Tarbert, 15 October 1912 - Dr Malcolm Mcleod

12,965. (Chairman) You are a graduate of the University of Aberdeen ; an M.B., Ch.B., and you had eight years’ experience before your present practice ?

12,966. You have been two and a half years here ?

12,967. You have been ten years a doctor altogether ?

12,968. Where were you before ?
—London and Blackburn, and as locum all over the country.

12,969. Do you prefer this place ?
—No, I prefer London.

12,970. Your area is twenty-four miles by twelve miles, roughly ?

12,971. You reside in Tarbert ?

12,972. You practise over the whole island of North Harris ?

12,973. There is another doctor in South Harris ?

12,974. Does his practice overlap with yours ?
—He has the parish work of both North and South Harris.

12,975. Where does North Harris extend to ?
—From the border of Lewis, Ross-shire, down to Tarbert.

12,976. There is a hospital near you ?
—Yes, a private hospital. It is not a free hospital.

12,977. It is Sir Samuel Scott’s hospital ?

12,978. The population of your area is between 3000 and 4000 ?
—Yes, roughly. I could not find out definitely

12,979. The furthest away patient you have is about nineteen miles from your house ?
—Yes, roughly.

12,980. Is that one patient or is it a township?
—There are several—it is a township.

12,981. How do you get about? Do you keep a motor cycle ?
—No ; it would be very little use to me because of the villages off the roads and the isolated homes.

12,982. Where is the population in North Harris?
—The most congested part is the island of Scalpay. There are about 600 inhabitants on that island.

12,983. You tell us that roughly about half of your practice is within five miles of your house ?

12,984. How much is within three miles ? That is a distance a doctor is supposed to go without charging  mileage.  Is Scalpay within three miles ?
—No, it is about four.

12,985. What population do you think are within three miles?
—About one-eighth, I should think.

12,986. The roads are very bad ?

12,987. You get about by hiring a trap ?

12,988. You have a good deal of boating ?

12,989. Do you take a boat down to the places on the East Coast?
—Yes, in fine weather it is more convenient, but in bad weather like today I would have to walk.

12,990. Along that coast there are no roads for driving?
—No. To the east there are roads. There are no carriage roads; they are foot paths.

12,991. Is there much of a population on the East Coast of North Harris?
—Yes, I shoul say about two-thirds of it.

12,992. What have you to say about vaccination ?
—I have nothing to do with them. They are all defaulters. I don't vaccinate any children in my practice; they are all vaccinated by the parish doctor if they are vaccinated at all

12,993. (Dr Mackenzie.) Are they all vaccinated ?
—No. I should think that five per cent. of them are unvaccinated.

12,994. (Chairman.) In some places we found that there were about five per cent. vaccinated. They are nearly all conscientious objectors ?
—Really !

12,995 Tell us about Sir Samuel Scott’s system here—the club system ?
—The crofters are expected to pay 5s. yearly for medical attendance, and the cottars half a crown. They are not forced to pay ; they are not compelled to pay, and the consequence is that only about 15 per cent. of cottars pay anything, and 15 per cent. of the crofters don’t pay, yet they get medical attendance.

12,996. The system is that the crofters are supposed to into a club system—to Sir Samuel Scott’s factor ?

12,997. He collects it along with the rent, I suppose ?

12,998. And about 15 per cent. never pay ?
—Yes, mostly the cottars. They pay no rent and they pay no doctors’ fees.

12,999. Are the medicines extra?

13,000. And the maternity cases are extra ?
—Yes. They are only 5s.

13,001. And operations are extra ?
—No, they are free.

13,002. Are they expected to get free medical attendance for this 5s.?

13,003. You don’t charge a check fee ?

13,004. Are you often called out for frivolous reasons ?
—Yes, very often, for toothache. I often go the full distance of my district for toothache.

13,005 You find it a distinct grievance that they send for you unnecessarily ?
—Yes ; it is entirely through their ignorance.

13,006. Do you think if they had to pay you a fee they would not send for you unnecessarily ?
—They would send less frequently if they had to pay higher for me, especially those living about four miles from me.

13,007. What do they pay you ?
—They pay me nothing for mileage, but 1s. per mile when they provide a trap. Had they not to pay that, I have no doubt I would have double the amount of work I have.

13,008. If they don’t mind paying you that they would not mind paying a small check fee besides ?

13,009. It would need to be a substantial fee to prevent them sending unnecessarily. Would you say that ?
—No ; I would not say that altogether. Very often they die without sending for me.

13,010. How do you explain that ?
—It is due to ignorance and the common idea among them that in certain illnesses, the doctor can do nothing.

13,011. Do you find that you are not sent for often enough?

13,012. Even although they know they are not charged for it?
—Yes. In fact, I often tell them to send for me oftener.

