..PRE AND POST
There are ample facts about the overall introduction of the NHS available
from various press articles and leaflets, so, as our family have had a
76 year connection with Health Care in Uist, my plan is to mention aspects
which are locally related and not necessarily available from other sources
and to include some of my personal memories.
Uist, before the 1939-45 war, there were no causeways, no electricity,
no telephones, virtually no public water supplies, poor roads, few cars,
poor housing, almost no council houses. There was one GP in each of North
Uist, Benbecula, South Uist and Barra for a much greater population. There
was a County Council Doctor covering Public Health and schools who was
based in Lochmaddy. There were Queen`s Institute District Nurses in many
areas. Daliburgh Hospital was staffed by Nursing Nuns. Lochmaddy Hospital
patients were a combination of very poor people and psychiatric patients.
The first Outer Hebrides Air Ambulance was to North Uist in 1933 (Cairn
at road side near Clachan and described in "Air Ambulance" by
Iain Hutchison). I regard the start of this service as the greatest local
advance in health care as it brought the island patients almost on to
the same level for accessing urgent specialist care as mainland patients.
In the same year, Captain Fresson began flying patients from Orkney. From
March 1936, Sollas had its hangar and was a licensed air field where the
schedule aircraft was based and did request landings at Benbecula, Askernish
and Barra. Stornoway did not get its scheduled flights till 1942. The
Uist area was administered as part of Inverness County Council.
1959 - Dr AJ Macleod Craigard - Horse on way to Baleshare.
father, Dr. Alex J. Macleod moved here from Applecross in 1932 and then
married Dr. Julia in 1933. Inverness County Council had failed to get
Dr. Mackenzie of Scolpaig to retire so they established a new practice
based on Lochmaddy. Interviews were held in Lochmaddy and a doctor from
Kent was appointed. His wife declined to come so my father was then offered
father`s salary was based on a small amount for Lochmaddy Hospital, small
payments and mileage for certain patients, direct fees from patients and claiming fees from varied insurance schemes that some subscribed to. From
1936, He was one of the first in Scotland to have an assistant for winter
help. This was subsidised for six months. For the rest of the year, the
assistant would do locum here or in other Highland practices. It was really
the predecessor of the more recent Associate scheme. Like many GP`s, my
father was very poor at claiming his fees.
1959 - Nurse Ferguson
I can remember one time about 1946 (when he was away at a meeting) my
mother and the then winter assistant sitting at our dining room table
and sending out bills based on the careful diary that all GPs had to keep.
Frequently fees were paid in kind and, sometimes, live Cockerels and Hens
would be delivered. That the GPs and the District Nurses had a small basic
salary was due to the Highlands and Islands Medical scheme that had been
introduced as a result of the Dewar report.
In each of the islands, the surgery was part of the house so our dining
room was also the waiting room. There were only occasional visits from
dentists so the GP had to do extractions. There was a second door to the
surgery and if we saw father carrying his pan of dental instruments though
to boil them in the kitchen it became a signal for us to crouch behind
this door and listen to the patients` reactions. Once discarded, some
of the angled dental forceps were great for getting at car engine nuts,
in awkward places, as car maintenance was also part of the job.
Dr AJ Macleod in Surgery
and requests for visits came by Telegram or a messenger in a hired car or lorry. The Telegraph
"Boy" would wait in case
there was a reply. The Telegrams were passed by Morse Code between the
Post Offices. Two single wires, on poles ringed the island. Telephones
were not available till 1944. My father had a regular schedule for visiting
certain areas of North Uist and, in each one, there would be a place
a Post Office
where he would stop and collect any new local requests
It is generally thought that the concept of Group Practice developed
with the NHS but the Uist GPs were away ahead as on 26th April 1943,
the GPs of North Uist, Benbecula, South Uist and Barra held a meeting
at Lochboisdale and amongst other decisions was one that the areas
of Uist and Barra should become a group practice. Unfortunately neither
the Inverness County Council, the Department of Health in Edinburgh
nor the British Medical Association backed the plan.
the years, my mother`s primary responsibility was to her family, her milking
cows, hens and
ducks. However, she was always available to cover his absences
whether they were to distant parts of the island
he had 15 sea crossings
to islands or isolated promontories
or was off the island for meetings.
