It’s not everyone who is fascinated by the transportation problems of early twentieth century highland nurses. It doesn’t immediately sound like a particularly glamorous or exciting topic, but you’d be surprised how many ears prick up when they learn of the solution these women were presented with; a vehicle long associated in popular culture with the adventurer, the renegade, the adrenaline junkie – the district nurse?
There is something about the image of a 1920s nurse on a motorbike that really captures the imagination. It’s not the type of pairing you expect to encounter in that period…or is it? Forget feathered flappers with drop-waist dresses and Eton crops, what image better encapsulates the trailblazing roaring twenties woman than the motorised district nurse? This lady has a lamp alright, and it’s on full-beam, coming at you at 40mph. A rebel with a cause – and a supply of castor oil. But let’s not get too carried away now; the faces looking up from the handlebars in such pictures may be confident, competent and possess just a hint of swag, but the women themselves, and the whole plan to equip them with these machines, could not have been more sensible. It was one of many measures taken to improve healthcare coverage for the scattered highland population and to make the work of the professionals attending these districts easier. The Highlands and Islands Medical Service (HIMS), established in 1913, was at the heart of such improvements. Yet, even as someone who comes from Argyll (one of the counties that benefited from HIMS), it wasn’t until conducting research into the establishment of the NHS that I even discovered such a thing existed – never mind the fleet of ministering hells angels.
I am currently in the second year of my PhD in Creative Writing and History of Medicine at the University of Strathclyde. My practice-led project explores the experiences of early twentieth century female medical professionals in rural Scotland, engaging in particular with issues around contraception and sex education. I was intrigued as to how an examination of these topics intersected, not only with the shifting gender dynamics of the turbulent twentieth century, but also with the growing calls for healthcare reform – calls which in the Highlands, by as early as 1912 (thirty years before the Beveridge Report), had become impossible to ignore. Over the course of my first year, my research had taken me to archives in Glasgow, Edinburgh and Argyll, but there was a large Highland shaped hole I was eager to fill. I knew the Highland Health Board records were held in the Highland Archive Centre in Inverness, and my communications with staff there had revealed several tantalisingly titled collections. But how much would there be on HIMS, and its significant ‘hers’? And lacking a motorcycle of my own, how exactly was I going to get there?
‘Difficulties of Travel’
It’s at this point that I have to offer my profound thanks to Women’s History Scotland for awarding me a research bursary to travel to Inverness and spend two days at the Highland Archive Centre. I was delighted to have my proposal accepted, particularly as someone working on an interdisciplinary project on the periphery of the historical studies community. I am still at the stage where I find archives endlessly fascinating but rather daunting, so as I travelled north I found comfort in the words of Michelle T. King, who has written that ‘we go to the archives not to find answers, but to articulate a better set of questions…it is literally impossible to ‘not find anything’ in the archives’ (2012, p.22). However, any fears were quickly allayed when I walked into the search room and was immediately greeted by a 5ft cardboard cut-out of Nurse Flora Ferguson and her BSA motorcycle. ‘Ah, yes, there’s my friend Flora over there,’ the Archivist told me, ‘I quite like just having her next to my desk.’
One of the first items I viewed from the Highland Health Board collection was the final report from the HIMS Committee, more commonly known as the Dewar Committee, after its chairman Sir John Dewar MP. The committee was appointed in 1912 and charged with the task of gathering evidence as to the scale and nature of the issues facing highland medical practitioners and their patients. Transport was a recurring theme. As the report states:
The greater part of the area under review is sparsely peopled. A considerable portion of the population is from twenty to thirty miles from the nearest doctor. The country is rugged, roadless and mountainous, and where not composed of islands is very largely peninsular on the seaboard, and inland is broken up by lakes and rivers. The weather conditions, too, and particularly in the winter-time, add enormously to the difficulties of travel (Medical Service in the Highlands and Islands, HHB/90/1/2, p.587, Highland Archive Service).
It’s hardly surprising that nurses struggled either on foot, or with a pushbike – this is something that came up again when I explored other collections held at the archives, looking at applications made to cottage hospitals around this time; when a vacancy for a Nurse Matron came up at John Martin Memorial Hospital at Uig, Skye, several applicants mentioned that they wished to apply for the post as they were beginning to find work in the rural districts too physically taxing.
