Dr JOHN PRINGLE TOLMIE, called and examined.
13,451. (Chairman.) You are a Graduate of the Royal College of Surgeons and Physicians, Edinburgh, and you were 5½ years in Barra?
13,452. You have been sixteen months in Obbe?
13,453. Is it an improvement on Barra?
—It is much about the same.
13,454. Dr M‘Leod overlaps your practice to some extent?
—Yes; he comes down into my district.
13,455. The population of South Harris is 2262?
13,456. Bernera is a good way off?
—I don’t go to Bernera.
13,457. Some of your pauper patients live thirty-seven miles away from you?
13,458. It will be rather difficult for you to give them medical attention. You have no motor bicycle?
—No, just an ordinary bicycle.
13,459. Have you never thought of getting a motor bicycle?
—I can’t afford it.
13,460. It would be of great assistance to you if it was procured for you?
13,461. You have a good deal of walking where there are no roads at all?
13,462. How far are the townships usually from the public roads?
—They are usually about three miles from the public road.
13,463. Do you do much travelling by fishing-boat?
— No. They never come for me. They only came once for me on a Sunday, and they did not guarantee to take me back, so I would not go. I went the next day by steamer.
13,464. Was it an urgent case?
—No, it was a man who had been sick for four years.
13,465. You say here you have never had a private hire paid for you since you came here?
—Not since 1 came here.
13,466. You do it all yourself?
13,467. Your house belongs to Lord Dunmore, the rent of which is £8, 8s.—and the rates amount to £2?
13,468. It is not sufficient for your purposes?
13,469. It is an old school that was built in 1858?
13,470. It is a very inappropriate house for a doctor?
— That is so.
13,471. The Parish Council cannot provide you with a better one?
—They do nothing.
13,472. What are your emoluments as medical officer the parish?
—I get £120 from the Parish Council. I had £110 the first year, but I asked for a rise and got it.
13,473. You have fifty
—six paupers to attend to besides their dependants?
13,474. Have you another fifty dependants?
13,475. You are medical officer to the Harris School Board, and you get £6, 6s. for that also?
13,476. Your answer to No. 13 is exactly the answer that the previous doctor gave us, that in your private practice the people don’t ask you to vaccinate the child?
—That is so. They wait till they get on the defaulters list to save paying the half a crown, and I have to go over the whole place.
13,477. We were told that you vaccinate children in battalions?
13,478. You have a club system in your parish?
13,479. How does it work?
—They pay 5s. for each house.
13,480. Who do they pay that to?
—There are collectors in each village.
13,481. Do you get what is collected, or are you guaranteed a certain sum?
—I just get what is collected.
13,482. Is it pretty well collected?
—Not in my district. I only get £40 a. year, and if they all paid I would get £100.
13,483. Why don’t they pay the 5s.; are they not able to pay?
—They are able to pay it.
13,484. Do they get free medical attendance for the 5s.?
13,485. At any time in the day?
—Yes, or the night.
13,486. Do you find that they send for you unnecessarily?
13,487. Do you find that they continue to do that; that is to say, we had one doctor who told us that after the first year it was not so bad, but that during the first year it was pretty bad?
—They don’t do the same way with me.
13,488. What do you say?
—What can you say when you have got twenty miles and you find it is a case of toothache?
13,489. Are they not ashamed of having sent for you?
— There is no shame in them; they are only proud of doing you.
13,490. The proprietor or the shooting tenants
—do they help in this club?
—Not the shooting tenants, but the proprietor gives £10 or 10 guineas a year. I think it is in view of the rent.
13,491. Do you charge any people fees at all?
13,492. These are the sources of your income—the £40 and the £120?
—Yes, and the 6 guineas from the School Board and the £5 that I get as Local Medical Officer of Health.
13,493. Do you prefer a club arrangement to payment by fees?
—They would never pay by fees?
—They could not pay.
13,494. Does your charge of 5s. a family per annum include medicines?
—No; I charge them extra.
13,495. Do you charge extra for confinements and for operations?
—Yes, but they never come for me. Supposing you go to Stockinish for a case and ask them to come for medicine, they never come. Once they see your face, that is all they want. They don’t lay out much money on medicines.
