Memories of the Western Isles Health Service - Sandy Matheson

In the period before the NHS (1946/47) I was too young to appreciate the extent of what was going on, but I remember as a child the patient debate surrounding the implementation of Bevan's Act. There was a great deal of patient debate as to whether a National Health Service was the correct way of tackling the problem of providing free and quality health services to the people. Many attitudes were shaped by the people's experience in the war.

I would have thought my father (Dr Alexander Matheson) and his colleagues would have welcomed the imminent NHS, but I don't think the doctors were convinced there was compatibility of non-payment of medical bills for medical treatment and a good quality service.

Some people were afraid that the NHS would lead to a diminution of the service. Without the health service many patients would not have sought medical treatment. The whole question of having to pay meant that the patient was responding not to necessity, but ability to pay. The National Health Service was one of the fantastic things that our various governments have ever done - in creating this thing called 'the National Health service - Free for All'.

Lewis didn't get its first proper hospital until 1896 when the Lewis Hospital was created and built on Goathill Road - a mere 300 yards from where I was born. From the next 50 years it drew its income entirely from fundraising and Carnivals every year in order to pay for the hospital and treatment. The hospital was an interesting place in the early days, in that the patients were looked after by their own doctor rather than staff doctors.

During the war the Lewis Hospital took in a lot of servicemen. The patients then would have been paid for by the military. The hospital had increased turnover and better funding. Apart from the Lewis Hospital there was a County Hospital, it had its genesis in the 1920s. It was built primarily to deal with returned servicemen who had been injured, but it soon developed into an isolation hospital for the treatment of tuberculosis, which was the scourge of the island. I was aware from a very young age of the problems of TB. My own contemporaries went out to the 'sani'. Before the intervention of drugs the treatment included better diet, and sunshine. As a boy I passed the 'sani' frequently and in reasonable weather the patients slept out on the balcony rather than inside - that was because the fresh air was good for them (a flawed theory, as it wasn't until 1948/9 that streptomycin was introduced to treat TB). Incidentally if the NHS hadn't been introduced, people would not have been able to afford streptomycin.

My father ran a practice of 4,000 patients. He had regular surgeries between 9-10am, 2-3pm and 6-8pm. In those days, a lot of people didn't have telephones, so it was just as easy to go to the doctor's house as to go to the phone box. Frequently of an evening, someone would knock at the door for help, and I could go for days on end not seeing my father because he and the District Nurse were attending a 'maty' (a maternity case). 90% of the births in those days were home births - and the doctor and midwife would have to be back and fore to supervise all stages of the birth. I remember the sense of relief when he would appear home again. It always appeared to be around lunchtime that himself and the midwife would appear and have a huge lunch to celebrate the end of the process of having to look after the mother and baby.

My father, every Christmas-time, was given presents from his patients - payment in kind for the services he had provided. The bobban socks that I had were knitted by some lady in the country!

I can remember in the wee school in Matheson Road, when I had started school in 1947, we were playing in the playground and the teacher stopped me, and said: 'you're a doctor's son, there's a young girls here who has fallen and scrapped her knees, will you take her in and wash her knees for her?" I wasn't even sure what a knee was at that age! It was quite an experience to find I was expected to do a job like that.

When I was a young boy, if you had a bad tooth it was taken out, a filling was not a common thing. The dentist that I had was DJ Macdonald. He was a wonderful fellow, and I would go to his surgery on Church Street, where the Police Station is now. He would talk to me about his experiences in Gallipoli. He didn't have any fancy electric drills, we would have to sit in the chair while he ground away at your filling - the whole experience of a filling was more painful than extraction. Middle aged people used to get all of their teeth out and get false ones.

In 1947 sweets were still rationed and I remember being taken by the hand by my mother down town round the sweetie shops buying sweets and fruit. I thought we were going to have a party. My mother gathered everything up and made her way to the pier. My mother was a quiet lady, and she went down the step son the side of the pier and a gentleman came over and she handed over the whole bag of goodies. I remember thinking 'what a waste' and she told me they were for refugees - people escaping Russia and they found their way to Stornoway.

One of my delights as a child was going with my father on his rounds. After morning surgery, he would go to visit his home patients and I would sometimes go with him - often on schools days, for a minor illness or even feigned illness precluded school but not necessarily to do something useful or active. He would go into the house and I would normally sit in the car - though sometimes I too would be allowed to go into the patient's home where I always received a warm and hospitable welcome. That's how I got to know what was going on in the country districts of Stornoway. Going out in the car with my father was a different kind of classroom for me.

I wasn't there, but I remember on one occasion my father went to visit an old lady who was bed-ridden. My father was extrovert and had a wonderful bedside manner. He was taking the lady's pulse as the lady lay there in bed and on the bedside table, he spied the Free Presbyterian monthly magazine. He looked at her and he said 'I see you're a Free Presbyterian'. The women went into raptures afterwards and said 'what a wonderful doctor he is - he knew by taking my pulse that I was a Free Presbyterian!'

Part of my father's work was as a social worker as well as a clinician! I remember people in great distress asking him to intervene in other matters. I remember one Saturday afternoon our whole household being disrupted because a hysterical woman came to the house because she had over-bought on her higher purchase system and the bailiffs were knocking at her door. So the doctor was there not just for her health - but to get the bailiffs off her back!

After 1948, there were still three divisions: public health was run by the local authority, general medical services were run by the Executive Council and the hospital was run by the local regional board - our hospital was managed and run from Inverness. In 1973 all of that changed and we had the creation of Western Isles Health Board. From that time on the hospital services, general medical, dental and pharmaceutical services were run by the new Board. I was appointed in 1973 under that system. People in the Western Isles were allowed to run their own health services. One significant change since then has been the move away from medicine to health prevention and health promotion, with intervention at a much earlier stage. People were also made more aware of the need for a good diet.

In my own experience of illness, I would like to remark on how the health service has changed for the better. The steps that have been taken are absolutely remarkable in such a small area as ours. Who would ever have dreamt that cancer would become a treatable condition. That's tremendously important and people sometimes take the health service for granted, in terms of the services that are given. Without the catalyst of the NHS, I don't know where we would be.