The Scottish Air Ambulance Service, 1928-1948.
In Australia the future Flying Doctor service began taking medical aid to patients in remote locations in 1928. That year, in Scotland, moves were instigated to fly patients from remote locations to urban medical care. This culminated in the birth of the Scottish Air Ambulance Service in 1933, formalised through financial support from central and local government in 1934. The article traces the role of emerging airlines in air ambulance evacuations between 1933 and 1948, the importance of the service to Highland and island doctors, how in-flight nursing developed during the pre-NHS era, and how the service was funded during this period.
Early air ambulance provision in an international context
Recognition of the benefits of aerial medical transport preceded the aero-plane, originating in the demonstrations of Montgolfier's balloon in 1784, and being put to practical effect by the French physiologist Paul Bert (1833-86) to evacuate wounded soldiers during the Franco-Prussian War in 1870. The concept of using fixed-wing heavier-than-air aircraft is credited to US army medical officers George Gosman and A. L. Rhodes in 1909-10, but it was in France that the first heavier-than-air evacuation is reputed to have occurred, Varon et al. recording that 'in 1917 the French Dorand AR-II was the first air ambulance that actually carried patients'. In 1918 a JN-4 Jenny biplane was adapted by the US army to serve as an air ambulance. However, both the Dorand AR-II and the JN-4 Jenny were used for evacuation of military personnel from World War I battle zones rather than for civilians. (1)
While these early air ambulance developments were stimulated by the need to move wounded soldiers from combat areas to medical treatment centres, civilian aerial medical evacuation was generally prompted by the difficulty of linking specialist medical care with patients living in remote locations. This continues to be the case even in a modern context, Godden et al. noting in the case of Scotland in 2004 that 'health services in small island communities tend to focus on primary care delivery because population numbers may be insufficient for high-order services to be provided'. (2) The notion of 'remoteness' is often dictated either by long distances between small communities and locations of health care provision, or in more compact communities by slow and difficult terrain. The role of the aeroplane, along with innovations such as wireless telegraphy, is highlighted by Stephen Kern as being fundamental to changing concepts of time and space, (3) a theme continued by Scott Palmer in his analysis of aviation in projecting modernity and material progress in the prostranstvo (vast space) of rural Russia. (4)
The historical model often cited is Australia's Flying Doctor service, established by the Australian Inland Mission of the Presbyterian Church of Australia at Cloncurry, Queensland, in May 1928 (5) and expanded in 1933 to give nationwide coverage with the formation of Australian Aerial Medical Services. (6) De Havilland Fox Moths were operated under contract to Qantas Empire Airways and MacRobertson-Miller Aviation, (7) and from 1939 Connellan Airways held contracts to operate from Alice Springs. (8) The concept was based on doctors flying to patients rather than patients being conveyed automatically to urban hospitals, and in 1932-33 200 patients were visited, compared with twenty-six who were airlifted. (9) Formal air ambulance provision in Australia was slower to appear. A limited service was introduced in Victoria in 1959 yet barely acknowledged by Bird in his history of wider ambulance provision in the state, (10) while the Ambulance Service of New South Wales, established in 1895, did not employ air ambulances until 1967. (11)
Canada's wide open spaces are also ideally suited to specialist roles for aviation. Saskatchewan Air Ambulance Service was formed in 1946, Lemoal and Wiley boldly claiming that 'it was the only one of its kind in the world for two decades'. (12) In Europe the rugged terrain of mountain and fjord made Norway ideal for early adoption of air ambulance provision. Wideroe's Flyveselskap, founded in 1934, included air ambulance evacuations among its activities, (13) but Jan Nilsen, Medical Director of the Norwegian Air Ambulance Foundation, notes that the Norwegian air ambulance was not established until 1978. (14) Other parts of Europe were equally erratic in introducing air ambulance services. The airlifting of a skier from Otztal in the Tyrol in 1943 is traced as the first instance in Austria, (15) while Orszagos Mentoszolgalat (OMSz) was created to provide air ambulance services in Hungary with Yakolev Yak-12 aircraft in 1957. (16) New Zealand has similar terrain to Scotland and Norway, and its pre-World War II airlines performed occasional air ambulance flights. Yet the comprehensive histories of these airlines compiled by Richard Waugh do not record them, the first acknowledgement being the transfer of a prematurely born infant from Haast to Hokitika in 1959, and mention of aircraft utilisation for appendicitis cases in the early 1960s. (17) World War II stimulated the creation of the US Medical Air Ambulance Squadron in 1942 (18) and the creation of the Aerial Nurse Corps of America. (19) This process has continued in the course of other conflicts, such as the use of air ambulances noted by Mehra during the conflicts between India and Pakistan. (20) Following World War II it was the development of comprehensive state health care systems in a number of countries that prompted the creation of civilian air ambulance services.
Recognition of air ambulance service development has been given little attention by historians. What has been written is submerged within broader aviation histories aimed at a popular audience. For an academic audience, Robertson mentions air ambulance provision as part of his wider survey of 1930s Scottish air service development, (21) but it is the medical profession that has contributed most to learned journals by way of preamble to air ambulance provision in the modern context. R. A. Collacott, former general practitioner on the Orkney island of Westray, notes that 'the development of an efficient air ambulance service [in the Orkney Islands] has had a major impact on medical care [and] started in 1934'. (22) Mehra, in his survey of contemporary air ambulance services in India, correctly notes that 'it was not until 1933 that the British civilian air ambulance service was started, serving the Scottish isles'. (23) Unfortunately, some articles are ill informed, e.g. Caldow et al, whose international survey culminates with the statement that 'the Scottish air ambulance service began using aircraft to transport patients from remote Scottish islands to the mainland in the 1960s'. (24) The statement writes off three decades of Scottish air ambulance history.
The beginnings of the air ambulance service in Scotland
Scotland is a geographically and demographically diverse country. The bulk of the population live in a 'central belt' that runs eastward from Greenock through its biggest city, Glasgow, to the capital, Edinburgh, and then northeast to the cities of Dundee and Aberdeen. North and north-west of this populous area are the Highlands, the islands of the Hebrides, Orkney and Shetland. The 1931 census not only highlighted irregular population distribution but showed the first decrease in population since censuses began in 1801, especially in island parishes--Argyll island parishes had declined by 14.8 per cent between 1921 and 1931 (Table 1).
