Lochmaddy, 16 October 1912 - Thomas Wilson
14,500. (Chairman.) You are a Deputy Small Holdings Commissioner, and you have been a long time in these posts?
14,501. You know the local conditions of the people very well?
14,502. You are very intimately connected with the subject we are here about?
14,503. You have been clerk to the most of the Parish Councils?
—Yes, from 1894 till lately.
14,504. You know all the circumstances of the medical service in these districts?
14,505. What do you say about the social condition of the people?
—They are not very well able to pay adequate fees to a professional man.
14,506. In the case of people who are far away from a doctor, they are quite unable to pay an adequate fee?
—It is quite hopeless.
14,507. To overcome that difficulty to some extent the Parish Councils have given liberal fees for the cost of looking after the paupers?
—Yes, they are very big fees.
14,508. They are out of all proportion to the work they do for the paupers?
14,509. We had one case where they got twelve guineas a pauper?
—I never heard of a case like that.
14,510. They could not get doctors at all unless they did something of that kind?
14,511. So that at the present moment a. considerable part of the cost of medical attendance is borne by the poor rate?
—Yes, about one half of it.
14,512. You know about the club system in this district here?
—Not in this parish.
14,513. You know in a general way of some club systems that you worked yourself?
—I tried them all in different places.
14,514. Were they a success?
14,515. Did you find that sometimes in a succession of years no doctor was needed in a family, and the crofter began to think it was unnecessary to pay?
—He began to fall off.
14,516. If it had been a compulsory system would it have been a success?
14,517. Do you see any reason why it should not be made compulsory?
14,518. What sum do you think you could get from the average crofter?
—5s. for every crofter.
14,519. Do you see any method by which it could be graduated?
—Yes; the man who paid a higher rental should have a higher subscription to pay. That was done in all the schemes I had to do with.
14,520. It was according to the rental?
—Yes, or their ability to pay.
14,521. You left it to the local committee to manage it?
—Yes. The method in Harris was that every crofter paid 5s. and that the better—off people paid up to 30s. and £2.
14,522. Do you think that would be a better system than if you got 5s. from the crofters and left the others to pay their fees in the usual way?
—I would make it compulsory, because you would find some who were wealthy drawing out of it.
14,523. How would you constitute a committee?
—I would give the Parish Council the power to assess.
14,524. You have no reason to think that it would not work well?
—I believe it would work perfectly well. I have not any doubt about it.
14,525. You have never thought of any other means by which we could get a steadier income from the community?
—There is no other way. I have tried them all. In North Uist they pay up wonderfully well, but that is because it passes through the hands of the Estate management. In other club systems where they have not that power it falls through.
14,526. We are trying to devise a method by which we could have a better-paid medical service, and we are also trying to get better medical service; we are trying to devise a fund from which that could be drawn. This is a scheme that has appealed to us, the scheme of a club, and then there is the parish rates that are taxed. I think you are up to the limit just now?
14,527. You don’t think the rates in the Outer Hebrides can bear any more?
—I think they are as high as they can go.
14,528. There are various appointments for the medical practitioners—there is the medical officer of health, the school medical attendant, and all that sort of thing that would come into the fund. Is there any other source except an Imperial grant?
—Not that I know of. If there was a grant for the pauper lunatics and the medical relief, that would relieve us.
14,529. Over and above all that, there would need to be an additional grant of some kind?
—We could stand more on the rates if the Government would relieve us of the burden of the lunatics and the poor. I gave evidence to the Poor Law Commission to that effect. You see, we are overburdened with rating because of the lunacy and the poor.
14,530. If the paupers and the lunatics, and certain other charges, were made Imperial charges, the rates could bear the burden of the medical service?
14,531. From your knowledge of the people, do you think that the people would not resent or would willingly agree to a scheme of this kind, if they thought it was to improve the medical service?
—They resent the present system, and would agree to such a compulsory scheme.
14,532. Who collected the club subscriptions?
14,533. I suppose you will agree that most of these doctors are very much underpaid?
—It depends upon the doctor.
14,534. Do you support Mr Chisholm’s view that there should be a central authority?
—Yes, but I think we are quite safe in Scotland. If I cannot get my case dealt with in Edinburgh or Glasgow, I won’t bother going to London. I think that the doctor should be appointed by the Local Authority, but with the approval of the Central Body, and that the dismissal should be the same, that the approval of the Central Authority should be given.
14,535. Do you approve of the view that the Central Authority should have power to dismiss him over the head of the Local Authority?
14,536. Do you think the Parish Council continue with men after they should have dismissed them?
—They are very long-suffering.
14,537. In the interests of the public health, is it desirable that there should be a central authority?
—Yes, I think it is.
14,538. You support the view that occasionally there should be some authority who should step in and regulate matters?
