H.—lB

506

From Dr. A. F. J. Mioklk, Christchurch. Sir, — 64 Armagh Street, Christchurch, 10th August, 1912. I duly received your letter of request that I should reply to the questions forwarded to me —eighteen in all. This I haye 1 done in the best way that I could in the time at my disposal. I have not made any reply to question 18. It would-require more time and study to do justice to. I think there is a tendency to extravagance and waste, and towards too much amusement; then, too, gambling and dissipation is accountable for much. A reversion to a simpler and more home life would be of most service. lam sorry I cannot do more for you, but perhaps my replies may be of some service. I am, yours obediently, A. F. J. Mickle, M.D. To the Chairman of the Cost of Living Royal Commission. 1. How many years of practice in New Zealand? ' I have practised in New Zealand thirty-one years, the whole of the time in Christchurch, excepting during eighteen months spent in revisiting England on two occasions. 2. What is the average remuneration of lodge doctors? I am surgeon to the Independent Order of Rechabites and to the Sons and Daughters of Temperance; both are on the total-abstinence principle from alcoholic beverages. The remuneration to the doctor is the same in both—viz., 10s. per annum for professional nttendance and medicines, <&c, for single members, and 20s. per annum for married ■ members, including wife and children up to sixteen years of age. I believe that in some other lodges— e.g., the Odd Fellows—the remuneration is 30s. pei- annum for married members. The remuneration has not altered during the past thirty years. When the friendly societies' dispensary was established an adjustment was made, but this did not increase the doctors' payment. No other body of men than doctors or clergy would have continued to work for the same remuneration during the great changes of recent years. 3. Have medical practitioners and friendly societies been generally in amicable relations? So far as my experience goes, yes. In the early years of my residence in Christchurch I had occasionally a little trouble with some lodges. This would arise out of apparent neglect on my part, but I was able to show that it was unavoidable. Some members of lodges (friendlysocieties) are apt to think they may be neglected in favour of private patients, but this is not the case ; the most urgent cases are given preference, whether lodge or private. For many years my relations with the members of the societies I am surgeon to have been very amicable, and I have received reasonable consideration from the members in respect of attendance required. 4. Have expenses of doctors increased greatly of late years? If so, in what direction? Yes, rents are higher; wages are at least 50 per cent, higher; the motor-car is more expensive than horses, and generally the cost of living is greater than it was fifteen years ago, but not higher than it was thirty years ago —probably less, except in the matter of wages. 5. Has the cost of medical attendance increased in the last ten years, or in twenty years? Tf it is meant by this question, Has the cost of medical attendance to the patient increased during the past twenty years, I must reply that Ido not think it has done so, My personal experience is that lam not so well remunerated as formerly, say, fifteen.or twenty years since. 6. Have the cost of drugs and quality of drugs varied in late years —that is, is a finer quality or more expensive kind of drug demanded now than was formerly the case? During the past twenty years, and more particularly the last ten, there has been a continuous introduction of new drugs on a large— i.e., a numerous—scale. New remedies are as a rule high in price, and generally drugs are dispensed in an improved and more palatable form, but at increased cost. Having always kept my own surgery and dispensary, I am able to speak definitely on this point, and I should say that the cost of dispensing has increased from 25 per cent, to 50 per cent.; I think the latter estimate is nearer the increase, and in some cases this is exceeded. The new drugs are brought under our notice by the manufacturers, with reports of trial by recognized authorities, so that we feel bound to use them, and so decide for ourselves as to their merits. Many of these newer drugs are of very high value in the treatment of disease. Unfortunately, many of them are very expensive. The duty of 20 per cent, put upon drugs some fifteen years ago increased the cost of the drug bill considerably. I have always been of opinion that all drugs and appliances used in the treatment of sickness should be free of duty. 7. Have maternity expenses increased, arid in what direction? The chief increase of cost in maternity cases has been in the nursing. Up to fifteen years ago efficient nurses —not highly trained nurses, but practically efficient—could be engaged at 30s. to 425. per week. Now the charge is from 425-. to 635.; but certainly the present-day nurse is better trained and more reliable. The charges at maternity homes are also higher. It is now ,£3 3s. to £4 4s.—usually the latter charge—per week; but here, too, there has been a vast improvement. Most of the maternity homes are well equipped and well conducted. Then, the patient has every advantage of skilled nursing and the best environment, lire fees of medical men in maternity cases have not, as far as I know, varied during the past thirty years. My own practice has been to charge a higher fee in first cases, which require much more attention and time and special assistance. The fee varies from £2 2s. to £5 55., and in cases involving unusual attendance a further charge according to the number of visits required.