[FIGURE 1 OMITTED]
Before the era of air transport, the inhabitants of these counties were particularly aware of their remoteness from medical help in the event of illness or accident. This was highlighted by Ogilvie Grant, County Medical Officer for Inverness, in the 1890s:
it is almost impossible for the poor cottars of the west to pay for medical attendance ... in some parishes there is no resident man; while in others, distances are so great and means of communication, by land and sea, so uncertain, that it is difficult to obtain medical aid. (25)
Geologist Sir Archibald Geikie (1835-1924) recorded an incident encountered on the isle of Canna. A man injured by collapsing masonry endured two sea crossings in an open boat before a doctor was located. Geikie wrote, 'It was some thirty-six hours after the accident before the poor sufferer was at last placed in medical hands. The first thing to be done was, of course, to amputate the mangled leg.' (26) In 1946 an unidentified 'Woman Doctor' in the Hebrides described improvements following the Highlands and Islands (Medical Service) Grant Act of 1913. This introduced an allowance to subsidise general practitioners serving sparsely populated localities where poverty was endemic. Communications remained difficult, tracks often being inaccessible to cars and some patients living on small islands. She recalled that 'On one occasion, when the call was urgent, we took five hours to go [by boat] those twenty-one miles. ... The patient was dead when I arrived.' She noted that 'doctors ... agree [the air ambulance's] dominant place in the growing conveniences that serve the islands and Highlands today'. (27)
The drama surrounding the first flight on 14 May 1933 flight was detailed in the Glasgow Herald newspaper (see Figure 2):
Shortly after 9.30 a.m. a telegram was received at the headquarters of the St Andrew's Ambulance Association asking that a plane be sent for an urgent case. The Scottish Flying Club were communicated with, and they in turn got in touch with Midland and Scottish Air Ferries at Renfrew. A 'plane was immediately dispatched, and arrived at Bridgend 40 minutes after leaving Renfrew. The patient--John McDermid (33), fisherman, Bruichladdich--was got into the machine, which returned to Renfrew, where an ambulance wagon was waiting. He was conveyed to the infirmary, where he underwent an operation for abdominal trouble. (28)
[FIGURE 2 OMITTED]
The Scottish Flying Club was the operator of Renfrew aerodrome, the airport for Glasgow. Midland & Scottish Air Ferries (MSAF) had begun scheduled air services from Renfrew to Campbeltown in April 1933, (29) a service that was to be extended to Islay on 16 May. (30)
The telegram that launched the drama read: 'Please send airplane immediately to Islay. Urgent case. Reply where airplane landing to Coastguard Kilchoman. Stewart.' (31) Press coverage suggests that the timely response to this telegram was the result of fortunate circumstances, but Clegg notes that 'John Sword [proprietor of MSAF] ... decided to place a specially equipped DH Dragon at the disposal of the Glasgow area hospitals to fly in seriously ill patients from inaccessible spots.' (32) Indeed, the airline's brochure, published in the spring of 1933, announced that its fleet now included 'The Flying Hospital. The first of its kind in Scotland, it will be used to convey serious cases from the Highlands and Islands to any Infirmary or Hospital in Glasgow.' (33) Also, the Scottish Daily Express had been informed on 1 May that MSAF were taking delivery of three new aircraft and that 'one of them will be capable of being converted into an ambulance at a moment's notice'. The airline had stated, 'This service will be available for the most outlandish districts, and provision made for the patient receiving attention on the flight.' (34) The aircraft, a de Havilland DH-84 Dragon, had been delivered to Renfrew aerodrome on 13 May 1933, the day preceding the call from Islay.
Dr Stewart (sic), who instigated McDermid's airlift, was Donald Norris Stuart. Having telegraphed a similar appeal to the Scottish Flying Club on 1 August 1930, he was already familiar with the benefits offered by the aeroplane in medical emergencies. This requested the urgent dispatch of medicine by air, which was prepared by Cockburn manufacturing chemists in Glasgow and delivered by Flying Officer Powell of RAF City of Glasgow Squadron. A twenty-four-hour surface journey had been condensed to 150 minutes from the sending of the telegram, considered crucial to the patient's recovery. (35)
Aviators' exploits and the potential benefits to be gained from the aeroplane were topics of daily media coverage in the 1920s and 1930s. The advantages to remote communities were apparent both to airline entrepreneurs and to communities detached from a technologically progressive mainland. The aeroplane symbolised that exciting new world, but there were sceptics who doubted that aircraft could make a valid contribution to island life and to medical care. This was reflected through attitudes within the health care community, but there were those who saw opportunities offered by the aeroplane. For example, on 18 July 1929 an aircraft alighted on the isle of Tiree on the occasion of the annual sports day, highlight of the island's social calendar. The aircraft was the star attraction at the 1929 event, and Tiree's Dr Hunter enthused that 'it would be of value to the medical services of the isles to be able to count on aerial transport for cases requiring urgent and major operative interference'. (36) Indeed, in 1928 a former branch secretary of the British Red Cross Society stated his belief that 'ambulance aeroplanes' were already used for urgent cases of illness in France. (37) He pleaded for a similar system in Scotland and, while unsure 'whether this will develop in the near future or not among our ambulance organisations', was convinced that it would happen. (38) The enthusiasm of the St Andrew's Ambulance Association (SAAA) was revealed a week later with the report that the District Road Surveyor on the isle of Lewis had been asked 'to investigate the possibilities of establishing an aeroplane ambulance service, the object of which would be to speed up the transfer to hospital of urgent hospital cases from districts in Western Scotland where the existing facilities for transport to Glasgow entailed serious and sometimes fatal delay'. (39)
In 1929 general practitioner Dr Campbell McIntyre advocated the benefits that an air ambulance service would bring to the people of Islay. When McIntyre retired in 1954 he recalled:
I took up my task in November 1929. There was much controversy during that year about a proposed hospital in Islay and I held the view that the transportation of acute surgical cases by an [air] ambulance was the correct procedure, a view also held by Dr Guy, the Assistant County Medical Officer. Our views were scorned by the Department of Health and County Medical Officer but we were able to prove to them, with the co-operation of Scottish Airways, that not only was our scheme feasible but ideal. A complete change of attitude then took place and Department and County co-operated in the scheme which you now know so well as the Air Ambulance Service, and which the younger generation take for granted. (40)
The annual report of the SAAA for 1932/33 confirmed that 'the use of air transport for the conveyance to hospital of urgent cases has been under consideration of the council for some years'. The Association had concluded that 'it would be difficult, if not impossible, for an Ambulance Association alone to undertake the cost and administration involved in an Air Ambulance Service' (41) and it lauded MSAF's willingness to provide aircraft to the extent that, within days, it had designed 'a special Ambulance Stretcher for use in aeroplanes' the first of which would be offered to the airline. (42) John Sword (1892-1960) announced the closure of MSAF from 29 September 1934 because of sustained losses and conflicting business interests, but his commitment was such that he retained an aircraft for ambulance flights until a new operator could take up the service. (43)