Reading the committee’s report, and then tracing the subsequent grants through the county or hospital records has furnished me with some specific examples of the early, and lasting, positive impact HIMS had on both professionals and patients. But reading the testimonies also got me thinking about the physical experiences – what was it like traipsing about the back of beyond, at all hours of the night, in any sort of weather? What did their feet feel like by the time they reached their patients, and was there any hope of getting sufficiently warm or dry when tending to the poor of the parish in their damp dwellings? And how then did it compare, to go roaring along the hillside, or the lochside, with the wind in your skirt and the midges flying at your mouth? As a writer I like to get my hands on as much contextual material as possible to imagine myself into these situations – but there is always the final leap of conjecture to be faced when venturing into the inner world; the point where the facts end, and fiction begins.
‘Circumstances of the People’
On day two of my archival research I started to read the minutes of the evidence taken by the Dewar committee in 1912. The committee visited 17 locations throughout the Highlands and spoke to local doctors, ministers, priests, inspectors of the poor, the occasional teacher, chemist or other related professional, and a handful of farmers and crofters.
The evidence given provides a snapshot of life for certain sections of the population, complete with economic hardship, insanitary dwellings and inferior diet. With many in their parishes so poor, it was difficult for highland doctors to make any sort of living, never mind setting something aside for retirement. The following responses given by Dr Alexander Mackechnie of Bunessan, Mull, are typical:
Are you able to get a fee which pays you for your attendance on a patient ten or fifteen miles away? – No.
But you have to go to them all the same? – Yes.
You have never refused to attend a poor person? – Never in my life.(Minutes of Evidence, CRC/13/6/1, p.400 – Highland Archive Service)
Some doctors received no payment at all for up to 75% of their visits. It is hardly surprising then that ‘a good fixed salary’ is something that comes up again and again, with doctors in agreement that a state service would be for the best. Considering the opposition the British Medical Association put up against the proposed NHS, until as late as May 1948, it would appear that necessity had already made radicals of the highland doctors.
Every district must have its doctors, but the one thing singled out in the final report as being most likely to improve the situation in the Highlands, is having an adequate supply of trained nurses. Despite the attention given to the provision of nurses, and the rigorous questions put to each doctor by the committee’s Marchioness of Tullabardine, regarding his preference for the Jubilee or Govan variety – it is annoying, yet not surprising, that the committee doesn’t appear to have spoken to any nurses. In this context it was very fortunate that I had the additional time to look at the records of some nursing associations and collections of correspondence from several cottage hospitals, so I could try and get closer to the nurses themselves.
Regarding the Advertised Position…
An examination of the correspondence regarding nursing vacancies gave a remarkable insight into the lives of these working women. Applicants to cottage hospitals were not just rural district nurses looking to hang up their bicycles – they often had a variety of previous experience ranging from the nursing homes of Belgravia, to the private agencies of South Africa, and by the 1920s almost all had added a war hospital to their list of testimonials. On top of the right qualifications, advertisements for posts, such as that at Uig, advised that Gaelic was desirable. Many highland women were keen to remain in, or return to, their native area. Some had never married, others had been widowed. The evolution of the professional nurse, and the various restrictions placed on her, have much to tell us about the positon of women in society during any given period.
I have always found correspondence and private papers to be hugely helpful in making connections with individuals in the past. And it is not just the words they have chosen to set down; it’s the letterhead, the handwriting, the colour and thickness of the paper, the tell-tale black edging – the smell even – it all helps to get a feel for the particular period, and more importantly, a feel for the person. Witnessing their personal triumphs and tragedies and slanting scrawl or poor punctuation, brings them to life, and serves as a reminder that their stories must be handled with care. Writing historical fiction comes with ethical responsibilities, and navigating these is another part of what King calls the ‘hard work that awaits…long after one has returned home’ (2012, p.22).
I’m looking forward to incorporating some of the material viewed into my fiction writing. I will also be utilising the HIMS sources in an interdisciplinary exhibition planned for May 2021. It will be my great pleasure to be able to remind people of the achievements of this vital service that not only played a crucial part in the lives of highlanders, but in the history of the nation’s healthcare and the ultimate establishment of the NHS.
I would like to thank Women’s History Scotland again for enabling me to visit Inverness. I’m very grateful for the award and the whole trip has been incredibly beneficial. I would also like to thank the staff at the Highland Archive Centre for their kind assistance.
King, Michelle T. (2012), ‘Working with/in the Archives’, in Gunn, Simon and Faire Lucy (eds.) Research Methods for History. Edinburgh: Edinburgh University Press, pp. 15-30.
Mara Dougall (University of Strathclyde) @DougallMara