13,013. If there is a serious case do you go to it often?
—It is quite impossible on account of the distances. I have to wait till they come for me.

13,014. Why ?
—They say it is understood. Most of my serious cases have been in Scalpay or the Kyles of Scalpay, and they come by boat for me, and I simply wait till they come.

13,015. Even although you know the patient needs you?
—Yes. Occasionally I have them brought up to Tarbert.

13,016. You let them know you expect them to come for you?
—Yes, but then they don’t come when I do ask them to come.

13,017. You don’t think this club system a good one?
—Yes I do.

13,018. You say in your precognition it is rotten ?
—It is the only workable one. Sir Samuel Scott’s system of allowing all and sundry to join in the club system is rotten; that is what I meant.

13,019. It is rotten in this respect, I suppose, that they are not compelled to pay ; it is voluntary. If it was compulsory it might work well enough ?

13,020. Do you think 5s. is a fair sum for the average crofter here to pay ?
—No ; the better-off of the North Harris people only pay 2s. 6d.—the local people, the merchants.

13,021. Why are they let off like that ?
—Because, being not crofters, they come into the cottars’ list.

13,022. The cottars are better off even than the crofters?

13,023. Do you get your salary irrespective of the number of visits you pay to the patients ?
—Yes. The fewer I pay the better for me.

13,024. What happens about the fees ; do they pay them to the factor ?

13,025. And it does not affect you whether they pay or not ?
—I have been asked to ask every man who comes to me if they pay or not, and if they don’t pay I should tell them I am going to charge them. However, I do it free to everybody, because it saves trouble.

13,026. You think this is the best system for a parish like this?
—Yes, some form of a club system is the only system workable.

13,027. Would you think if Sir Samuel Scott organised a system of a check fee it would be an improvement or not? That is to say, a small fee, as is done In some cases —in the lighthouses, for instance, where the patients have to pay 10d. for every time the doctor calls. Do you think that would work here ?

13,028. Manifestly, of course, the people in this district have much better medical attendance than if you depended on their fees ?
—You would not have any at all then.

13,029. You consider the population in the village of Tarbert fairly well off ?
—Yes, better off than I am often. They pay their half-crown.

13,030. They are fairly well able to pay here, except the crofters ?

13,031. I think there are some of the crofters very poor ?
—No, I don’t think there is a poor man in North Harris.

13,032. What is their livelihood ?
—Making Harris tweed. There is also a. whaling station, and they also have lobster-fishing.

13,033. How many are employed at the whaling station, about fifty?
—There is more now. They are replacing the Norwegians by Harris men.

13,034. You say twelve to twenty people in your district die yearly without having medical attendance of any kind ?

13,035. Are they old people ?
—Yes, and consumptives.

13,036. They don’t think it necessary to send for the doctor ?
—That is so.

13,037. Have you much consumption here ?

13,038. Is it increasing ?
—I cannot say; I have not been sufficiently long here to find that out.

13,039. You have never had a case that you have had to send to Glasgow or Edinburgh?
—Yes, many of them.

13,040. You say you can attend to many of them yourself ?
—Yes, if I had a hospital.

13,041. Do you send any cases South ?
—Yes, I should say I send one a month South, at any rate.

13,042. What are your arrangements for dealing with serious surgical, medical and maternity cases? You say, “ I have none, and could attend to everything myself, but,  of course, feel the need of nurses’ assistance ” ?
—Yes, that was put shortly. I could attend to mostly all urgent cases with nurse's assistance here.

13,043. What is the hospital ?
—It is a hospital containing two beds and two cots. There is a fee of 5s. weekly expected off each patient on admission. Now, the Stornoway Hospital is free; of course, Glasgow is free, and they can go there for nothing.

13,044. It costs them something to go ?
—Very often Sir Samuel Scott pays their fee.

13,045. (Mr Grierson.) Does the 5s. cover their medical attendance and everything ?

13,046. (Chairman) And they dislike to pay 5s. a week ?
—Yes, naturally.

13,047. And they prefer to go to Glasgow and pay £1 or £2 to get there and back ?

13,048. You have between thirty and fifty maternity cases a year ?
—Yes. Of course, there are several hundreds of them.

13,049. That is all you attend ?
—Yes. Of course, they are really urgent cases I attend. The others receive no attention.

13,050. Are they attended by unregistered midwives?
—No, there are none there.

13,051. Are they attended by neighbours ?
—Very often, and occasionally by the husband. There is no maternity nurse in the district.

13,052. Have you known of cases where there was no skilled attendance, and where the woman suffered and died ?
—Yes; I have heard of that more often in South Harris. The bulk of the population of South Harris have to depend on me as well as my own district. They are nearer to me than to their own doctor, and they often send for me in an emergency. I have known of three deaths there in twelve days—all mothers.

13,053. And no inquiry ?
—No inquiry.