Support from government did not initially embrace the enthusiasm displayed by the SAAA, airlines, doctors and islanders. On 11 July 1933 A. N. Skelton, Conservative Under-Secretary of State for Scotland responsible for health, was pressed by Labour MP David Kirkwood to support the use of aircraft for urgent medical cases. During an era of 'National Government' Kirkwood was known as a fiery socialist, and this was just one of many issues that he raised. Skelton's answer showed his ignorance of landing sites and about the reliability of such a service, but he agreed to examine the options further. This, and a later exchange in December, highlighted competing agendas of developing air ambulance and local hospital provision based on varied perceptions of cost and efficiency. Skelton agreed to approve assistance from the Highlands and Islands (Medical Service) Fund and initiated discussions with Argyll County Council. One of many parliamentary jousts, Kirkwood does not give this 'victory' significance in his autobiography. (44)
Early ambulance flights
In the meantime, further air ambulance flights took place and were enthusiastically reported by the press. The second flight occurred on 22 May 1933. Dr Alex Macleod (1894-1979), medical practitioner on North Uist from 1932, was travelling home from a medical course in Cambridge. Passing through Glasgow, he visited one of his patients, Malcolm Gillies, minister for Clachan, in the Western Infirmary. John Macleod, Alex Macleod's son and successor to his medical practice, recorded:
[My father] found that the man was so ill that the hospital staff felt that he would not survive a homeward journey by train and boat and so they were preparing to continue his terminal care in Glasgow. Rev Gillies was weak, but was able to speak, and he was desperate to return home to die in his own manse, among his own parishioners and with his wife caring for him. My father had seen the press accounts of the evacuation from Islay of John McDermid on 14th May 1933 so he set about trying to find an aircraft and a sponsor to bring the Rev Gillies home. (45)
The Daily Record recognised the opportunity for a scoop and chartered an aircraft from MSAF, flown by Jimmy Orrell (1903-88), the pilot who had operated the flight from Islay. (46) This first landing of an aircraft on North Uist created another facet of air ambulance work, that of conveying ailing patients home following medical treatment in mainland hospitals.
The press reported other flights in 1933 and two required little journalistic embellishment. The first occurred on 19 July when Jimmy Orrell flew to the northern tip of the isle of Skye, where Dr Alan Fothergill of Edinburgh had been taken ill while on honeymoon. Confounding Skelton's disparaging comments about the limitations of the aeroplane, one report acknowledged that 'Uig district is definitely unfavourable for landings' yet was able to record that 'the pilot picked a likely spot on a hillside and set his machine down safely'. (47) The second drama followed an explosion on the submarine L26 in Campbeltown harbour on 8 October 1933. The explosion reputedly resulted from sea water penetrating the vessel's batteries, while stoker John Fairclough believed the fatalities and injuries occurred because the men 'had been blown straight up against the ceiling of the messroom'. (48) Fairclough was one of two submariners uplifted by an ambulance aircraft. Archibald Young, Professor of Surgery at the University of Glasgow, had an all-night road journey to attend the injured. In contrast, Fairclough, and his colleague, Henry Taylor, were flown to Glasgow for hospital treatment in forty minutes. (49) Such flights made good copy for journalists conscious that the public were thirsty for stories recounting the feats of intrepid aviators. The extent of this is demonstrated by the page of the Glasgow Herald carrying reports of the explosion, there being six other accounts of flying 'feats'--from Wales, Italy, Burma, Karachi, Calcutta and Toronto. (50)
In the years that followed, ambulance flights continued to fill newspaper columns with accounts of heroic pilots battling the elements with frail aircraft, but these descriptions were also a reflection of the rugged terrain occupied by island communities, the technical limitations of the aircraft and navigation facilities available, and the determination of pilots to reach patients in time of emergency. De Havilland DH-84 Dragons were used on early flights, but they were joined by DH-89 Rapides with landing flaps fitted to accommodate short airfields, while Northern & Scottish Airways (NSA) also added Spartan Cruisers to its fleet. NSA, established at Renfrew by George Nicholson (1905-50), took the place of MSAF in 1935. Following discussion with NSA on 28 November 1934, SAAA announced that 'an airplane, convertible to an ambulance in five minutes, will always be available at Renfrew'. In the north of Scotland, Edmund Fresson (1891-1963) set up Highland Airways at Inverness, beginning operations on 8 May 1933. (51) Fresson's airline was also active in ambulance flying, from at least 1934, as part of its Orkney Islands operations, notably from the North Isles to the Orkney mainland, (52) and Fresson stated that, along with passengers, mail and newspapers, this represented important income. Highland Airways joined with NSA to form Scottish Airways in 1935, but they operated as two autonomous divisions. Aberdeen Airways, renamed Allied Airways (Gandar Dower) Ltd in 1937, was set up at Aberdeen in 1934 by Eric Gandar Dower (1894-1987), and on 2 February 1936 the airline's chief pilot, Eric Starling (1911-97), undertook the company's first ambulance charter, from the island of South Ronaldsay to Stromness. (53) These airlines had sole use of their airfields unless they accepted Air Ministry radio stations, so retention of monopolies had to be balanced against improved safety. Although the SAAA had encouraged the Isle of Lewis to provide a landing site for an ambulance aircraft as early as 1928, Stornoway did not get a regular airfield until 1939. Prior to this, Fresson paid many visits to Stornoway, landing either on Melbost Sands, or on the golf course. He made an ambulance flight to Lewis in March 1937, recalling that 'the chairs had been taken out of the cabin and a mattress placed on the floor and made into a comfortable bed'. (54)
[FIGURE 3 OMITTED]
[FIGURE 4 OMITTED]
Certain flights particularly caught the public imagination, such as John Hankins's evacuation of seventeen-year-old Betty McKenzie from Hearnish in the Monach Isles after her boat transfer from Shillay on 26 April 1937, (55) Henry Vallance's landing at Esha Ness in north-west Shetland four days later (56) and Hankins's night landing on Sanday, assisted by car headlights, in March 1939. (57) They highlighted the difficulties that surrounded flying medical aid to rural communities. Publicity also established in the public eye the 'normality' of using aircraft for medical cases, one singular account on 7 July 1936 reporting three cases carried by NSA in one day, two from North Uist and one from Campbeltown. (58) Airline operators had an eye to publicity, Fresson timing his first landing on Fair Isle with delivery of George VI coronation newspapers for its news value. (59) Finlay Macdonald, witnessing the first landing of an aircraft on Harris in 1936, foresaw when his island too might have this 'life-line in time of medical emergency'. (60) The availability of air evacuation was growing rapidly and, although 'A Woman Doctor' recalled in 1946 that the service suffered some contraction during World War II, Scottish Airways recorded that it and its predecessor, NSA, had made 540 ambulance flights between January 1935 and 31 July 1943. (61) (Smith's assertion that, by 1948, 275 patients had been conveyed on 245 flights since 1933 (62) is probably an underestimate.) Aided by press coverage, in the ten years since McDermid's flight from Islay, the Scottish air ambulance had become well known in Scotland.