13,496. The main sources of income are fishing, crofting, and Harris tweed weaving?
—Yes, that is the main industry.
13,497. Do the men work at the tweed at all?
—A lot of the men are weavers.
13,498. Are there any fishermen down your way?
—Not down our way; they are mostly lobster-fishers.
13,499.You say the majority of the people in South Harris are not able to pay doctors’ fees?
—I think not.
13,500. You think it is a poor island. Is it poorer, relatively speaking, do you think, than Barra?
—I don’t think so.
13,501. Sometimes they are very prosperous in Barra?
— Yes, they sometimes have good seasons.
13,502. You send your serious cases to Glasgow Infirmary?
13,503.Do they go from Obbe?
13,504. You have about eighty confinements in your districts in a year?
13,505. But you are only called to about six of them?
—Yes, I think that is all I have in the year.
13,506 And you are only called to the serious ones?
— Yes, unless it is to the upper ten.
13,507. Who attends to the others?
—There is a nurse.
13,508. She attends to them?
—Yes, and some of these old howdies.
13,509. There were two cases of mothers and one of an infant that have died from improper or insufficient attention?
13,510. Was the attention of the Procurator-Fiscal drawn to them?
13,511. You only charge 10s. 6d. for a. confinement?
13,512. Is that under the club arrangement?
13,513. Is there much tuberculous disease in your district?
—I have not seen much since I came here. I have only notified one case since August, but I believe there are a lot. The number of uncertified deaths make me believe there is a lot of consumption. There were six deaths last year from consumption.
13,514. Do you think there is more consumption here than in Barra.?
—Of course there is a bigger population here altogether.
13,515. What do you think is the cause of the consumption here?
—The cases I have just now have no stamina; they cannot stand the strain of the work in the cities, and they spit about and knock about from one place to another.
13,516. Do they spit more in Harris than anywhere else?
—They don't care where they spit; they will come into your room and spit on your carpet. Some of the farmers too, from whom you would expect better, do it.
13,517. Are they worse than in Barra?
—Just about the same.
13,518. Have you noticed that they hand about the pipes from one mouth to another?
—Yes, that is the great thing.
13,519. It is done on the land as well as on the sea?
13,521. We don’t think that your emoluments were sufficient last year at all. Are there two maternity nurses in your district?
—Yes. I don’t know the qualifications of the one in the middle of South Harris. I asked her for her qualifications, and she replied that she did not know what the Highlands and Islands Committee had to do with her qualifications. The other one is an old crofter’s wife, and goodness knows how she came to be a nurse; she cannot read and she cannot write. She is great on that ointment called Zam—buk. She always says, “I wish I had some of that ‘humbug ointment.”’ When using the medical term “placenta” she will say, “I wish that presentor would come.” When speaking of iodoform she says “iofferdum.” She will tackle anything. I was at a case the other day
—it was a case of colitis—and she said to a certain party she knew long ago what was wrong with the case; she said I knew fine it was “kitis.”
13,522. How do they charge, do you know?
—I cannot say. I think some of them charge £1. They will be there two or three days after the case.
13,523. You have no properly qualified nurse at all?
13,524. You want one?
—Yes, one or two.
13,525. I suppose the public health is suffering without one?
13,526. The other doctor told us that what a properly qualified nurse would do would be to teach the people better habits?
—Yes, and she could teach them a lot of things. A lot of these women don’t know an illness that is peculiar to them. The nurse would be very important there.
13,527. Do you ever take advantage of their services in any of your cases?
—-Yes, the one I have been speaking of never stays at a private case; only at a midwifery case.
13,528. You have no kind of control over them?
—No. The one that refused her qualifications is kept up by an old lady who left money to support a nurse.
13,529. Is she a native?
—No; I think she belongs to Sutherlandshire.
13,530. One lives at Manish. Is Manish on the Mainland; it is not a little island?
13,531. You don’t nurse infectious diseases; what is done with them?
—All the family clear out.
13,532. Who nurses the patient?
—The father. The only case of infectious disease I had was a typhus case, and the father nursed the patient. He went about with a bag of carbolic and a black tape of cloth on his jacket to show the people that they were to keep clear of him.
13,533. Did the patient survive?