13,054. You have known up to twelve deaths in a year of mothers ?
—Yes. Not all of these may have been in my district.

13,055. You have known three cases of mothers dying in twelve days ?

13,056. What is your fee for a confinement ?
—I am not supposed to charge more than 5s. in North Harris.

13,057. And even with a fee of 5s. they neglect to send for you ?

13,058. That must be the fault of the people themselves, not the fault of the system ?
—Yes, quite.

13,059. What proportion of your patients are consumptives ?
—It is almost impossible for me to say.

13,060. A half ?
—Quite. Quite a half of my visits, barring confinement cases, are on consumptive patients.

13,061. Are there many die from it ?
—Yes. I think quite 50 per cent. of my death certificates are for consumptives.

13,062. What locality is the consumption in ?
—In the Island of Scalpay mostly.

13,063. How do you account for it ?
—It is over-populated. The habits of the people are so filthy, and they are so ignorant.

13,064. Are the houses very bad there ?
—Yes, very bad.

13,065. Have you any houses in Harris with cattle in them ?
—No, I don’t think so.

13,066. But the houses are not what they should be, all the same ?
—Far from it. I would sooner have cattle in them than the present condition of them. The people are dirtier than the cattle.

13,067. Does the tweed industry flourish in Scalpay ?
—No, I think they mostly depend on herring-fishing.

13,068. Can you assign any special cause to the prevalence of consumption ?
—Yes. I notice consumption in Harris people always begins in the throat. It is a common habit with the men to put their fingers in their months; it is a filthy habit they have.

13,069. Surely smoking is an antiseptic, is it not?
—They pass the pipe from one to another. One boat’s crew usually have only one pipe. I have known of three of one boat’s crew dying of consumption in a year.

13,070. Out of different families?

13,071. And they have usually only one pipe on board the boat ?
—Yes ; I have never known them to have two.

13,072. (Dr Mackenzie.) Do you attribute the spread of consumption to the passing round of the pipe ?
—Yes, I do, and their filthy habit of spitting.

13,073. (Chairman) There is no visiting nurse in the district at all ?
—There is no nurse.

13,074. But you have a nurse at the hospital ?

13,075. You have no uncertified nurses, have you ?
—No. We had one, but she retired quite recently. She was a local woman trained by Sir Samuel Scott; at least her training was paid for by him.

13,076. Won’t he give you another one ?
—He wants to see what the Insurance Bill is going to do.

13,077. But Sir Samuel Scott apparently is a sort of providence to this district ?
—Yes; we would be very badly off without him.

13,078. He pays the nurse £35 a year ?

13,079. But it is quite insufficient for the requirements of the district ?
—Yes. The hospital is of very little use on the present lines on which it is run, because I cannot admit deserving cases who may not be able to pay. I tried to get it made free, but Sir Samuel Scott won’t do it; he thinks they get too much.

13,080. They won't go in because they don’t want to pay ?
—Very often they don’t have the money.

13,081. There is a difficulty in getting money ?
—Yes, ready cash. They don’t like leaving home and going to an hospital. Of course, it is quite a novelty for them.

13,082. How long have you had the hospital ?
—About five months. There are two patients in it to-day, and I have other four lying rotting at home. I cannot take them in because they won’t pay.

13,083. Is that from Scalpay ?

13,084. It must be heartbreaking for you trying to cure people in these houses ?
—You can do nothing for them. One nurse here would do more good in a week than I do in a year ; she would teach the people

13,085. The nurse was directly under your control?
—Yes, quite.

13,086. Has there been a doctor here after Dr Fletcher?
—Yes, there were two ; Dr Chalmers was here for nine months, and there was a locum here for six or seven weeks before I came.

13,087. You say that the nursing provision is quite inadequate and disgraceful ?
—Yes, quite.

13,088. You have certain suggestions in your statement as to the improvement of the medical service. You want to have a central authority to supervise medical service generally ?

13,089. Would you be satisfied with the Local Government Board ?

13,090. You have not a parish appointment, but in regard to parish appointments, do you think it would be an improvement to have the area for medical service not the parish area ?

13,091. You approve of the system in this district of an inclusive fee for a family ; you say it is the only workable one ?

13,092. A patient who lives a long way from the doctor cannot afford to give an adequate fee to the doctor for attending him ?

13,093. You think the doctor should have facilities for travelling about freely in the Highlands?
—Yes, I do.  For one thing we should have roads in Harris, and the paths might be improved.

13,094. You only get 5s. extra for confinements?

13,095. Do you think that is enough ?

13,096. You think there should be extra fees for night visits ?
—I have very few night visits. The people are afraid to come out at night except in great emergency and confinement cases.

13,097. You want an additional nurse at least in this district ?
—Yes, at least.

13,098. She should be a qualified midwife?
—Yes. The district really requires two nurses, both qualified midwives.