One specific instance, of standing in, was in the second week of January
1935. Father was across in Grimsay and a boat came from Lochportain with
a message from the Lochmaddy Nurse requesting urgent help with a delivery.
Mother collected the midwifery bag went off in the open boat for the 45
minute trip to Lochportain, walked the 2 miles on a rough track to Cheesebay,
helped with the delivery and then returned home.
Dr AJ Macleod in dinghy leaving Lochportain
1954 - Dr AJ and Julia Macleod
days later, she went by the Lochmor and a car to Stornoway where she
lodged in the Old House on Francis
Street and her first child was delivered
two weeks later by my father`s long time friend
The baby she delivered in Cheesebay was Duncan Mackay and he still thrives
today. The one she had in Stornoway was myself. At the beginning of
the War, she started the North Uist Branch of the Red Cross and ran
it till she handed over to my wife Lorna in 1976. During and just after
the War, mother organised the purchasing of wool, the knitting of garments
and then had a team of local ladies who helped make up parcels for the
North Uist troops with special ones for those who were Prisoners of
to the NHS, the District Nurses were employed by Inverness County Council
but part of their salary came from local funds. There were also certain
aspects of their work for which the patient was expected to pay but
were technically free if carried out by the GP. The Nurses cottages
at Lochmaddy, Carinish and Berneray were built and maintained by those
communities. The west side nurse was from Skye and married to a Tigharry
crofter so there was no cottage there till about 1966. The nurses lives
were as hectic and un-predictable as those of the doctors. Nurse Mary
Ferguson told me that there was a time when she had a patient in Locheport
and one in Grimsay who required daily visits. She would cycle from Carinish
via Clachan to Locheport, attend to that patient, leave her bicycle
there and walk over the moor to Claddach Carinish. From there, she would
either be collected in a rowing boat or wade across the ford to Grimsay.
When her work was completed, she made her way back to Carinish. The
next day, she did the trip in reverse.
1959 - Tigh na Bochd
would often be reluctant to contact the doctor or nurse so they frequently
had to deal with situations that were very far advanced. Immunisation
was not available so infectious diseases like Measles were rife. Tuberculosis
was common. There were no antibiotics so Scarlet fever took many lives
of young and old. Travel to a specialist out patient appointment would
either be via hired car to Newton or Lochmaddy then sea journey to Harris
followed by another car to Stornoway. Alternatively the trip could be
by the Lochmor (mail boat) to Mallaig and then train to Glasgow. Urgent
cases were flown out but the family had to pay for the flight. In the
case of a patient dying in a mainland hospital the family had to pay
the full cost of bringing the remains home and so there were "Funeral
Funds" which continued to function until the NHS accepted the financial
1959 - Leaving Craigard
the 1939-45 war, the UK Government agreed on the concept of the NHS
and decided that whichever party was in power afterthe
war, would introduce
it. Therefore there was much planning activity. Dr.A.J.Macleod and Dr.
Murdo Maclean of Dunvegan were two of the doctors who represented Inverness
shire at the planning meetings in Edinburgh. They fought to try and
get some of the best bits of the Highlands and Islands scheme included
in the final proposals. With the travel pattern and the war time restrictions
it meant that my father would be away for five days for the one half
day meeting. The representatives succeeded in several of their objectives.
One early result was a cine film called "Highland Doctor"
of which a large section was filmed in North Uist and Harris. This film
was a national propaganda film designed to show the rest of UK that
an NHS would be good for them as the Highlands and Islands scheme had
been such a success.
The start of the NHS with free medical and dental care for all led to
a chaotic time for the health professionals as there was such a back
log of untreated illness. It led to the development of new electric
drilling machines for dentists with emphasis switching from extraction
to conservation. I remember the travelling dentist...Mr. Luth with his
drill that he worked with a foot pedal so you can imagine how slow and
painful that would have been. Local patients now had free travel to
and from hospital under a special Crofter County travel scheme. They
also had choice of hospital and that continued freely till about 1990.
