in this parish, with a respectable living wage?
—Yes, about £4 a week and a free residence.

14,431. You would guarantee that to each man?
—I guarantee nothing.

14,432. But you would like to guarantee that?
—Ycs.

14,433. If the State cannot afford to do a big thing like that, and if the local funds are insufficient to meet a big thing like that, would you not be prepared to accept a reasonable arrangement such as having an assistant instead of having nobody at all?
—Oh, certainly, an assistant would be better perhaps than nothing. I am not discussing the ways and means.

14,434. With your high views of the medical service, you understand that a small locality like North Uist could hardly of itself maintain the services of two highly experienced men?
—That I don’t know. This district of islands on the whole is of very low value. It has roughly one-third of the rural population of Inverness-shire, and its rateable value is about one-seventeenth, or £20,000.

14,435. Funds not being available, you would be agreeable to the next best thing, which is having an assistant under an experienced medical man?
—Yes.

14,436. That seems reasonable, does it not?
—We have a large and valuable population requiring exceptional treatment, and unless the State comes to the aid of the district liberally with money, I don’t see how we can do it.

14,437. We have been trying to assess the probably available amount in regard to your own parish here, and it does not seem to point to us being able to do anything without a very considerable Government subvention?
— No, we would require 15 or 20 per cent on the rates to meet the medical service alone.

14,438. Well, now, with regard to this club arrangement which exists in North Uist, I suppose you are satisfied that the method of collection is probably the most feasible one to provide funds for remunerating the doctor?
—At present it is. We do not know what is collected altogether.

14,439. We are not going into the question of the exact amount?
—No.

14,440. The central funds should be devoted just to the crofting and fishing population?
—The crofting, cottar, and industrial population.

14,441. The people in the position of professional men and wealthy farmers and merchants ought to pay the ordinary fees?
—Yes, but then these men pay rates, and if their money is taken out of the rates they feel that they ought to have some benefit too.

14,442. I am very interested to see that you approve of each medical appointment being approved of by a central medical authority?
—In my opinion, each appointment always should be approved of not merely by the parochial body, with its little squabbles and feelings and all that sort of thing, but it should be approved of by a central authority.

14,443. And in the event of a complaint being made against either the doctor or the parish, the public or the doctor should have the right to appeal to the central body and in a case of dismissal the central body should have a veto?
—Yes, I would see no objection to that, assuming that the central body is a. very independent one.

14,444. I would have it as independent as it is possible to have it. Do you object to the Local Government Board for Scotland being the central authority?
—I do object to it. I could furnish a better.

14,445. You object to it, but you would agree to somebody like that?
—Yes. I would approve a joint medical authority in London, who would be near the General Medical Council headquarters, where I assume there is a record of every medical practitioner from the time he started practising.

14,446. The Local Government Board being the highest body we can point to at the present moment, you would agree to it?
—It is like every other body—it makes mistakes. I have known it to appoint an unqualified commissioner, who reported to it a non-existent epidemic, and blamed a parish council and others, and praised a doctor— all quite wrongly—in that connection. The Local Government Board acted on that report, giving unwarranted praise and blame.

14,447. Where cases are reported to you by the local police of deaths, say, in childbirth, do you make any inquiry?
—No, not unless there is any suspicion.

14,448. The mere fact that it is a death in childbirth does not entitle him to report?
—It does, but it would be a futile proceeding. The people do the best they can under these circumstances. In the outlying islands here the men have, by force of circumstances, to act the part of midwives and deliver women in extreme cases at times. I heard of a case where fish-hooks were used.

14,449. It seems rather a pity in my view that the police authorities don’t take cognizance of cases of that sort?
—If there was a case where there was a death through absolute inattention, I have no doubt that the police would report it, but where all the possible attention is given to the woman they ought not to interfere.

14,450. Would you say that all the available attention had been given when there was a qualified midwife or a doctor available?-
—No, I would not say that unless they were called.

14,451. Have you heard of cases of deaths under these conditions?
—I never had a case like that.