The development of in-flight medical attendance
Nursing attendance of air patients on the Scottish Air Ambulance Service has been attributed as a feature from its very beginning. John McDermid was accompanied by Mrs A. W. Ferguson, a nurse holidaying on Islay. (63) Jimmy Orrell recalled that he always took a staff member in case there was nobody to accompany the patient, but that usually there was a relative or nurse, occasionally a doctor. (64) The MSAF brochure declared that 'Provision can be made for the patient receiving attention during the flight, an important thoughtful point.' (65) When Rev. Gillies was repatriated to North Uist it suited both parties that Dr Alex Macleod joined him on the aircraft. (66) In another instance Alex Campbell, general practitioner for Kildalton and Oa on Islay, prompted a night landing for a patient with a perforated stomach 'who had little chance of survival if he had to wait overnight'. Campbell recalled that:
As the patient was only going to be accompanied by a somewhat nervous relative I decided on the spur of the moment to accompany him myself so, after sending a message to my wife, I did just that. ... An ambulance was awaiting our arrival at Renfrew and we were soon in the Western Infirmary, Glasgow. I attended the patient's operation which went into the small hours of the following day. (67)
When the two submariners, Fairclough and Taylor, were flown from Campbeltown to Glasgow on 10 October 1933 they were tended by Nurse Isobel Watson, a member of the Voluntary Aid Detachment. (68) Donald Steele was flown from Glasgow to South Uist on 13 September 1933, accompanied by an ambulance attendant from SAAA, (69) and in 1935 the Association indicated that 'trained attendants are ... held in readiness to accompany the aeroplanes when required'. (70)
Island district nurses sometimes accompanied patients. For example, Alexander Kennedy was flown from Tiree to Glasgow on 9 May 1935, (71) but there was no regular air service to facilitate the nurse's speedy return. Because of such situations, in 1938 an arrangement was made whereby a mainland nurse would accompany the outbound aircraft. Two nurses, Jane (Jean) Govan (1895-1982) and Maggie (Peggy) Boyd (1905-99) (72) of privately run Paisley Trained Nurses Association, were contracted to undertake this. In 1993 Peggy Boyd recalled how this came about:
It was initiated by Dr Shearer of Edinburgh and the Medical Officer of Health for Argyllshire at that time. (73) [The MOH] came to Paisley, to the Royal Alexandra Hospital, and asked Matron if she would allow her nurses to attend the air ambulance and help with the crew. But she refused to risk her nurses ... When the two gentlemen arrived [at the Association's nursing home], they explained to us that, up until now, the aeroplane went to the island and came with the patient and the district nurse, and by the time the district nurse got back to the island, it took three days. So they decided to make [nursing provision] direct from the mainland. (74)
Peggy Boyd undertook her first flight on 4 March 1938. She and Jean Govan provided in-flight nursing until November 1941, when, due to wartime demands, they withdrew because of a shortage of trained nurses for their nursing home. (75) The Department of Health for Scotland then transferred the arrangement to the Southern General Hospital, Glasgow, which, from February 1942, supplied volunteer nurses from its staff for air ambulance duties. (76) This arrangement continued until 1993, when paramedics of the Scottish Ambulance Service replaced them.
During Peggy Boyd's time as air ambulance nurse, simultaneous telephone calls were made to her nurses' association and to a local taxi company to activate a call-out. Being only one mile from Renfrew Airport, she was generally available to board the aircraft ten minutes following receipt of the call. Her equipment consisted of a first-aid box with the most basic of equipment. Therefore, during a delay in departure from Campbeltown with a patient experiencing a high level of pain, she had to call a doctor to administer morphine. She described landings in rough fields, and on beaches where the aircraft would sink into the sand while awaiting the arrival of the patient. Her faith in David Barclay (1905-81), the pilot who undertook most ambulance flights during this period, was complete. Peggy Boyd and Jean Govan were oblivious to instances of danger, such as perilous loss of height when ice caused an engine to stall and which Barclay revealed to the nurses only some time after the event. (77)
By the 1990s the role of the volunteer air ambulance nurse from Glasgow's Southern General Hospital, Kirkwall's Balfour Hospital and Lerwick's Gilbert Bain Hospital was an entrenched part of the folklore of the Scottish Air Ambulance Service. Their work was directly linked to the presence of Nurse Ferguson on the first flight on 13 May 1933. However, during the first ten years of the service, patient care during air ambulance journeys was diverse, undertaken by road ambulance attendants, island-based district nurses, medical practitioners, patients' relatives or airline personnel.