—Yes. You see, we cannot get a hearing when we send up an objection against the doctor from these parts. When we advertised for a medical man there was repeatedly advertisements put in warning medical practitioners against coming out to these islands. They stated no reason, of course. They would give reasons their own.
14,539. You will find that the British Medical Association prevents you often getting a fair number of applicants.
—Yes, because we could only get the rough of the medical profession after that.
14,540. That is another reason why there is some difficulty in getting efficient medical service out here?
—Yes. I agree that it ought to be, if possible, a Government medical service in these islands. Not only would the doctor get absolute fair play, but the population would have fair play too.
14,541. The conditions are quite special here, and you would be prepared to apply that system here, while you would leave it as it is for the rest of the country?
14,542. Do you think that there is a large proportion of the people who don’t get medical attendance just now when they need it?
—I cannot speak to that. There must be a lot of these poor people who never think of sending for the doctor.
14,543. You agree with Mr Chisholm that more doctors are needed?
14,544. And more nurses?
—Yes, particularly nurses. We have not nearly enough nurses, and the method of family subscription is very good. It ought not to be that it ought to be better than that—it ought to be paid by the Government.
14,545. Would the same fund for the doctors be available for the nurses?
14,546. Have you thought about improving the means of communication?
—I thought if a motor-car in thse parts was got for the mail service it would be available for the doctor.
14,547. Could he make much use of it?
—Yes. There are a good number of patients who could be attended a motor-car.
14,548. You know about the Harris case, and the doctor there told us what perhaps would do more than anything to improve the medical service there, would be a new road down the east side. Is that your opinion?
—It would help very much.
14,549. About telegraphs and telephones, the telegraph is pretty well developed. Could it be improved?
—Yes. There are two or three places where they ought to have telegraphs and telephones where they are not supplied yet. I think we are well supplied, on the whole.
14,550. We had evidence to the effect that the Post Office people are proposing to take away a telegraph?
— Yes, because they want a seven years’ guarantee renewed for other seven years. That is in Eochar, in South uist. They are a poor lot of people, and I question whether the Parish Council will come under the obligation of guaranteeing the money. .
14,551. You think it is of the greatest importance to have an extension of the telegraph and telephone system to improve the medical service here?
—Yes. I don't suppose the doctors will thank you for them, but they will be a benefit to the public at large.
14,552. Some doctors think it would save many a useless visit?
—That is quite right. There should one at North-Bay in Barra and there should be another one down about the Kilbride. There should be one in the north end of Benbecula and one in the middle of South Uist.
14,553. Do you know about the telegraphs that are used as telephones in the island?
—Yes, there is one from Scalpay Island in Harris, and one in Eochar, South Uist, from Eochar to Stilligarry.
14,554. Do you know if the people are allowed to speak over these telephones?
—Not that I ever heard of.
14,555. Do you see any reason why they should not be?
14,556. It is against the regulations for them to be allowed to speak over them?
—I think so.
14,557. You don’t see why they should not be allowed to speak over them?
14,558. You are in favour of a great extension of the nursing scheme?
—Yes, very much.
14,559. Have you any knowledge of the kind of nurses you would require?
—She ought to go for a course of training?
14,560 A three years’ course in a hospital?
14,561. You prefer that to the ordinary maternity nurses?
—Yes. Thoroughly trained women could take up an ordinary cases until the doctor arrived.
14,562. The maternity women are very largely local women?
—Yes. A large number of the women follow up the nursing and they make very good nurses. There is one in South Harris. I don’t think there is one in North Harris. There are two in North Uist, one in Benbecula, and there are none in the south end of South Uist except the sisters of mercy. They do good work.
14,563. Generally, what do you recommend to be done here?
—If you relieved us of the burden of taxation for lunacy and the poor, we could make a household tax on every house or on every smoke for the medical service.
14,564. To make a compulsory rate you would need legislation?
—I don’t see how you could do it otherwise.
14,565. Legislation is difficult to get. Something is needed at once. Do you see any way, from your knowledge of local government, whereby with a promise of a grant more money could be supplied locally?
—You could not depend upon it unless there was compulsion.
14,566. Even with the inducement that they would get an additional grant?
—They would soon forget that. The grant would be a great blessing to-day, but in two years afterwards, they would forget all about the grant.
14,567. (Mr Lindsay.) I suppose the old age pensions have improved the condition of the people here?
—Yes, they were a perfect blessing.
14,568. We had evidence to the effect that there were houses being built in Harris to accommodate both man and beast. You know the condition of the black houses. We heard to-day that houses are being built now, which really, from the point of view of public health, are more insanitary than the black houses?
—I don’t know them. A good black house is excellent. I have been through 250 within the last two months, and I have gone into every room of every one of them.