14,452. (Dr Mackenzie.) Are not the police under the same local influence as the doctors?
—No; you may be sure that there is not a more independent class of men than the policemen here.

14,453. Supposing you had a case of a woman dying of puerperal fever and an unqualified midwife had been in attendance, and she goes on in practice, and there are 3, 4, 5, or 6 cases happen, would that not be a case for inquiry by the Procurator-Fiscal?
—Certainly, if he heard of it.

14,454. You have never had such a case in your district as Procurator-Fiscal?
—No. If I had it would have gone to the Local Government Board, and the fact would come before you of the want of attendance.

14,455. (Mr Lindsay.) We had evidence to-day to the effect that maternity cases are taken by neighbour women and are quite successful?
—That was common enough.

14,456. And they produce a very fine population?
—Yes. They would no doubt be better if they had better housing and feeding.

14,457. (Dr Miller.) I think you may take it from the Committee that evidence has been brought before them showing that there has been laxity
—I am not quite sure whether there has been in your district,—and that the Committee will be bound to take note of any such cases that come in their way; and it is only fair to you to say that cases have happened and have been reported to us sudden deaths in confinement without proper attention?
— You have sudden deaths in confinements even with proper attention. .

14,458. Surely, but then they are legalised. It is the duty of the Procurator-Fiscal to see that the fundamental elements of the law are being preserved?
—I am very confident that if any case of that kind did come to the ears of the police it would be reported.

14,459. What about the Registrar of deaths? Are you sure it would not escape?
—He ought to inform the police of course, if he knew such a case.

14,460. It is quite likely that the police may be ten or fifteen miles away from him?
—Yes. The police are as scarce as doctors here. We have about a sixth of the police force of the county to about a third of the population of the county; hat is one policeman, roughly, to every 2000 people scattered all over many islands.

14,461. In the case of an uncertified death, you are not bound to take notice of it?
—No, we could not possibly overtake inquiry in all such deaths, merely to ascertain a techical name for the cause of death.

14,462. They are not always deaths of old people and casualties?
—Any death that occurs by violence, or any death where there is suspicion attached to it, is inquired into for other reasons.

14,463. Or from neglect?
—Yes, but not necessarily from medical neglect.

14,464. The registrar is not bound to report anything to you that he suspects?
—No.

14,465. He would be found fault with if he did?
—No, I don't think he would be found fault with, but it would be a serious thing in the Highlands if he was to send in a list of every uncertified death and they were to be inquired into. The work would be enormous, and I believe unnecessary for the protection of life.

14,466. But, say, in the case of a death which has occurred within forty-eight hours?
—Unless it was an old person and it was clearly from natural causes I would make inquiries very exhaustively.

14,467. In those confinement cases, I think with all deference to you, that they are cases that might be taken note of by public authorities in some way?
—I will see to them if heard of.

14,468. There is another point. With regard to the case which occurred in May last, just to clear up my own opinion of the matter, how many doctors were actually in attendance on that old lady before she died?
—Two doctors saw her.

14,469. And were any in attendance before you gave instructions?
—No. They did not hear of the case until they heard from me. I heard by wire of the case, and at once by wire took steps. I thought that the woman might be dangerously injured, and apart altogether from the criminal aspect of the case, I sent orders for a doctor to be got once.

14,470. Two doctors did see the old lady before she actually died?
—Yes, all through my orders.

14,471. (Dr Mackenzie.) One important point is that you are quite satisfied from your long knowledge of these island—and you talk of what is called the Long Island —that there is not enough medical attendance for the number of cases requiring medical attendance, taking them all over?
—Yes, not half enough.

14,472.You are quite satisfied in assuring us of that?
— Yes. The distances and the way in which the districts are cut up by water are features to be considered; and there is the weather, which makes the thing still worse.

14,473. You are not merely thinking of North Uist, but of the whole of the Hebrides?
—Yes. The doctor in Barra parish goes to Barrahead, which is twenty miles along a chain of small exposed islands, and there is the Minch on the one side and the Atlantic on the other.

