How the health service has its roots in the Highland potato famine

Sir Robert Peel, 1788–1850
Sir Robert Peel, 1788–1850

By Elizabeth McQuillan

Scottish physicians, as early as the eighteenth century, recognised that poverty was inextricably linked with poor health. Whether in the overcrowded industrial centres, or working the land, the effects of poor diet, overwork and inadequate shelter led to “debility”.

In 1846, the potato blight that had caused the Irish poor to suffer the pain of starvation arrived in Scotland. The areas hardest hit were the Highlands and Islands, where the people relied on a successful crop for sustenance. The result was a Highland famine.

The humble potato provided a high yield on the small plots of land left for cultivation due to the Highland Clearances. With little other food being grown to sustain the local people, the failure of the potato crop proved disastrous.

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The crofters looked to their chiefs to provide help at their time of greatest need, but help was often not forthcoming, with the landlords by now looking to replace their tenants with sheep at the earliest opportunity. Many turned a blind eye, some simply evicted their tenants (many were reduced to living on the streets of Inverness), and a few hired boats to transport their tenants off their own land to foreign territories.

The government did eventually intervene and provided rations of oatmeal – 680 grammes for men, 340g for women and 280g for children – but not without the crofters showing that they were still working for their food. Despite having a calorie input that barely sustains basic physiological function, the crofters were expected to work eight hours per day, six days per week.

Unsurprisingly, the people suffered terribly with the many medical problems that famine brings: malnutrition, scurvy, typhus and cholera. This lasted for a full ten years while the crops failed. There was little, if any, medical help available.

The Poor Law in Scotland did not make provision for the care of the walking sick (which most of the victims were) in the local parish. William Pulteney Alison, Professor of Medicine at Edinburgh University, along with other Scottish social reformers of the time, demanded in the House of Commons that the Poor Law must be altered to ensure that every parish had the services of a resident medical officer.

Sir Robert Peel, the prime minister, was not keen, but the pressure remained on and Peel eventually (in 1848) conceded a compromise. An annual grant of £10,000 was made to the Board of Supervision of the Poor Law to finance a subsidy for any parish that agreed to finance the formal appointment of a medical officer.

The people of the Highlands and Islands needed particular help. Following the Napoleonic wars, cattle prices had dropped to make their meagre stock worthless, the kelp industry that provided employment collapsed, herring fishing failed and there was a general recession in Scotland. The potato blight simply compounded the problem of abject poverty.

Ultimately, the Poor Law did not help much. The doctors who relocated to the Highlands and Islands as medical officers, hoping to make a living, soon realised that life was tough. Attending patients was difficult due to the large distances and inhospitable landscape, as well as bad weather and the problems of having to often travel by boat. Most patients were so poor that they could not afford to pay. Many doctors returned home.

Sympathy for the plight of the suffering Highlanders was not overwhelming from lowland and English quarters, and the notion of state handouts was not encouraged. Many ideas were put forward to deal with the problem, but the physician Coll MacDonald could see the way forward:

“The simplest and cheapest plan to give medicines and medical aid to tens of thousands living in the Hebrides would be to employ a few sober men of good character and energy, provided with medicines and instruments and a small steamboat (as the Marquis of Salisbury has done for Rum) to move constantly about among the people when they could conveniently assemble to be cured of their diseases. By this plan [salaried medical practitioners] would more economically and efficiently be brought into contact with the sick and the maimed than by the establishment of stationary practitioners.”

This idea was ahead of its time, but in 1913, the same ideas reappeared in the creation of the Highlands and Islands Medical Service, the first comprehensive and free state health service in Britain. Though the advent of world war one delayed the roll-out of the Highlands and Islands Medical Service, more than 300,000 people across Scotland were covered by the 1930s. It offered a model for the wider national scheme, the National Health Service, which finally came into being on 5 July 1948.

Reference: Royal College of Physicians, Edinburgh

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