University of Aberdeen, Scotland (Spring 2017)
Nicola MacArthur, November 2016.
The Isle of Lewis is the largest island of Scotland’s Outer Hebrides. Its current population of 18,500 has decreased from 30,000 in the eighteenth century, when one fifth lived in the capital, Stornoway. Throughout history Stornoway was an important center for the fishing industry, naval harbor during World War I, and air force stagingpost during World War II.
The remoteness of rural communities and their stout adherence to tradition meant there was often a delay in accepting modern public healthcare. An example in Lewis was non-compliance with smallpox inoculation, which began in mainland Scotland in 1726 but did not reach the western isles until 1764, leading to more recent mortality from smallpox.1Furthermore, overcrowded housing, unsanitary water supplies, and non-compliance with modern medical and hygiene approaches meant ‘OldWorld’ diseases such as cholera, typhoid, scarlet fever, smallpox, and tuberculosis caused significant mortality.2 Inhabitants of the Outer Hebrides survived mainly by means of subsistence crofting and fishing, thus sufficient money to pay for medical care was seldom available. Early government policies (Poor Law (Scotland) Amendment Act 1845 and Public Health (Scotland) Act 1867) placed an obligation on parishes to improve public health and medical care for those without the means to support themselves. In 1912 the Dewar Committee, led by Sir John Dewar MP, recognized this and detailed a compelling case for healthcare reform, concluding that the principle of healthcare was a basic human right regardless of income, class, or geography. Subsequently, in August 1913, the Highlands and Islands Medical Service (HIMS) was established as the first state-provided health service in the world and a precursor to Britain’s National Health Service (NHS). This essay describes the evolution of four pre-NHS hospitals on Lewis.
Mossend Fever Hospital (1876- 1938)
The need for a fever hospital was determined by three major factors: the Public Health (Scotland) Act 1867, reports by government sanitary inspectors, and the high prevalence of infectious diseases on the island, (due to poor sanitary standards). In 1872 the Proprietor of Lewis, Sir James Matheson, donated land to build an isolation hospital “For Smallpox fever or any other contagious infections or epidemics”.3 In 1876 the 12-bed Mossend fever hospital was built on the outskirts of Stornoway by the Stornoway Town Council.
In 1908 the town water main was extended to supply the hospital, which until then had used water from a well. The lack of piped, clean water in the treatment of patients with infectious diseases is an example of the challenges faced in providing healthcare rurally. Professionally qualified nurses were finally established here in 1909 upon donation of £1000 by Mr Kenneth Nicolson.4
The Mossend Fever Hospital closed in 1938 and patients were transferred to a specialist infectious diseases wing at the County Hospital. Only the hospital’s unmarked ruins remain today.
Lewis Combination Poorhouse(1897- 1979)
The Lewis Combination Poorhouse Committee (with representatives from the four Parishes of Lewis) met on 12 July 1893 with Mr Charlie Orrock, the Lewis Chamberlain, as their chairman.Their objective was to build a poorhouse for the island.5The poorhouse committee rented a three-acre site in the north of Stornoway for £9per year. A two-story building, designed by James M Thompson of Edinburgh6, provided sixty beds and was formally opened as the Lewis Combination Poorhouse on 8 September 1897 by Major Donald Matheson, who inherited Lewis from his uncle Sir James Matheson.
The poorhouse admitted residents (known then as“inmates”) from 28 October 1897.5Admission was principally because the person or family had no means of supporting themselves, for example: unmarried mothers, orphans, the elderly, and sick-poor. Inmates were given food and a dormitory bed and were expected to work during their stay. While not technically a hospital, the poorhouse provided needed medical care for chronically sick paupers.Sufferers of mental illness were also admitted to the poorhouse because of the inadequacy of specialist or social care. The poorhouse was formally licensed to accommodate patients with mental illness in 1911, and inmates admitted with depression, learning difficulties, or other mental health problems were disparagingly termed harmless lunatics. When the Poor Law system was abolished in 1928, the poorhouse continued to care predominantly for the elderly. Throughout its final decades, it provided food and bathing facilities for homeless persons, thus maintaining its original function as a poor-shelter.
In 1979 the original poorhouse was demolished and replaced by the Dun Eisdean Residential Home, to which residents were transferred. The poorhouse’s Governor’s house is the only original building which remains of the establishment.
Lewis Cottage Hospital (1896- 1992)
The late nineteenth century saw growing concern among medical professionals at the lack of adequate hospital facilities. There are anecdotes of nurses cleaning and preparing kitchen tables for doctors to perform operations, not only for the island’s permanent population but also for visiting fishermen during the busy fishing seasons. A committee was formed in March 1892 to raise funds to build “a well-equipped medical and surgical hospital”. Over four years, subscriptions from locals and Lewis descendants worldwide, donations, church collections, community events, harbor fees, and court fines were accumulated to finance the hospital.7 The Lewis Cottage Hospital was opened to patients on 1 February 1896 by Major Donald Matheson. It was built by John H. Gall of Inverness at a cost of £2353 and was completed free of debt.8The committee had been led by Dr. Murcoch McKenzie, a local physician, who was appointed as the island’s medical superintendent and whose efforts had raised funds for essential medical instruments for the hospital9.