Financing the service
Until 1948, hire of an ambulance aircraft was a private arrangement between patient and airline. It cost 12 [pounds sterling] 10s for an ambulance flight from Renfrew to Campbeltown, and 15 [pounds sterling] to Islay. In 1933 a flight to South Uist cost 30 [pounds sterling], while Dr Alan Fothergill's flight from Uig on Skye to Edinburgh cost 35 [pounds sterling]. (78) Between 1933 and 1947 charter costs appear to have remained around the same level, at 12 [pounds sterling] 10s an hour, according to A. L. Lloyd, who observed that 'even for folk who can make 3 [pounds sterling] a night in good times at lobster-fishing, that's a lot of money'. (79) Indeed, in 1935 the average weekly wage for a semi-skilled manual worker in Britain was 2 [pounds sterling] 11s 6d, (80) with crofters in subsistence economies having to get by on considerably less. Dr Alex Campbell of Islay recalled that 'the request for an air ambulance had not to be made lightly ... and the patient was nominally responsible for the cost'. (81) Mrs Helen McCaig Sutton, an expectant mother, was flown from Campbeltown to Glasgow when she had an 'accidental haemorrhage' resulting in the spontaneous delivery of her baby. Her child did not survive and Mrs Sutton recalled that 'the Doctors in the hospital ... got my husband [on military service] a forty-eight-hour pass and the ambulance plane to fly me home'. The Suttons paid Argyll County Council 6 [pounds sterling] towards the cost of the air ambulance. (82)
Dr Alex Macleod solicited the sponsorship of the Daily Record for Rev. Gillies on 22 May 1933. (83) The Royal Navy would have paid the costs for the two injured submariners from the L26. Nurse Peggy Boyd accompanied a brucellosis patient whose flight was paid for by J. & P Coats, cotton thread manufacturers in Paisley. (84) But such underwriting was not available to most air ambulance patients. Some financial support was offered by county councils from 1934. Government intervention at national rather than parish level in the west and north of Scotland can be traced to the creation of the Highlands and Islands Medical Scheme, which resulted from the deliberations of the Dewar committee, in 1912. It recommended subsidies for doctors, improvements in hospitals and enhancement of nursing and consultancy provision. (85) Stephanie Blackden notes that the report was 'accepted by Parliament with almost no opposition and legislation setting up the Highlands and Islands Medical Grant Scheme followed eight months later'. (86) David Hamilton argues that the scheme got off to a slow start, but in 1919 it came under the new Scottish Board of Health and was highlighted for its success when the Cathcart report of 1936 laid out plans for a national health service for Scotland. (87) A 1943 government propaganda film depicted the air ambulance service as resulting from a progression of benefits accruing since the Highlands and Islands Medical Scheme's introduction. The scheme, it proclaimed, had brought about 'a way for people [in the Highlands and Islands] to get medical attention as easily and cheaply as those in the south.' (88) Helen Dingwall acknowledges that the scheme 'is generally seen as an important influence on the subsequent gestation of the NHS'. (89)
In 1933 the Under-Secretary of State for Scotland was reluctant to acknowledge the feasibility of using aircraft for medical cases, but agreed to hold discussions with interested parties. By late 1933 Skelton had relented and announced that 'arrangements are being made to give assistance from the Highlands and Islands (Medical Service) Fund in cases of need and emergency towards the cost of hire of aeroplanes to remove persons from the Highlands and Islands to central hospitals'. (90) In March 1934 the Department of Health, responsible for the Highlands and Islands Medical Scheme from 1929, (91) concluded an arrangement with Argyll County Council whereby its Medical Officer could nominate cases for transport by air ambulance. Skelton announced that 'the charges for the hire of the aircraft, so far as not met by the patients, are shared by the County Council and the Department of Health'. (92) In July 1934, following the evacuation of a woman from North Uist to Inverness, Inverness County Council applied to the Department of Health for a similar arrangement to Argyll. (93) In October 1934 an agreement involving Orkney County Council was announced whereby the council paid the airline the charter cost then recovered it from the patient. In hardship cases a proportion of the cost was borne by the council and the department in a ratio of 1 : 2. (94)
Despite this support, some communities, still conscious of duress experienced in a time of illness, raised funds for use in emergencies, as had happened in the past to fund other medical provision such as Highland nursing associations. (95) The Islay parish of Kildalton and Oa operated one such fund. It origins were described by Dr Campbell:
[The cost of an air ambulance] was alleviated to some extent by the action of Mr Harry Clifton, the proprietor of Kildalton Estate at that time, who one day 'out of the blue' handed me a cheque for 50 [pounds sterling] to be used for any philanthropic purpose which I might think fit. We set up a fund called 'The Doctor's Fund' with that gift as a beginning. The fund was thereafter augmented by the proceeds from concerts, dances, whist drives, etc., and the occasional donation. There was never a great deal of money in the fund but usually sufficient to give much needed help to patients travelling by air ambulance, or indeed by the ordinary route because any non-urgent cases continued to go by [steamer]. (96)
The retail Campbeltown Co-operative Society launched an 'ambulance scheme' on 14 January 1937. During the first two years 220 people, including attendants, travelled to city hospitals. Most travelled by surface transport, but a small number travelled by air ambulance and forty-nine flew on the scheduled air service. The Society noted that 800 of its 1,060 ordinary members were subscribers to the 'ambulance scheme,' which, including dependants, was available to approximately 2,400 people. Travel costs worked out at just over 1 [pounds sterling] 5s per person and the Society claimed that its innovation brought 'favourable comment throughout the country' and enquiries from abroad. (97) In 1939 the evacuation of a child attended by Peggy Boyd was reported as a 'striking demonstration' of 'the value of the Air Ambulance service administered by Scottish Airways Ltd, in association with the Campbeltown and District Co-operative Society'. (98)
In 1946 state-owned British European Airways (BEA) was created. BEA took over airline operations in Scotland in 1947 but continued to operate 'ambulance charters'. Senior personnel of the private airlines were marginalised by the new corporation and Edmund Fresson and David Barclay were sacked. Sir Basil Neven-Spence, MP, attacked these events, stating that 'Captain Barclay ... has built up the highly valued ambulance service in the West of Scotland, and has been responsible for saving probably 800 lives during the years this service has been running.' (99) (The figure of 800 is somewhat optimistic--see Figure 5.) Barclay was subsequently reinstated by BEA and, with the creation of the National Health Service in 1948, air ambulance provision was thereafter paid in full by the Department of Health.