13,099. What do you do with your infectious diseases here. Are they nursed in the houses?
—Nothing; they  are nursed in the houses.

13,100. Who nurses them ?
—Mostly the mother. They don't get any nursing: they simply lie there till they are  better. They get no nourishment beyond milk and water.

13,101. Can you tell us what the people in this district live upon mostly ?
—Scones and tea, salt mackerel and herring and potatoes for perhaps eight months in the year They live mostly on bread and tea.

13,102. Is there a scarcity of milk ?
—Yes, a great scarcity

13,103. You don’t think the Parish Council is quite up to its work ?

13,104. Why don’t they change them ?
—There is no change to be had. We cannot get any better.

13,105. Who is the clerk of the Parish Council now?
—I don’t know the new clerk. I think it is a local man they have got.

13,106. You think it is a disadvantage that the parish doctor should live forty miles away from his patients?
—Yes, I think it is.

13,107. You also emphasise the disgraceful condition of the houses in the district ?

13,108. And you think something should be done to improve them ?

13,109. Have you any views as to how that could be done ?
—The sanitary inspector might help to do it.

13,110. Supposing the sanitary inspector condemns them, have the people any money to build new houses?
—Formerly Sir Samuel Scott used to assist them to build houses.

13,111. Even with his assistance they are apparently in a pretty bad state ?
—Yes. The people in North Harris have been so well treated by Sir Samuel Scott that they have been spoiled.

13,112. Have you any views yourself as to how something might be done to improve the houses?
—They are beyond improvement.

13,113. I mean, to get new houses. Are the people able to afford to put up new houses ?
—No. I may say that stone houses are being built usually now, and they are built mostly from money made in South America and the Falkland Islands. They come home and settle down.

13,114. They settle down on their crofts ?
—They are squatters mostly.

13,115. You suggest that all houses where there is phthisis should be burned to the ground ?
—Yes; there is not one at any rate, worth a sovereign.

13,116. Do you ever do that ?
—I often condemn them. No action may be taken.

13,117. You say the way the Harris people spit is surprising?
—The children learn it as soon as they learn to walk.

13,118. You suggest that school medical inspection should be carried out by the local medical officers, as well as the treatment?

13,119. I think you are quite right with regard to the latter part of your remarks. There is a difference of opinion with regard to the first part. The question of school treatment is very important ?

13,120. There has been nothing done to any of them ?

13,121. They have been inspected, but nothing has been done afterwards?
—Nothing. I have had one or two notes from Dr Fletcher, the examining doctor, given to me by the children. One or two have been sent to me from South Harris.

13,122. You say, “The children’s hair should be croppedregularly, say monthly, by a school attendance officer "?
—I would save a good deal of trouble in the line of skin diseases, enlarged glands, etc.

13,123. (Lady Tullibardine.) I think you told the Chairman that you thought you saw many difficulties in the present club system ; that you did not think a check fee per visit as well as the club subscription would improve matters?
—If it were a small fee it is possible that they might be able to pay it.

13,124. Your objection would be that they could not pay a considerable fee ?
—They could not.

13,125. Obviously, if it were a fee in addition to a club subscription, it would have to be a small one?

13,126. Do you think if they were paying 5s. a year per family they could afford 1s. per visit as a check fee ?
—Yes, most of them could afford that.

13,127. Do you think that would save you from frivolous calls?
—No. They would send for me occasionally for toothache if they had to pay £5 a visit; they send on account of the severity of the pain.

13,128 Can you suggest any means by which that difficulty can be got over? Would dentistry meet the case?
—No. They won’t have a dentist here.

13,129. They prefer to have their toothache treated by you?

13,130. Do you have frivolous calls for anything else ?
—No, very little.

13,131. Of course, they don’t send for you for toothache unless they are in great pain?
—Yes. Occasionally they send for me, and the patient is not at home when I reach it.

13,132. Have you found that the frivolous calls tended to decrease as you got to know the people ?
—Yes, they have.

13,133. You have been able to explain that they should not have sent for you, and perhaps they have not done so again?

13,134. Do you think that a club system with a moderate check fee would in time put matters right as between doctor and patient ?
—No, but a nurse would, I think.

13,135. Because a nurse would be able to sift out the cases?
—She would be able to educate the families.

13,136. And to see, on the one hand, that the sent for you early in an illness, and on the other han , that they did not send for you unnecessarily ?

13,137. You regard the nurses as the most important way of improving the service ?

13,138. Do you attach importance to having fully qualified nurses ?
—Yes, in all respects.

13,139. I think you said you would like to see two nurses. Would you want to see them both fully qualified?
—Yes. The ordinary midwife alone is quite useless here.

13,140. Because there is so much illness here ?