It is little known, that in the rest of the UK, patients who were on
benefits had choice of hospital and free travel so such a patient from
Cornwall could travel and be treated free at a London teaching hospital.
The parallel development of new vaccines meant the rapid decline of
the infectious diseases which had taken so many small children. My father
had always been keen on using vaccines and I am sure that none of you
are aware that he tested every new one by trying it on me and my siblings
before using it in the practice.
Mary MacAskill, Nurse MacArthur, Nurse Macleod on old jetty, Berneray
Community Nurses now on NHS salaries, it meant that remote GPs were
able to involve them more directly in the health care of their districts.
Patients would make initial contact with the Nurse who would assess
and discuss with the GP. My father, like several other remote GPs would
give the nurse a small stock of certain drugs which she could administer
in certain circumstances. The nurses telephoned the GP each morning.
This superb arrangement was abolished by Western Isles Health Board
though it continued for Berneray and Eriskay till they got their causeways.
It could recur, in the future, as Dr. David Murray of the Lochcarron
practice pioneered a system where his Community Nurse shared nights
on call with him.
the midwifery side, in the 30`s with many large families, I have records
that show the pregnant mother having only one contact with the midwife
before delivery. This is quite a contrast to the system today.
Dr AJ Macleod at Newton Ferry, returning from Berneray.
late Nurse Morag Macdonald told me that before the development of the
Home Help Service, there was a time when she had six bed ridden patients
to attend and help before starting any other visits.
Much of this aspect of care has been taken over by the Home Help Service.
This was established in Uist in 1962 with the appointment of Norman
Johnson as Welfare Officer. He was so successful that, for a time, Uist
had the highest ratio of Home Helps in Scotland.
X ray machine, at Lochmaddy Surgery. In
1945, the Lewis Hospital, which was then a voluntary one supported by
public subscription, bought a new X ray machine. Somehow, Dr. A.J. Macleod
was able to get the old one. I do not know if he paid for it but he
certainly paid for its dismantling, the freight and the installation
at Lochmaddy as is shown on the cheque stubs from "The North Uist Medical
Amenities Fund". It was installed in his small surgery. The doctor`s
house and surgery was one of a few County Council buildings, in Lochmaddy,
that received electricity from a generator at what was "The Institution"
and which became Lochmaddy Hospital. The electricity was for lights
and radio only but ironing could be done during daylight hours. I do
not know if he had permission from Inverness County Council to install
the machine. When it was ready and tested, he was refused power to use
it, so, it remained unused until it was taken out in 1975.
Although it took a long time, the NHS gradually changed its emphasis
from being a pure "sickness service" to one where prevention
and health promotion had an increasing role. The service has always
been under funded and for example, at a time when the UK was spending
6% of its gross income on health care, the USA where most of its care
was paid for privately, was spending 10%. Even there, it meant that
20 million low income Americans did not have access to free care. On
that basis, you can see why the UK`s NHS was the envy of the rest of
the world. It has been a turbulent service to work for
and locally, with so much change and the future for a free service is
cloudy as the population ages and the care of the elderly becomes such
a major part of it.
I am proud to have worked in the NHS and particularly in Uist where
I was able to continue and expand the pattern of the service developed
by my parents. Being single-handed for most of the 27 years meant that
.as had been the case in my own childhood
.my time being
active with our children was limited.
Whatever I achieved could not have been done without the help of my
wife Lorna, the Community Nurses and the staffs of the Uist hospitals.
Dr John AJ Macleod, and his wife Lorna
Photo by Peter Rintoul
John A.J.Macleod, MBE, DL, FRCGP, FRCP (Hon.Glas),FFCS Lochmaddy.
General Practitioner, North Uist and Berneray 1973-2000.
Mrs.Lorna Macleod, Practice nurse 1974-2006.
delivered at Uist and Barra Hospital on 8.7.2008 as part of the 60th
anniversary of the NHS.
.Dr. A.J.Macleod OBE, FRCGP 1932-1974.
Dr. Julia Macleod MB.Ch.B.1933-1973.
Photos are courtesy of Dr John A .J. Macleod's collection.