13,534. What did you do with the house?
—I fumigated it.
13,535. Was it a black house?
—Yes. It should have been burned by right.
13,536. Had you to do that yourself?
—No, the sanitary officer did it.
13,537. Is there a house in Harris with cattle under the same roof as the people?
13,538. Where is this case?
—Down in Strond, near my own place I reported it twice to the District Committee and they took no notice of it. I was going to a house where somebody was sick, and I was met by a calf; it was a calf that answered the door.
13,539. Was there a cow too?
—Yes. I reported the case twice, and the sanitary inspector reported it twice.
13,540. Is it still going on?
—No, there was a party staying with this woman, and they had a row and she pulled the house down.
13,541. Am I right in saying that there are no cases now?
—When I was vaccinating in a certain district I came across a case, and I was told that the cow was very sick, that it had had a calf, and it was in the house, but it would be out the next day. There is no doubt that there are a few, but not very many.
13,542. How long have you been here?
—Since 15th March 1911.
13,543. There have been a good many changes of doctors in your district?
13,544. Did they leave?
13,545. It was not through any difference with the Parish Council?
—I don’t know whether it was that or not. There is a doctor, William Reid from Glasgow, who comes to the fishing at Rodil, and the first time he met me he said, “Have you had any difficulty with your Parish Council yet,” and I said no; and he said “Well, your predecessors had difficulty with them, and you had better look out.”
13,546. I suppose you are in favour of having an appeal to the Local Government Board in a case of difference of opinion with the Parish Council?
13,547. You find it a considerable handicap on your own part, as well as on the part of your patients, that you are not able to take a holiday and rub up your medical knowledge?
—I get no holiday at all.
13,548. The medical supply for South Harris is adequate, but you want some additional and better nurses?
—Yes, fully trained nurses.
13,549. You have a very interesting answer to question 34 in your statement. You say, “What would improve the medical service in South Harris would be a trunk road through the eastern seaboard where all the people reside, by which a medical man could get along by horse and trap and see the patients daily if required.” I have often wondered why a road is not made there?
—We have not a proper county councillor. When the question comes up at the County Council meeting at Inverness, there is no one there and it is passed on.
13,550. You say, “ Also a club arrangement on a proper basis, where each person of a certain age would be made to pay. Nurses trained, not maternity alone, should be in districts so many miles apart. Small cottage hospitals and also a small fever hospital would be of great service.” With regard to the club arrangement—you have no objection to a club arrangement—whatever may be said about a club arrangement in the South, the special conditions of the Highland districts, you are of the opinion, are not you, lend themselves to an organisation under the club system?
—Yes, because they could not pay otherwise.
13,551. It is unfair that a patient twenty-five miles away should have to pay 25s. for a doctor, whereas the patient next door to him gets the doctor for 2s. 6d.?
—You would never get satisfactory treatment; you could not do it.
13,552. You think that some system, properly organised, would help to facilitate the medical service in the Highlands? —Yes.
13,553. Is there anything else you would like to say?
13,554. (Lady Tullibardine.) You have spoken of unnecessary calls. Do you think that a small check fee would prevent them?
—Yes, of course that would do it. Supposing they paid a club subscription and there was a small fee for extra calls, that would stop them.
13,555. Would that be more satisfactory than having a check fee, say, for the first visit, or for every visit?
— That would stop them from calling any time. When you go to a case you know when to call again. Just now they come for you and demand you to go after they have paid their 5s. a year.
13,556. Do you have fixed times for going to the different parts of your district?
13,557. Do you think that would be a good arrangement, provided the access were easy?
—Yes, and let them come to call me at certain times too.
13,558. Would it be a convenience to you supposing you were called specially to a place if the call had to come in before ten o’clock in the morning?
13,559. Would you be ready to let these visits be free and let the check fee be for these special calls?
—Yes, that would be better, because when you are in the district you could make a good few calls. '
13,560—13,561. I see that you want a hospital for Harris because the North Harris hospital does not quite meet all your needs?
—It is no use to South Harris whatsoever— unless for an accident.
13,562. Do you think that if a hospital were available for South Harris the people would be willing to go to it?
—It is very doubtful. They are very scared about hospitals. The first death that occurs in that hospital will make them unwilling to go to it again. .