13,141. Do you think that there are cases in which the nurse would have to sleep in the house of her patient ?
—No; I would not advise it either, except in very rare cases, say a case of pneumonia.

13,142. You would not advise it because there is no accommodation ?
—Yes, that is so.

13,143. Would two nurses manage the work in your district?

13,144 .Would they be able to get to all the cases and get back to their lodgings at night ?
—Yes, they would.

13,145. With the help of bicycles ?
—Yes, and mostly by foot and boat. I don’t think a bicycle would assist the nurse very much here.

13,146. Then I understand that under the present circumstances you charge mileage to your distant patients in the club ?
—No, I don’t charge anything.

13,147. You charge the hire ?
—Yes. They come for me with a hire; they provide a hire and they come to the doctor with it.

13,148. They make no difficulty about providing that ?
—No, none.

13,149. As to how this club system could be improved, you make one or two suggestions. Would another improvement be if messages had to reach the doctor before ten o’clock in the morning ?
—It would be a great improvement.

13,150. That would enable you to map out your day better?

13,151. Have you a telephone service here ?
—We have it from Sir Samuel Scott’s place, twelve miles away, which assists the people who are further on.

13,152. Is there a telegraph service to Scalpay ?
—Yes, I am often wired for to go to Scalpay by boat.

13,153. May I ask why you say that a club fee should include medicines ?
—Because I don’t think they get medicines sufficiently often. They don’t come for them because they have to pay for them.

13,154. Even with a club fee of only 5s., you would like to see medicines included ?

13,155. Do you think that the sum of 5s. is a fair one for most of the families in this district ?

13,156. Why not ?
—For some it is too much—a few—but the great majority are quite able to pay double that fee.

13,157. Who are the people to whom it is too much ?
—Widows, and such people.

13,158. Do widows living alone pay as much as a man with a wife and family ?

13,159. So that you would like to see a reduced fee for certain people ?
— Yes, I would.

13,160. The other people can pay the 5s. without difficulty ?
—Yes. Some of them laugh at paying it; it is so ridiculous.

13,161. Are these the merchants ?
—No, not altogether ; it is some of the fishermen in Scalpay who are rather well off.

13,162. Can you give us any idea of their income ?
—I know of one man who made £300 in six weeks this season.

13,163. What were his expenses ?
—He had nobody except his boats crew to pay.

13,164. Would you wish to see any limit fixed ?
—No, not in Harris among the crofters and cottars.

13,165. Would you like to see a graduated scale of fees, according to the circumstances of the people ?
—It is very difficult really to know what to do in Harris. There are certain people in Harris I would put outside any scheme whatever.

13,166. They could pay an adequate fee, even for long distances ?

13,167. Are those people included in the club just now?

13,168. You would have to fix an income limit to exclude them ?
—You would never find out what it was.

13,169. Suppose you were keeping them outside the limit, that would not benefit anybody but Sir Samuel Scott ?
—It would not benefit him either.

13,170. He would have to give less to the fund ?
—I don’t know. I don’t think so. Sir Samuel Scott provides widows with meal very often.

13,171. You cannot suggest to us how to make the system of payment more adapted to the means of the people in Harris ?
—In making a fee per family.

13,172. I am assuming a club system where 5s. would be enough for members to pay in a year ; but when we come to the people about whom you have told us, to whom it is a ridiculously low fee, have you any suggestion as to how to deal with them? Would you exclude them altogether ?
—Yes, quite.

13,173. May I ask if you have much work to do ?
—Yes ; I have occasionally too much to do, especially since the nurse resigned —the local village nurse, the midwife.

13,174. How long ago was that ?
—About three months ago or four months ago. I have only been with her three times since I came to Harris. She refused on all the occasions on which I sent for her, but used to go out on her own both in North and South Harris.

13,175. You have been very busy, then, during the summer months here ?
—Yes, the summer and winter months don’t vary very much ; the work does not vary very much. Very often I am busier in summer than in winter.

13,176. You have told us that a good many people don’t send for you ?

13,177. And you cannot account for that except on the ground of ignorance ?

13,178. Do you think if there were nurses in the district that you would have more cases or fewer cases ?
—I would have more work, but pleasanter work.

13,179. You would feel it would be more satisfactory work ?
—Yes, because I have more midwifery to do now. The people know now they can send for me; when they used to come for me before I used to send them to the nurse first of all. Now the know they can come to me on every occasion, and they do it.

13,180. Suppose you had a nurse or nurses in this district, would the work be more than one doctor could manage ?
—No. One doctor could manage the whole of the work.

13,181. (Dr Mackenzie.) That is taking the whole year round ?

13,182. For certain seasons, probably, you would have more ?
—I don’t know about that.

13,183. (Dr Miller.) I suppose it would be quite impossible for this district to maintain a doctor without some guarantee ?