[FIGURE 5 OMITTED]
Early air ambulance flights in Scotland were frequently reported in the press as highly dramatic events. The aircraft used were unsophisticated, navigational aids were minimal at best, and landing sites were often unprepared fields or beaches. Pilots were often represented as adopting a 'heroic' approach to their work in times of emergency, yet there were no serious accidents resulting from air ambulance operations up to 1948. Press coverage fed public interest in aerial quests and accomplishments in the 1930s, while news focusing on air ambulance flights helped create awareness of the vulnerability experienced by Highland and Island communities.
The first ambulance flight took place on 14 May 1933. It was not, as mythologised, an event where luck and coincidence combined to bring aircraft and patient together on an Islay beach. John Sword had taken specific steps to offer such a service, and this had been preceded by lobbying over the previous five years by far-sighted men in the medical profession and in the SAAA. The volunteer nurses who accompanied patients for half a century, beginning in 1942, made them intrinsically associated with the history of the Scottish Air Ambulance Service, and it has been easy for commentators to see a direct link between them and Mrs A. W. Ferguson, the nurse who accompanied John McDermid on the first flight. However, from 1933 to 1942, patients were also accompanied by island district nurses and doctors, St Andrew's ambulance attendants, Paisley nurses Govan and Boyd, airline personnel and patients' relatives.
When the first ambulance flights operated, the cost of hiring aircraft represented a commitment by the patient directly to the airline. Following initial scepticism within government circles, financial aid was made available through the Department of Health for Scotland. Although patients were still expected to make some contribution, state support for this type of service marked innovatory expansion of health provision in the Highlands and Islands during a period when laissez-faire still held sway and helped establish the air ambulance as a special institution in popular perception. Personal obligation to pay for a portion of the cost of an ambulance flight was removed with the introduction of the National Health Service in 1948.
Following rapid advances in air ambulance provision during the 1930s, operations were necessarily scaled down during the Second World War. However, a system which brought together island medical practitioners, city hospitals, volunteer nurses, airlines, road ambulances and an administrative bureaucracy were well established upon the creation of a state airline corporation in 1946 and a National Health Service in 1948, and which saw the Scottish Air Ambulance Service expand considerably during the years that followed. Provision of air ambulance flights was an integral part of the development of the independent airlines in Scotland between 1933 and their absorption into British European Airways in 1947.
The early Scottish Air Ambulance Service was pursued by a new generation of young men who saw the aeroplane as symbolising a modernity that could be harnessed to enhance medical provision for small communities made remote from specialist medical technology by the nature of the geographical terrain of Scotland. The role of the media aided the efforts of young medical and aviation innovators in overcoming the conservative resistance encountered in the medical and political establishment. It provided a template that continues today, using fixed-wing aircraft and helicopters. In an international context, the concept can be seen in the work of relief organisations such as Mission Aviation Fellowship, dating from 1945, (100) African Medical and Research Foundation, set up in 1956, (101) and Aviation sans Frontieres from 1968. (102) In Scotland, the spirit and expertise embodied in the Scottish Air Ambulance Service between 1933 and 1948 were utilised in re-establishing the service, disrupted by World War II, (103) in the Orkney Islands in 1967, and in expanding it to new areas, such as the islands of Fetlar, Foula, Out Skerries, Papa Stour and Unst in Shetland from 1970. (104)
The author would like to thank, for access to material, Linda Blair of the St Andrew's Ambulance Association, the late Peggy Boyd, the late Dr Alex Campbell, Peter V. Clegg, Captain Ken Foster, Richard Fresson, Sheila Harper, Tony Naylor, the late Captain Eric Starling, the late Helen Sutton and the late Captain Henry Vallance; and, for their comments and suggestions, the anonymous referees.
Address for correspondence
School of History and Politics, University of Stirling, Stirling FK9 4LA, Scotland. E-mail iain@ keapub.fsnet.co.uk
University of Stirling
(1) Joseph Varon, Olivier C. Wenker and Robert E. Fromm, Jr, 'Aeromedical transport: facts and fiction', Internet Journal of Emergency and Intensive Care Medicine 1, 1 (1997), www.ispub.com/ostia/index/php?xmlFilePath=journals/ijeicm/vol1n1/aeromed.xml (accessed 23 September 2006). Joseph Varon, Robert E. Fromm, Jr, and Paul Marik, 'Hearts in the air: the role of aeromedical transport', Chest: the Cardiopulmonary and Critical Care Journal 124 (2003), 1636-7. A. Mehra, 'Air ambulance services in India', Journal of Postgraduate Medicine 46, 4 (2000), 314-17. Marie L. Berry, Improving Interface between Aeromedical Evacuation and En Route Systems (Maxwell Air Force Base AL, 2002), p. 4. Bruce Green, 'Challenges of aeromedical evacuation in the post-Cold War era', Aerospace Power Journal (winter 2001); Green notes that the Dorand II carried its first patients in Flanders in April 1918.
(2) D. J. Godden, A. Ludbrook, L. McIntyre, J. G. Perez and R. Harvey, 'Consultant supported intermediate care: a model for remote and island hospitals', Rural and Remote Health 276 (2004), 2.
(3) David Harvey, The Condition of Postmodernity: an Enquiry into the Origins of Cultural Change (Malden, 1989), 265.
(4) Scott W Palmer, Dictatorship of the Air (Cambridge, 2006), 1, 99, 154, 157-8.
(5) For an overview see Stephen A. Langford, 'The Royal Flying Doctor Service of Australia: its foundation and early development', Medical Journal of Australia 161 (4 July 1994), 91-4. Also a response concerning the initial racial bias of the service from David P. Thomas, Medical Journal of Australia 161 (21 November 1994), 637.
(6) Marc A. Shampo and Robert A. Kyle, 'The Flying Doctor Service of Australia founded by John Flynn', Mayo Clinical Proceedings 80 (1), 14 (January 2005), 14.
(7) 'Let's get this right', The Aeroplane, 17 February 1937, 184.
(8) Stanley Brogden, 'He serves the outback', Aircraft, June 1947.
(9) Steven A. Langford, 'The Royal Flying Doctor Service', 93.
(10) Paul H. Bird (ed.), A History of Ambulance Services in County Victoria (Bendigo, 1999), pp. 70, 98-9.
(11) www.ambulance.nsw.gov.gov.au/about/history.html (accessed 25 September 2006).