13,563. Do you think it is more the fear of the hospitals than the fact that it is the fee they have to pay?
—It is the fear.
13,564. More than the fee?
13,565. In time that would be lived down?
13,566. So that you don’t think it is necessary that a cottage hospital should be free to everybody?
13,567. (Dr Mackenzie.) About your vaccinations, you do them in battalions. How far are you able to follow them up before giving a certificate? Are you able to see every case before you are done?
13,568. Do you get them to come a second time, or do you visit them as occasion offers?
—I have to go to every house. The places are scattered about.
13,569. You will take a district and go round the people?
13,570. Where do you get your lymph?
—From the Local Government Board. .
13,571. About your confinements, is there much puerperal fever about?
—You don’t see a case at all. It is very very wonderful. I didn’t see any in Barra the whole time I was there, and I have not seen any here yet. Of course, I have not had many cases.
13,572. Are there any cases of tetanus here at all?
—No, I never noticed any.
13,573. Have you ever had a case in Barra?
13,574. Are there any cows in the houses in Barra at all?
—No, I don’t think so.
13,575. It is not a regular custom at all?
—No. They do have cleaner houses in Barra than in Harris.
13,576. You have had typhus fever since you came?
— One case.
13,577. Have you had typhoid?
—I have never had a case of typhoid.
13,578. What troubles you most?
—We have a lot of measles in the year.
13,579. You have no facilities from the Public Health side at all?
13,580. You have got the sanitary inspector to do anything that is neceasary?
13,581. Do you think that one man would be sufficient medical service for the whole of the Harris district?
13,582. What total population have you?
13,583. That includes North and South Harris?
13,584. Even supposing you had a system of nurses, such as you indicate, to act under your direction, and if you had one hospital and a small fever hospital, you would not consider that one man was sufficient to deal. with all that?
13,585. That is to say, that the amount of sickness is such that even two men are required?
—Yes, and the roads are so bad.
13,586. Do you visit Taransay?
13,587. You are the doctor for there?
—No, I don't go; they don’t pay me a penny.
13,588. Have you much tuberculosis?
13,589. A good deal of bone tuberculosis?
—Yes. When they have bone disease they use the old remedies. There was a man suffering from keratitis and he was not getting well. It is a difficult disease to cure in an old person. He was not getting on, and I had to go over one very wild day to see him, and when I arrived he was away from home— it was a fearful day —and he had to drive nine miles and walk about another six to an old lady at Licisto. The old lady made up some rhyme and mixed some grasses with water and sand, and sang. He came back and said he was a little better. The seventh son is supposed to be able to cure such diseases. I know of one case of at person who had a carbuncle on the back of his neck and it did not heal, and he got a seventh son to come to his house, and every night for a long time he put cold water on it and a sixpence round his neck.
13,590. Did you have anything of that sort in Barra?
— Yes, they had the superstition about the seventh son there.
13,591. Have you much plithisis, much lung tuberculosis?
—No, just one.
13,592. How many paupers have you? You said you had 56?
13,593. Do they give you much trouble in the way of attendance?
13,594. How often do you see them, on an average? How many visits have you to make in the year?
—Not many at all.
13,595. Are they fairly well housed?
13,596. Have you many lunatics?
13,597. These are boarded out?
13,598. How often have you to visit them?
13,599. Do you get specially paid for them?
—No, I don’t get my fares paid. I was at one the other day where I had to pay 8s. to cross a sound.
13,600. The Parish Council allow you to be out of pocket to that extent?
—Yes. You never get paid for it. I cycled sixty-six miles and walked ten. It is also a very dangerous ferry.
13,601. Have you to go there to private cases or to paupers?
—The Rainigatle road is a very dangerous one.
13,602. How often do you do that journey of sixty-five miles by bicycle and ten miles walking in a year?
13,603. You pay 8s. for the ferry?
13,604. Do you see any private patients when you are there?
—If they come to me when I am there I treat them. It is the same all over the Highlands. The last time I was there I had ten of them; one after the other they came into the house.
13,605. It is quite obvious that whenever you go into any of these outlying places you always discover there are a lot of people needing medical treatment that otherwise would never be seen at all?