14,474. Apart from the quality of the doctors, assuming they are all first-class men, the same number of men as are at present in the service could not do all the work that is necessary?
—Double the number could not do it.

14,475. That is to say, if you were putting these islands on approximately the same footing as a decent, advanced, industrial locality in the South, it could not be done without at least doubling the number of medical men?
—Yes, and providing a local hospital here and there.

14,476. You have one hospital in South Uist. Have you anything in Benbecula?
—South Uist is a hospital kept up by Lady Bute.

14,477. It does a good deal in helping the sickness in the community?
—Yes; they get medicine and nursing all free. That is a private charity.

14,478. Do you think that such an institution here would be of good service?
—Somewhere in North Uist, yes. We have often to send cases from Harris and here to the Western Infirmary, Glasgow.

14,479. Do you think the people would take advantage of a small cottage hospital if it was erected?
—Yes, certainly.

14,480. It might be used as a home for a nurse?
—Yes.

14,481. Taking outdoor and indoor patients?
—Yes. They are an intelligent people. There is no nonsense about them in the way of fear or anything of that sort in regard to hospital treatment.

14,482. You have a big population in North Uist, It is a. well—known fact, I mean, that there is no general feeling against an hospital?
—No.

14,483. They would be quite ready to take advantage of this institution?
—Yes, certainly.

14,484. I was struck with what you said about there being no advantage in having larger areas, such as the County Council's areas?
—I mean, there appear to be no advantages.

14,485. I presume that when you spoke of a larger area, you were thinking of a larger organisation including the County, the Education Committee, and other representatives; supposing there was a local authority established in that way to represent all the people interested in medical service, and that they were placed in definite touch with a central body who could control the administration of them, would that not meet the case?
—I am averse to giving the County Council the power.

14,486. I am thinking of a body ad hoc?
—The Invernessshire County Council takes for itself all the possible benefits for the Mainland and gives the outer islands as little benefit as possible from grants it can control disposal of.

14,487. Supposing you had an authority for the whole Islands here, would that meet you at all? If you had an authority made up for the purpose of local administration of this specific money, and representing all the interests concerned, such as the County Council and any others, the District Committee, the School Authority, the Insurance Committee, the Medical Associations, the Nursing Association, and so on, don’t you think that would be quite a good local channel that could be used by a central authority for the distribution of this money?
—That might meet the case.

14,488. It would be a good means of keeping in touch with all the medical men in the districts all over?
— Where would you have that body; in this district?

14,489. In this district, I presume?
—If it were out of this district and in Inverness you could not get the people from here to travel to Inverness to attend the meetings, time and cost of travel being great.

14,490. I take it as your view that it should be situated in the district?
—Yes.

14,491. Assuming it to be in the district, you would agree that it would be a good channel for keeping in touch with the medical men in the district and the nursing and so on, and it could be brought into relation with a properly constituted central authority. Do you see any difficulty in that as an administrator yourself?
—It depends altogether on how that body would be elected or constituted.

14,492. Do you think it would be of any value at all?
— That would depend on its composition.

14,493. Is there anything antagonistic to your idea of an efficient medical service?
—Not as stated.

14,494. We are trying to get at the same point, namely, a larger number of better-paid and efficient doctors, and a better nursing service?
—Yes.

14,495. You tell us that in this locality a free house, a bit of ground for a pony and a cow or two, free rent and rates, and £200 a year would be fair remuneration. Something about £300 a year would be the gross income?
—Yes.

14,496. Do you think that would attract a first-class young man?
—If he was given reasonable hope of promotion, I think it would.

14,497. It would depend a good deal on that?
—I don’t altogether think so. I don’t think it is so hard to get medical men as all that.

14,498. You are assuming that it will be a service where there will be promotion. In a private practice, when a doctor gets settled down, he is there for life?
—There are lots of Government appointments, such as surgeons to different places, that they could be promoted to from here.

14,499. But, on the whole, your mind inclines towards, for the special needs of this district, a publicly controlled medical service?
—Certainly.