(12) Larry Lemoal and Keith Wiley, 'Air ambulance history', 100 years of nursing on the prairies, www.100yearsofnursing.ca/english/content/SK_19.html (accessed 25 September 2006).
(13) Widerae's Flyveselskap, Som det stiger frem ... (1974), p. 13; Olav Gynnild, 'The beginnings, 1905-1940', in Norsk Luftfartsmuseum, 100 Years of Norwegian Aviation (Bod0, 2005), pp. 26-7.
(14) Jan Erik Nilsen, 'Does bystander trauma care save lives or just make things worse?' Trauma Care Journal (fall 2002), 35.
(15) www.taa.at/wTAA/unternehmen/history/history1.php?navid=10 (accessed 29 September 2006).
(16) Gunter G. Endres, 'Civil aviation in Hungary today', Air Pictorial (March 1977), 104.
(17) Paul Beauchamp Legg, 'Colourful final era', in Richard J. Waugh, When the Coast is Clear (Invercargill, 1994), pp. 66-8. See also Waugh, Early Risers (Invercargill, 1997) for inter-war air development around Hawkes Bay and Strait Across (Invercargill, 1995) for the Cook Strait area of New Zealand.
(18) Berry, Improving Interface, p. 5.
(19) R. E. Skinner, 'The roots of flight nursing: Lauretta M. Schimmoler and the Aerial Nurse Corps of America', Aviation, Space and Environmental Medicine 55, 1 (January 1984), 72-7; J. Barger, 'Rivalry for the sky: a prelude to the development of the flight nurse program in the US Army Air Force', Aviation, Space and Environmental Medicine 56, 1 (January 1985), 73-8.
(20) Mehra, 'Air ambulance services in India', 314-17.
(21) A. J. Robertson, 'The new road to the isles: Highland Airways and Scottish Airways, 1933-1939', Journal of Transport History 7, 2 (September 1986), 48-59.
(22) R. A. Collacote, 'The air-ambulance: Orkney's experience', Journal of the Royal College of General Practitioners (March 1984), 163.
(23) Mehra, 'Air ambulance services in India', 314-17.
(24) S. J. Caldow, T. R. J. Parke, C. A. Graham and P. T. Munro, 'Aeromedical retrieval to a university hospital emergency department in Scotland', Emergency Medical Journal 22 (2005), 53-5.
(25) First Annual Report of the Local Government Board for Scotland, 1894-1895 (Edinburgh, 1896), p. 117.
(26) Sir Archibald Geikie, Scottish Reminiscences (Glasgow, 1904), p. 163.
(27) A Woman Doctor, 'Highland doctor', in W M. Ballantyne (ed.), Scotland's Record (Edinburgh, 1946), pp. 101-5.
(28) 'Aeroplane dash from Islay', Glasgow Herald, 15 May 1933.
(29) 'Inauguration of air service', Argyllshire Leader, 29 April 1933.
(30) 'To Islay and back in an hour', Argyllshire Leader, 20 May 1933.
(31) Peter V Clegg, Sword in the Sky (Godalming, 1990), p. 30.
(32) Ibid., p. 30.
(33) MSAF publicity brochure (1933), p. 12.
(34) 'Scots islands to have Flying Hospitals aid', Scottish Daily Express, 2 May 1933.
(35) 'An errand of mercy', Glasgow Herald, 2 August 1930.
(36) 'Historic event for islanders', Glasgow Herald, 19 July 1929.
(37) The reference to France may relate to military evacuations from World War I battle zones.
(38) 'Ambulance 'planes', Evening News, 29 March 1928.
(39) 'Aeroplane Ambulance Service', Stornoway Gazette, 25 May 1928.
(40) Quoted in a letter from Elizabeth C. McAuslan, daughter of Dr McIntyre, to Captain K. E. Foster, Operations Director of Loganair, 17 January 1983, courtesy of K. E. Foster. Also reported in the Campbeltown Courier, June 1954.
(41) SAAA, Fiftieth Annual Report, 1 June 1932 to 31 May 1933, pp. 14-15.
(42) SAAA Finance Committee Minute Book No. 5, 25 May 1933, pp. 63-4.
(43) Clegg, Sword in the Sky, pp. 89-91.
(44) Parliamentary Debates, Fifth series, Vol. 280, col. 909-11 (London, 1933), and Vol. 284, col. 358-9 (London, 1934); David Kirkwood, My Life of Revolt (London, 1935). Detractors who felt that Kirkwood later deserted his socialist roots called his autobiography 'My Revolting Life'.
(45) John A. J. Macleod, 'The Doctors Macleod, Lochmaddy', in Iain Hutchison (ed.), Air Ambulance (Erskine, 1996) p. 86.
(46) 'Renfrew to Uist in ninety minutes', Daily Record, 23 May 1933.
(47) 'Rushed to hospital in aeroplane', Daily Record, 20 July 1933.
(48) 'Beaten back by fumes', Glasgow Herald, 10 October 1933.
(49) 'L26 injured in Glasgow', Glasgow Herald, 11 October 1933.
(50) Glasgow Herald, 9 October 1933, p. 11.
(51) Peter V Clegg, A Flying Start to the Day (Godalming, 1986), p. 15.
(52) E. E. Fresson, Air Road to the Isles, second edition (Erskine, 2008), pp. 128, 149. Robertson, 'The new road to the Isles', p. 55.
(53) Iain Hutchison, The Flight of the Starling (Erskine, 1992), p. 46.
(54) Fresson, Air Road to the Isles, p. 208.
(55) 'Air ambulance's lighthouse case', Daily Record, 27 April 1937.
(56) Information from the late Henry Vallance, 21 June 1993. 'Esha Ness lighthouse: mercy mission', Northern Lighthouse Journal (summer 1990), 37.
(57) Fresson, Air Road to the Isles, pp. 156, 259-61. John McIlroy, 'The extrovert pilot whose charm touched Orkney', Orkney Today, 19 December 2003.
(58) 'Air ambulance busy', Daily Record, 7 July 1936
(59) Fresson, Air Road to the Isles, pp. 216-19.
(60) Finlay J. Macdonald, The Corncrake and the Lysander, Part Three of The Finlay J. Macdonald Omnibus (London, 1994), p. 15.
(61) 'Memorandum on Air Ambulance Service' from the Chief Commercial Manager's Office of Scottish Airways, 6 October 1943.