13,606. You are quite satis?ed that there is a great deal more genuine sickness that needs treatment than ever comes in the way of the doctors?
13,607. So that in that sense your medical service is not adequate at the present moment?
—That is so.
13,608. So far as you as an official are concerned, owing to the poor remuneration and the long distances and the difficulty of access, the medical service could not be made adequate, but you need assistance to take you to the patients and to bring the patients to you?
13,609. And you should not be out of pocket 8s. for doing the work of the Parish Council?
—That is so.
13,610. Then in that case of typhus you referred to, is that house still occupied? It was fumigated; was it just with sulphur?
—I don’t know. It was the sanitary inspector who did it.
13,611. Has Dr Fletcher visited as Medical Officer of Health since he left?
—He attends to both things.
13,612. Have you had to refer any cases to him?
13,613. In fact, you are out of touch with him since he left?
—We report any notifiable infectious diseases to him.
13,614. About the school medical inspection, have you anything to do with the children in your capacity as School Board officer?
—No. We have something to do with the sanitation of the school.
13,615. How many schools have you?
13,616. How often do you visit them?
—Perhaps twice a year.
13,617. How many children would there be altogether
—I am sure there will be that.
13,618. How many of a population are you responsible for in your district?
—Just over 2000.
13,619. So that you will have somewhere between 400 and 600 children?
—Yes, about that.
13,620. Have any of the children been sent to you for treatment as the result of the school medical inspection?
—Yes, a good few. They come to me with these lines they get from Dr Fletcher.
13,622. What sort of things do they come to you specially for?
—Generally bad teeth.
13,623. Any glands?
13,624. And you have dealt with them?
13,625. And do the people carry out your instructions?
— Supposing they have bad teeth, I can only pull them. I will say the tooth will cost Is. and they say they cannot afford to pay it.
13,626 (Mr. Lindsay.) Judging from your statement, your house seems to be a miserable one. You say that the rest is £8, 8s. It is nothing like what you ought to have. Have you made any representation as regards the condition of the house?
—When I went there I was promised water in the house and they promised to make all the windows water-tight. I have had nothing done except a back door put in and a small closet upstairs.
13,627. Your house is not much better than one of the black houses?
—A black house would be more comfortable on a wet day.
13,628. All the representations you made were when you went there?
—Yes. A back door, a window, and a small closet are all the things that have been done since I went there. The windows were patched up, but they are as bad as ever. The proprietor was going to give me a coal house three or four months ago, but I have not get it yet. It is an old school, and underneath the floor of the lower ground it is all mud and muck.
13,629. The sanitary condition of your house should be a model for the rest of the parish?
—Yes, it should.
13,630. Have you ever made any representations to the Parish Council about it?
—They cannot afford to do anything.
13,631. Do they ignore and scoff at your requests?
— No; they sympathise with me and my house. That is all
13,632. (Mr Grierson.) Along with the things you suggest to improve the medical service in the Highlands, you think that fully qualified and trained nurses like Jubilee nurses is the most important?
13,633 I suppose you agree that a qualified trained nurse is less likely to injure you by doing anything like practising on her own account than the less fully trained ones. The more fully trained she is the less she is likely to act on her own?
13,634. You consider that a fully trained nurse would have a very great educative influence among the people?
13,635. She would do much more than you have time to do yourself?
—Yes. She would be able to do much more for the women and children at a birth.
13,636. Whatever can be done for the improving of your emoluments, you consider that nursing would come first?
—Yes. A lot of the children there when they are born are given sugar and water by the cupful, and they get the white spots on their tongue, and they snuff out.
13,637. You mean a system of nursing under your direction, of course?
13,638. At present you have no sort of control or management over them?
—That is so.
13,639. (Dr Miller.) It is a perfect marvel that you are taking the work under these circumstances. I cannot understand it. Is there anything to induce you to come to a place like this?
—I like to be in the country.
13,640. You like the people?
13,641. Are you a married man?
13,642. Not really?
—How do you think that?
13,643. Oh, really?
—Do you think a single man would come out here?
13,644. You quite agree that a club system is really the only feasible arrangement in a population like you have?
—Yes, in a scattered country like this, but not to let them get all their own way, and have me slaving away.