14,570. A statement was made to the effect that the ventilation of these black houses was good, and they also had the disinfecting agency of the peat smoke?
—The disinfecting power is certainly great, but I am not in favour of the old black house that has no chimney and no window at all. I was in one last week like that.
14,571. There are no bylaws with regard to the building of new houses here?
—There are no bylaws. Every man builds his house as he likes. I cannot say that I agree with you that the houses that are being built are not better. There are infinitely better than the black houses.
14,572. We were told that you were responsible for the clearing out of the cattle out of some of these black houses?
—I prosecuted the whole crowd, thirty or so in a batch.
14,573. Had they any difficulty in putting up a house?
—Some of them had. We gave them timber for the roof, and they built the rest themselves.
14,574. What did they do?
—They put the cattle out of their own dwelling-houses and built byres close to the house for them?
14,575. You don’t consider that it was a great hardship for them to build that byre?
—There were 460 cases in North and South Harris, and they are all gone except two. There are none in Bernera, unless there is one that I have not heard of. South Uist, North Uist, and Barra are almost quite clear of such.
14,576. I am laying stress on that is because it was said today that phthisis fifty or sixty years ago was unknown and that tuberculous disease altogether is increasing?
—I am not inclined to put it down to the bad housing. If you improve the housing you will help to put that out. I think that the increase of tuberculous cases is due to the changed condition of living entirely, and also to compulsory education. These children have got to go to school, and they come home from a clean atmosphere in the school to a vitiated atmosphere in the house. They ran about wild long ago and they picked up bits of food about the door, but now they are for long stretches at the school without anything to eat. It is not the bad houses at all. It is not the new houses that is doing it. It is the want of a good house. If you want to improve your medical scheme, the first thing to do is to house 50 per cent. of the people better.
14,577. The bottom of the whole thing is the bettering of the conditions of the people?
14,578. This scheme of medical service is supplementary?
14,579. (Mr Grierson.) Did this club in Harris work well?
—There was one in Harris for a while, and one in South Uist, and another in Barra for a while.
14,580. Did the club fee cover the medicines, or were the medicines a separate charge?
—They were a separate charge nearly always. .
14,581. Was the medicine paid for, or was it left unpaid for?
—In some cases it was paid for and in others it was not, but the doctors did not give much of great value in the way of medicines.
14,582. We have heard it often from the doctors that under this club system they were apt to be called out for unnecessary calls?
—That is bound to happen. You get cases of that kind in all practices.
14,583. Do you know of any cases of that sort?
—Yes. I have known cases where the people need not have called the doctor out.
14,584. Can you suggest how that can be obviated?
—It cannot very well be obviated, because no one knows how the case is going to turn out till the doctor gets there.
14,585. Would you suggest a small fee per visit?
—I don’t know. I never saw it tried. We had not really many cases of that sort. I did know of an odd case like that, but there were not very many. I think when the doctor got to know the people he knew that they were likely to be unnecessary calls.
14,586. You say that as regards nursing, you consider that nursing is one of the most important things?
14,587. Would you put a nurse before a medical officer?
—If we could not get a proper medical service I would put nurses first.
14,588. Some doctors told us that the nurses’ influence upon the people was more educative than what theirs was?
14,589. They go about among the people teaching them?
—Yes. There is nothing so good out here as the nursing.
14,590. They teach the people hygiene?
—I don’t know that they do that, but they show them how they ought to do things.
14,591. They teach them about their own ailments too, I suppose?
—I could not speak to that. I know they are very educative.
14,592. You would put nursing in the forefront, increased nursin?
—Yes. I would not give the doctors absolute control over the nurses; I would leave it to the Parish Council or the committees of management. The doctor would not have the power of engaging and dismissing them.
14,593. Would you allow them to work independently of the doctor?-
14,594. I suppose you agree with the other doctors that the better qualified the nurse is the less likely she is to practice on her own?-
—Yes. I want a properly trained nurse.
14,595. (Dr Mackenzie.) From your knowledge of the Hebrides, have your ever heard of a nurse going about like a doctor with a stethoscope, and extracting teeth just like a doctor?
—I have not heard of it.
14,596. (Mr Grierson.) Could you give us an idea of the number of insured persons?
—I have no idea.
14,597. With regard to security of tenure, it was suggested by one doctor, that before a doctor was dismissed there should always be a Parish Council election. You don’t favour that?
—I have been clerk to four Parish Councils since 1894, and they put up with a lot from their doctors.
14,598. Your evidence comes to this, that While there may occasionally be an unreasonable Parish Council, there mightalso be an unreasonable doctor?
—I know of one case where a Parish Council acted wrongly, but I know of several where the doctors acted wrongly towards the Parish Council.
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