13,184. Your population, I think, you say is between 2000 and 3000, and the Parish Council before Sir Samuel Scott made this arrangement did not find it expedient to appoint a doctor for North Harris ?
—My predecessor here had the parish work in North Harris, and he had some quarrel with the Parish Council.

13,185. And the Parish Council did not propose to resume the arrangement ?
—They have another arrangement now. They have a doctor living on the island of Bernera, and they give him a small fee yearly.

13,186. And he comes up here to attend to pauper cases ?
—No, he never comes up here now.

13,187. Do you act for him ?
—Yes, I do the work for Dr Tolmie, South Harris, but not for the Bernera doctor, and I get paid by fee.

13,188. You do most of the parish work up here ?
—Yes, in emergencies, as the parish doctor often refuses to attend, and mostly charge my visits under the heading “medicines.”

13,189. The Parish Council is not entitled to the Relief Grant on account of the money they pay you ?
—They try on all occasions, of course, to keep it off their own doctor’s salary.

13,190. They do ?
—Yes, and they have done so quite recently.

13,191. That is very generous of them. I was rather surprised to find that they were giving you a private fee for work up here ?
—They had not done so up to about six months ago. Now they are taking it off the doctor’s salary.

13,192. The kind of arrangement that exists here is very much what we have been groping after in our Inquiry, but evidently there are improvements that might be devised on the lines you yourself admit. You think that every family could pay something like 5s. a year for medical attendance ?

13,193. At present they are practically paying you a mileage fee per visit, which they willingly pay. That is, they furnish you with a hire ?
—That is, of course, only in one direction. It is impossible to drive in any more than one direction.

13,194. Don’t the Scalpay people come in boats for you?
—Yes, but I can only take a trap west to Sir Samuel Scott's castle there, and I have to walk from there.

13,195. How many miles ?
—5½ miles. They are broken-down roads, and I have to cross by a boat, and from there there is another place I have to go to, which is five miles over the hill. There is no road there.

13,196. As far as they can, it is understood that they have the responsibility of taking you to and from the patient ?
—Yes, they are always willing to do so. In fact, they are thankful when I say I will go.

13,197. Don’t you think that on the whole it might be as well with the system that exists of furnishing medicine as an extra would be a healthy one, both for the patients and for the doctor ?
—I don’t think it would be for the patients.

13,198. Don’t you think that on the whole a doctor would be inclined to prescribe better medicines if the prescriptions were to be paid for ?
—I quite agree with you.

13,199. A shilling fee for a bottle ?
—Yes, but they don’t come for a repeat bottle. I can charge them what I like. They never return. The more I charge them the better for me.

13,200. Perhaps there would be a difficulty in arranging that in a locality like this. I am not sure whether it would be a healthy arrangement for all concerned that the supply of medicines should be kept separated from the medical attendance altogether ?
—It would be if the people were more educated. I have no doubt that in the course of a year or two it will be better. If the nurse was here it would be better.

13,201. Your income is practically what is guaranteed by Sir Samuel Scott ?

13,202. Do you get house rent ?
—Yes, free;

13,203. You have got the price of drugs to take off your salary ?

13,204. So that you are somewhere over £300?

13,205. That is a living sort of wage ?

13,206. But you don’t think it is sufficient for the work you do ?

13,207. You think it is demoralising to the people to be giving them free attendance ?
—Yes ; they don't appreciate it

13,208. Sir Samuel is reembursed to a certain extent for his guarantee by the little sums that the people give?

13,209. Do you know if they contribute to any appreciable extent ?
—Since I have come here the contribution have trebled. The total, I think, before I came here was some £23 or £24, and now it has gone up over £60

13,210. Her Ladyship spoke to you about a check fee I think you agree that that would be so far a protection to the doctor ?
—Yes, it would.

13,211. As a matter of fact, at present something like that is in existence through the mileage system?

13,212. In drawing out a sort of scheme of classification of the people who might be included in this medical service system, would you be inclined to fix on the rent or the income or the occupation as the basis?
—The occupation in a small place like Harris where the occupations are so few.

13,213. Such occupations as crofting and fishing?
—No, merchants.

13,214. You would exclude them ?

13,215. Resident crofters and fishermen you would include in the scheme ?
—Yes, all of them.

13,216. You could not devise a scheme otherwise?

13,217. You could not devise a scheme of excluding the fisherman who comes home with £300 ?

13,218. This hospital that has been instituted is very much on the lines that we have been trying to seek after, namely, a small hospital with a qualified nurse in attendance who looks after what cases you send in. You say that even the small fee charged is a deterrent, and the hospital is likely to be of no service whatever ?
—Yes. In fact, it would be empty but for an accident. I put in the other and I pay for them myself, simply to get them in, to try and let them see the benefit of the place. The other one is being paid for by Mr Cameron of the hotel here.