13,645. There ought to be restrictions?
13,646. You agree that this is the only practical way in which the medical service can be improved?
13,647. There is practically no other practice than the club practice and the parochial appointment?
—There is nothing. The ministers pay £1. The merchants pay 5s., for the simple reason that they may be a merchant to-day and a crofter to-morrow.
13,648. About this system of vaccinating in battalions, taking the number of births, which is round about eighty a year, you vaccinate approximately about eighty?
13,649. And for these eighty you receive 2s. 6d.?
—Not a copper. I get £2, 10s.from the Parish Council as public vaccinator, and I put more than £2, 10s. out in travelling expenses in the year.
13,650. You have to vaccinate the whole parish for 50s.?
13,651. I think someone asked about lunacy. Is lunacy prevalent here?
—Yes, there is a good lot of it. I have had three cases since I came here.
13,652. You don’t get a separate fee for attending them?
—Not a copper.
13,653. With regard to your duties under the School Board, have you noticed that the children are particularly cleanly in their habits. Is there much pediculosis?
—Yes, there is a lot.
13,654. Does that exist in the houses?
13,655. It is considered a sort of perquisite?
13,656. Do the children wear their hair long?
13,657. Do they get it cropped?
—Yes, and very bare when they do get it cropped, and a good job. It is a slaughter of millions.
13,658. Do they get them cropped very often?
13,659. Is there much gland troubles at the back of the neck amongst the children?
—No; I don’t see much of that. It is the tonsils.
13,660. You don’t have much scalp irritation?
13,661. Do you get much assistance from the Chief District Medical Officer here?
—In what way?
13,662. In the way of assisting in Public Health Work?
—He gets £45 from the Harris District Committee and he gives Dr M‘Leod and me £10 each. .
13,663. About these deaths, were these puerperal fever cases?
—No, not puerperal cases.
13,664. The nurse was in attendance. Do you know of any cases where the husband does that?
—I have heard of them.
13,665. The Parish Council has asked Dr M‘Leod. to attend emergency cases that you cannot attend to?
—There is a rule that if there are any emergency cases they can call in Dr M‘Leod.
13,666. In that case the Parish Council pays the doctor I think?
13,667. Does the Parish Council deduct his fee from your salary?
—No, unless it was a case I would not go to. I have a minute to that effect in their book. It is a very funny thing; if they are not pleased with the medical officer, why don't they throw him out and get another one? It is very seldom you see an urgent pauper case. I will give you an instance : Dr M‘Leod was called to a case in the village of Tarbert there, and I happened to be up in his part and I went in, and what do you think it was? It was a gumboil. That was an urgent case. They sent for me to a case at Diriclate the other night; they said she was sick, and when I arrived she was sitting with a big plate of porridge that I could not have finished in a fortnight.
13,668. About the feeding of the children, we were told that the food supply in winter was very bad. Can you tell us anything of the character of the cows, generally speaking? Are they healthy?
—Yes, they are healthy, and they have plenty of milk when they do have it.
13,669. Are eggs consumed by the people here?
—I don’t think so.
13,670. Do they rear fowls? —Yes, they rear these barn fowls. Any eggs they get they never keep them for themselves. They would rather buy tea with them.
13,671. You agree that tea and scones is the principal meal ?
—Yes, unless they get fish. They sometimes get a barrel of cured herring.
13,672. (Dr Mackenzie.) As to the milk, does what you say about the sufficiency of milk apply to the island of Scalpay?
—I don’t know. When they have milk they have plenty of it.
13,673. (Mr Orrock.) Do you know anything about the rates?
—I think they are 9s. 6d. in the £1.
13,674. I see you pay £2 for taxes upon your £8?
— Yes; I think it is about that—a little over £2.
13,675. I suppose there is no other way of you getting a better house unless by building a new one?
—That is the only way.
13,676. Or by adding a few rooms to the one you have?
—It would be money thrown away. Of course, there is a loch at the back of my house. You get a good supply of water. It is an old house and the walls are damp.
13,677. If you had a new house erected probably you would be charged a bigger rent?
—I was paying £25 a year at Barra.
13,678. And then with the small emoluments you receive, it would be crushing?
—We would be away to nothing.