Initially the hospital was equipped with two six-bed wards, accommodation for visiting doctors and nurses (of which there was only one!), surgery, operating theatre, kitchen, and administration area. A separate block housed the laundry and mortuary. Within a year, 100 cases were recorded at the hospital including forty nine operations. The skill and efforts of Dr. Mackenzie helped to dispel the population’s belief that surgical operations were invariably fatal and paved the way for more accepting attitudes toward modern hospitals.9,10
An extension was built by George Gordon and Co. in 1926 and included an x-ray room, maternity ward, and electrical installations. The extension was opened in 1929 by T.B. MacAuly of Montreal, whose Grandfather had farmed the land upon which the hospital was built. In 1938 the Lewis Hospital Committee appealed for funds for further expansion work to the hospital, which was by then the only general hospital ministering to the needs of the island’s 30000 crofters and fisher-folk, seeing over 600 cases per year. Surgical and emergency facilities were adequate (though now oversubscribed), but medical facilities were not. The appeal was made to the subscribers, donors, and the Heath Department for financial assistance for two more ten-bed wards, a pediatric ward, and accommodation for additional staff. The Department of Health provided £14000 and the managers obtained the additional £10000 to equip the wards.
The hospital served the entire community free at the point of care, ‘irrespective of class or creed’11 until its closure in 1992 when the NHS Western Isles Hospital was opened. The building later became private housing and the hospital’s original wrought iron gates were reinstated and still stand today.
Willowglen Sanatorium (later known as the County Hospital) (~1916-1992)
Tuberculosis was very common during the nineteenth and twentieth centuries. It was recognised in 1870 as a major health problem and declared the single greatest killer in the island’s history. The Red Cross built the Willowglen Sanatorium during the First World War for the isolation and treatment of patients with TB and transferred ownership to the local authorities in 1920. In 1938 a specialist infectious diseases wing was added to replace Mossend Fever Hospital. Tuberculosis treatment saw huge improvement in the 1950s with the development of streptomycin and there was no longer a need for dedicated TB treatment establishments. The Willowglen Sanatorium therefore became the County Hospital for minor ailments and a war veterans’ convalescence home.Upon opening in 1992, the Western Isles Hospital fulfilled the combined roles of the County Hospital and old Lewis Cottage Hospital. The County Hospital was closed and demolished, leaving no signs of the original building.
As with many isolated rural communities worldwide, the population of Lewis adapted slowly to modern public health and healthcare. Traditional approaches to medical care were preferred and it was expensive for authorities to implement public health and sanitary measures for such widely dispersed communities. Poor quality infrastructure throughout the island added further challenge to the provision of medical services. Despite this, it seems that the Public Health (Scotland) Act 1867 and Poor Law (Scotland) Amendment Act 1845 were powerful influences in the establishment of hospitals in the Western Isles.
Early hospitals were the forerunners to current healthcare infrastructure on Lewis but there appears little demand for their preservation. Although buildings were beautifully designed, historic hospitals were uneconomical to maintain and were often associated with stigma and grief, so they were demolished without trace. The Lewis community regarded the Mossend Fever Hospital and Willowglen Sanatorium with trepidation, perhaps due to limited understanding of infection and management; and the poorhouse retained the stigma of poverty. For these reasons there was no incentive to preserve the buildings themselves. Conversely, due to community-wide collaboration throughout its establishment and development, the Cottage Hospital is celebrated and commemorated. Perhaps a lesson lies here in the merits of public engagement in developing healthcare services.
Exploring the evolution of hospitals reminds us of the hardships in the provision of healthcare through history. In order to improve standards of care and facilities, it is important to understand the origins and development of the services provided.
- Withers, Charles W. J. (1998)Gaelic Scotland: The Transformation of a cultural Region. Volume 19 of Routledge Library Editions: Human Geography Series
- Day, John P. (1918) Public administration in the Highlands and islands of Scotland. University of London press, ltd.
- Lewis District Committee Meeting Minute Books (1829-1900). Available from the Tasglann nan Eilean Siar (Hebridean Archives), Lews Castle, Stornoway, Isle of Lewis; HS2 0XS
- Highland News (1909) Nicholson Legacies to Fever Hospital and Library
- Silver, F. (2009) Glimpses of Stornoway. Intermedia Services
- Higginbotham, P. (2016) The Workhouse; Workhouse Locations; Scottish Poorhouses; Ross & Cromarty; Lews (Lewis). Available at: http://www.workhouses.org.uk/Lews/
- Eleventh annual report Lewis Hospital Stornoway 30th November 1907. Available from the Stornoway Library, 19 Cromwell Street, Stornoway, Isle of Lewis; HS1 2DA
- Lancet (1929) Volume 214; Number 5526 p.205: Medical Directory, originally published as Volume 2, Issue 5526 (1904). Available at: http://www.thelancet.com/journals/lancet/issue/vol214no5526/PIIS0140-6736(00)X4044-5
- Stornoway Historical Society (2016). Early Medical Men of Lewis 1700-1918. Available at: http://stornowayhistoricalsociety.org.uk/early-medical-men.html
- Crosfill, M. L. (1973)The Lewis hospital, Stornoway some aspects of the development of medical care in an island community. Medical History; Jan; 17 (1): 49-60. Available at: https://www.ncbi.nlm.nih.gov/pubmed/4595532
- Lewis Hospital Appeal (1938) Publication by Managers of Lewis Hospital as an appeal for funding. Available from the Stornoway Library, 19 Cromwell Street, Stornoway, Isle of Lewis; HS1 2DA
The author would like to acknowledge the support of Professor Steve Leslie, NHS Highland; Mr Jim Leslie, History of Highland Hospitals; The Highland Archive Service, Inverness; Tasglann nan Eilean Siar (Hebridean Archives), Stornoway; Stornoway Library; Mr Iain MacArthur, Stornoway Historical Society; Dun Eisdean Residential Home staff and funding by the John Blair Trust.
NICOLA MACARTHUR, BSc (Hons) is a third year medical student at the University of Aberdeen with a passion for the outdoors and in particular, cold-water surfing. Her family are from the Western Isles of Scotland and she has begun spending time understanding her roots via the beaches and wilds of the Outer Hebrides.