13,219. You attend quite a number of maternity cases—about forty in the year ?
—Yes, about forty or fifty.

13,220. This must take up a tremendous amount of your time ?
—Some of them take me a whole day.

13,221. It is too much for one man to undertake in this district ?
—Yes, of course, the others have to wait till I come back.

13,222. That would perhaps be met by having a system of nurses ?
—Yes. Of course, they often send for me too soon.

13,223. I was much interested in this habit of having one pipe in common applicable to the fishing-boats. Is that applicable only to Harris, or is it common in the Islands generally, do you think ?
—I don’t think it is common in the Islands.

13,224. Both this one-pipe arrangement and spitting?
—Yes. Of course, the spitting is common all over the Highlands. It is common at Lewis, at any rate.

13,225. I was going to ask you if can assign any particular reason for it. I am wondering if there is any extra chewing of tobacco here ?
—No. With the child watching its parents and its parents constantly spitting as soon as the child is able to walk it starts to spit. In fact, the child seems proud to be able to spit. They spit in bed, they spit on their blankets, and they spit on the chairs. I have done my best to try and put it down; I have threatened to report them to the police and all that sort of thing to stop them.

13,226. Are they small boats ?
—Small boats.

13,227. Do they live in them ?
—Yes ; they sleep in them doubled up some way.

13,228. I was wondering if that accommodation might be partly accountable for the tuberculosis that you find so prevalent ?
—They don’t sleep so very much in them; no more than a couple of hours.

13,229. Can you tell us about the state of the children's teeth ?
—It is very bad. There is not one child in Harris with good teeth —not one er cent. of them.

13,230. You have already told us that they have given up the habit of taking porridge and milk and they go in for tea and scones?

13,231. And the milk supply is very defective

13,232. Is this existent during the winter ?
—Yes, and during the summer too.

13,233. You told us that your work in summer is often increased ?

13,234. Is that because they can get at you more easily ?
—Yes. Some of the roads here are really dangerous. The road to Rainigatle is very bad; you have to walk on it sideways.

13,235. Have you much lunacy ?

13,236. Have you much illegitimacy ?
—Yes, a good deal.

13,237. The religion is mainly Protestant ?

13,238 (Chairman.) I don’t suppose there is a Catholic here?
—Yes, the policeman is a Catholic, and one or two of the gamekeepers. ,

13,239. (Mr Orrock.) Can you give us the population of South Harris?
—I think the population of North and South Harris together comes to something approaching 7000. I have tried to find it out, but I could not.

13,240. Do you think you could undertake the whole work for both South and North Harris ?
—Yes, excluding vaccinations as done at present.

13,241. I suppose Sir Samuel Scott runs the whole transaction ?
—Yes, quite.

13,242. Taking the risk of being recouped from his tenants at 5s. a head from his crofters and 2s. 6d. from his cottars?

13,243. Is it not rather a strange thing that the merchants of Tarbert should be included in the list of cottars and only pay 2s. 6d. ?

13,244. They would be perfectly able to pay a substantial medical fee?

13,245. Then, with regard to the houses in North and South Harris, the byre is separate from the dwelling-house?

13,246. And are the dwelling-houses ordinary black houses?

13,247. There is no cow in any of the dwellings ?

13,248. I think you mentioned that even a £5 note would not tdeter people sending for you for toothache ?
—That it so. I have had it often offered me.

13,249. So that it would appear that they are pretty well off in this part of the country ?
—They will get it

13,250 (Mr Grierson.) Why do they come to you for toothache?
—They don’t know it when they have it. They don't know what toothache is. I have drawn a tooth out for an old man, and he has told his wife I cured him

13,251. (Mr Lindsay.) There was one interesting statement you made about the tweed industry having something to do with the enormous number of phthisis cases you have in the district ?

13,252. Will you explain how that arises ?
—They sit all close together —the phthisical and non-phthisical together,  —and they are constantly spitting, and spitting on their hands and rubbing it on the first bit of tweed that is handy. The houses are very hot and the spit is dry, and it gets into the air and it gets into the lungs of other people. The making of Harris tweed is a slow process. Another habit they have here is the visiting of the sick when they are ill, especially consumptives, and they sit all round the fire smoking and spitting and drinking tea out of one tin.

13,253. You say in your statement, “ The sanitary conditions of the houses generally to be looked after better than at present, and the Local Authority to be bound to carry out certain improvements advised by the local district medical officer.” Do you mean to say the Local Authority is not carrying out anything ?
—That is so.

13,254. Has the medical officer of the county given reports on the sanitary conditions ?
—Yes, without coming here. He has not been once here up till now since I came here. His certificates and reports come in yearly.

13,255. You mean that the Public Health Act of 1897 is a dead letter, so far as Harris is concerned ?

13,256. In what respect do Parish Councils fail to attend to their duties ?
—They don’t look after the paupers properly.