(62) J. Smith, 'The Scottish Air Ambulance Service', The Practitioner, 170 (1953), 67, quoted in Morrice McCrae, The National Health Service in Scotland: Origins and Ideals, 19001950 (East Linton, 2003), pp. 19-20.
(63) 'Death defeated by Scots 'plane dash', Scottish Daily Express, 15 May 1933.
(64) Undated letter from Jimmy Orrell in the collection of Peter V. Clegg.
(65) MSAF publicity brochure (1933), p. 12.
(66) 'Renfrew to North Uist in ninety minutes', Daily Record, 23 May 1933.
(67) Correspondence from the late Dr Alex Campbell, 4 February 1994.
(68) 'L26 injured in Glasgow', Glasgow Herald, 11 October 1933.
(69) 'Ambulance of air', Bulletin, 14 September 1933. 'Air ambulance to the Isles', Glasgow Herald, 14 September 1933.
(70) SAAA, Fifty-first Annual Report, 1 June 1933 to 31 May 1934, 14-15. SAAA, Fiftysecond Annual Report, 1 June 1934 to 31 May 1935, pp. 14-15.
(71) Gordon Bishop, 'Air liner dashes to Tiree for patient', Scottish Daily Express, 10 May 1935.
(72) 'Boyd, Maggie Paton Davidson (Peggy)', in Elizabeth Ewan, Sue Innes, Sian Reynolds and Rose Pipes (eds), The Biographical Dictionary of Scottish Women (Edinburgh, 2006), p. 42.
(73) Morrice McCrae, The National Health Service in Scotland, pp. 15-16.
(74) Oral testimony from Peggy Boyd, 21 November 1993.
(75) 'Peggy was the first flying nurse', Ayr Advertiser, 19 May 1983.
(76) 'Memorandum on Air Ambulance Service' from the Chief Commercial Manager's Office of Scottish Airways, 6 October 1943.
(77) Oral testimony from Peggy Boyd, 21 November 1993.
(78) MSAF invoices dated 6 November, 24 July, 23 September and 22 July 1933, courtesy of Tony Naylor.
(79) A. L. Lloyd, 'Air ambulance to the Isles', Picture Post, 14 June 1947.
(80) Paul Johnson, Twentieth Century Britain (Harlow, 1994), p. 6.
(81) Correspondence from the late Dr Alex Campbell, 4 February 1994.
(82) Correspondence from the late Mrs Helen McCaig Sutton, January 1994. Receipt for 'portion of cost of air ambulance' issued by Argyll County Council, Campbeltown, to Mr E. A. Sutton, 3 May 1943, courtesy of Helen McCaig Sutton.
(83) Macleod, 'The Doctors Macleod, Lochmaddy', p. 86.
(84) Oral testimony from Peggy Boyd, 21 November 1993.
(85) Robert Mathieson, The Survival of the Unfittest: the Highland Clearances and the End of Isolation (Edinburgh, 2000), p. 231.
(86) Stephanie Blackden, 'From Physicians' Enquiry to Dewar Report: a survey of medical services in the West Highlands and Islands of Scotland, 1852-1912' II, Proceedings of the Royal College of Physicians of Edinburgh 28 (1998), 215-16.
(87) David Hamilton, 'The Highlands and Islands medical services', in Gordon McLachlan (ed.), Improving the Common Weal: Aspects of the Scottish Health Services, 1900-1984 (Edinburgh, 1987), pp. 487-8.
(88) Ministry of Information for the Department of Health for Scotland, Highland Doctor: a Film of the Highlands and Island Medical Service (1943), Scottish Film and Television Archive, ref. 0033.
(89) Helen M. Dingwall, A History of Scottish Medicine (Edinburgh, 2003), p. 214.
(90) 'Air service in Western Isles', Glasgow Herald, 14 December 1933.
(91) McCrae, The National Health Service in Scotland, pp. 16, 19.
(92) 'Air Ambulance Service in Argyllshire', Glasgow Herald, 7 March 1934.
(93) 'Air ambulance for Isles', Daily Record, 10 July 1934.
(94) 'Orkney air ambulance scheme', Glasgow Herald, 5 October 1934. See also Fresson, Air Road to the Isles, pp. 149, 1155.
(95) Pat Gibb, 'District nursing in the Highlands and Islands of Scotland, 1890-1940', History of Nursing Journal 4, 6 (1992-93), 322-3.
(96) Correspondence from the late Dr Alex Campbell, 4 February 1994.
(97) 'Interesting balance sheet', Campbeltown Courier, 25 March 1939.
(98) Campbeltown Courier, 1 April 1939.
(99) Parliamentary Debates, House of Commons, Fifth Series, Vol. 447, pp. 2200-1.
(100) www.maf.org.history (accessed 31 December 2006). For a flavour of early missionary flying see Russell T. Hilt, Jungle Pilot: the Gripping Story of the Life and Witness of Nate Saint, Martyred Missionary to Ecuador (Grand Rapids MI, 1997), first published 1959.
(101) www.amref.org/index.asp?PageID=101 (accessed 31 December 2006).
(102) www.asf-fr.org/index.php?rq_pag=_pages%2Ffr%2Frub2%2Fnotre_histoire.html (accessed 31 December 2006). See also Medecins sans frontieres, www.doctorswithoutborders.org/volunteer/field/themsfexperience.cfm/ (accessed 31 December 2006). Bernard Chauvreau, Pilotes sans frontieres : trente ans de vols humanitaires (Paris, 1999), gives an historical account of Aviation sans frontieres.
(103) Iain Hutchison, The Story of Loganair, Scotland's Airline: the first Twenty-five Years (Stornoway, 1987), pp. 18, 34-5.
(104) See Alan Whitfield, Island Pilot (Erskine, 2007).
Table 1 Population of Scotland and the main 'air ambulance' counties County 1921 1931 1951 Scotland 4,882,497 4,842,980 5,095,969 Argyll 76,862 63,050 63,270 Inverness-shire 82,455 82,108 84,924 Orkney 24,111 22,077 21,258 Shetland 25,520 21,421 19,343 Source Preliminary Report on the Fourteenth Census of Scotland (Edinburgh, 1931) and Preliminary Report on the Fifteenth Census of Scotland (Edinburgh, 1951). No census held in 1941.
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|Publication:||The Journal of Transport History|
|Date:||Jun 1, 2009|
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