13,257 In the way of ailment and nursing ?
—Both. The doctor, in the first place, is too far away from them.

13,258. He is twenty-four miles away from here ?
—Yes, and some of his people are forty miles away from him. The extreme westerly point of North Harris is forty miles away from him.

13,259. Why do you consider that school inspection would be better carried out by the local medical officer ?
—Well, if the appointments were given to the local medical officers, they might be made to pay monthly visits and examine the children as well as treat them.

13,260 You don’t think the medical officer would be deterred from doing his duty by any consideration with regard to the parents ?
—No, not here. In fact, here they would be very thankful for it.

13,261. I quite agree with you. You say the present school medical inspection is a farce. How often have you had them inspected since the Act came into force ?

13,262. How long is it since the School Board adoptedit ? Two years ?
—No it is not two years yet.

13,263. (Dr Mackenzie.) About these paupers, how many paupers are there in the parish roughly?
—About thirty or thirty-five.

13,264. Are there any in Lochmaddy Poorhouse, by the way?

13,265. How many ?
—I cannot say.

13,266. So far as you are concerned, it is outdoor paupers you were referring to. How many are there in your area ?
—About seventeen, I should say.

13,267. Is there a North Harris parish, or is it a single parish ?
—Yes, but the North Harris parish extends into the south district.

13,268. You have seventeen paupers in your district ?

13,269. Have you to attend to them in any way ?
—No. As local district medical officer I am expected to go seven miles in the North Harris district.

13,270. The parish medical officer is supposed to go over the whole area ?

13,271. How often does he visit the people here?
—He is up very frequently.

13,272. Are you prepared to say that the medical attendance is not sufficient ?

13,273. That is to say, that these seventeen paupers are not getting sufficient medical attention ?
—They are not. He is too far off.

13,274. As to vaccinations, you made an exception when you spoke about being able to undertake the whole work of the parish ; you said excluding the vaccinations as done at present ?
—At present they are done in batches.

13,275. Is there any objection to that ?
—The objection is that he vaccinates them at all ages, from six months up to six years.

13,276. What is your objection to that from the medical standpoint ?
—The vaccinations in Harris ought to be carried out when the doctor is visiting each village.

13,277. As long as it is done, does it really much matter?
—Yes, it is not done properly.

13,278. How is it one?
—It is generally done in a haphazard sort of way.

13,279. Does he come back and certify them ?
—Occasionally. Perhaps he sees the father, and he may inquire of him.

13,280. What is your habit ?
—I do no vaccinations.

13,281. They don’t ask you to do it ?

13,282—13,283. Any system of nursing must be a set of nurses that constitute your medical staff ?

13,284. That is the idea you have in your mind?

13,285. That if you had a free hospital and one or two nurses to act under your direction, you could easily have an effective medical service, and you could undertake the work of the whole parish ?

13,286. How would it be satisfactory for you to go the length of South Harris when it is not satisfactory for the other man to come to North Harris ?
—The South Harris doctor lives at one end of his district. I live in the centre of it. He gets an order from the Poor Inspector perhaps to-night to come up immediately. It is very often not possible for him to come, and he has to depend on me to do it.

13,287. Do you really think that with all that tuberculosis which you tell us of, and the island work, that one man would be able to look after all this parish ?
—Yes, if the most of my needless visits to confinements were cut off I could take a week-end any time.

13,288. What do you mean by needless confinements ?
—I am often sent for before the woman is ill, and often when a nurse would do.

13,289. How do you suggest to get rid of that ?
—Send a nurse.

13,290. You don’t want a maternity nurse; you want a well-trained nurse who would act under your directions for con?nements and would be able to do any surgical or medical work ?

13,291. You don’t want a mere half-trained nurse. There is no infectious diseases hospital here ?
—No, none.

13,292. You just allow epidemics to die out ?
—They had one little tin shed in the island of Scalpay some years ago, but I think they have closed it up. They use it as a store now.

13,293. About this cropping of the children’s hair, you made a statement of what is obviously an exceptional fact, that the hair here of the boys is rarely cut ?
—It is rarely cut. I think they grow it up to ten or twelve years of age, and their hair is all matted together and their heads are all broken out.

13,294. You are able to state that absolutely nothing is done to follow up the work of school medical inspection of children ?

13,295. And what is more, at the present moment no facilities exist, so far as school medical inspection is concerned, for following them up ?

13,296. And no arrangement has been made with you or with any other people in the locality to follow them up?

13,297. And no arrangement with the nursing service has been made ?

13,298. As you are aware, the Education Department has distributed a sum of money for the treatment of these children. Has any money been given to Harris?
—None, to my knowledge.

13,299. (Chairman.). You don't attend the island of  Taransay ?
—No, that is in South Harris.

No comments:

Post a Comment