Stornoway, 11 October 1912 - Dr Alexander Murchison

Dr ALEXANDER MURCHISON, called and examined.

10,836. (Chairman). You are a Graduate of Aberdeen University, and you became an M.D. in 1906?

10,837. You were for twelve years Medical Officer for Kilmuir Parish, Skye ?

you have to attend eighty-five paupers and dependents for that ?
—Yes, something like that.

10,846. How do you get on with the patients themselves ?
—When they call for me in the town I ask them to pay me 2s. or 2s. 6d. a visit, and perhaps I give them some medicine for that.

10,847. Is the most of your practice in the town or in the country ?
—It is about equal.

10,848. You have some very severe observations about security of tenure. You want an improvement in that respect ?
—Yes, it is much needed.

10,849. Have you experience of a club system
—Yes, I had.

10,850. Where was that ?
—I had it in Uist, and in England in the county of Durham and in Stoke-on-Trent.

10,851. When did you settle in North Uist ?
—In 1884, where Dr Mackenzie is.

10,852. Did you help to work that practice ?
—Yes, a year before he came there. I was there only a few months.

10,853. You say the doctors are usually the last people the people wish to pay ?

10,854. You say that a modified fee per visit is the best arrangement ?

10,855. Do you prefer that arrangement in North Uist ?
—My meaning was that if it is going to be a club practice there should be something else allowed to the doctor.

10,856. You find that the ability to pay a fee is not very high in the country districts here at any rate ?
—No. I go several miles for 8s. or 9s.

10,857. You have got a local hospital here ?

10,858. Do you send your patients to it ?

10,859. Then you attend them in the hospital ?

10,860. Does it work quite well ?
—I don’t know anything wrong with it.

10,861. You cannot, of course, give us the rate of confinements, because you have only been here a few months?
—-Yes, a few months only.

10,862. Is there a nurse at Kilmuir ?
—Yes, there was one within the last year or two.

10,863. Who attended the people before that ?
—Local women and myself.

10,864. You want security of tenure for the doctors; at least you don’t want ad vitam aut culpam, but you want an appeal to the Local Government Board ?
—I have no cause to put much faith in the Local Goyermnent Board ; I have appealed to them many a time and nearly always without redress. I would like appeal to some Board.

10,865. You don’t want the Government to pay for the whole cost of medical attendance on the people ; you want them to do something for themselves ?
—Yes; I want every one to support himself as much as possible.

10,866. What are your general suggestions as to the improvement of the medical service in the Highlands and Islands ?
—It is a shame and a loss to our land that the complaints of doctors in Scotland, and especially in the Highlands, regarding the Poor Law conditions were ignored by the authorities for the last twelve years. For example, in medical, and sometimes in daily papers, advertisements were inserted that doctors should not apply for such-and-such places. South Harris and other places were kept without a doctor for months, due to these advertisements. I would also like to state my own experience since 1896. In Applecross, I was then doctor for about £95 yearly, with a free house from Lord Middleton, and £30 for free attendance on his household, and for attendance throughout the district at a distance of twelve miles for 2s. 6d. a visit. It would have been better for me to be allowed to make my own charges, and I would then be free from the commands of Lord Middleton to some extent, but it happened that I displeased his Lordship for doing my duty, as is well-known in the parish, and he then sent me notice that I would have to get out of the house, and he knew no person would dare to give me a house on the estate against his wish. Consequently I had to leave Applecross, but I was on friendly terms with the Parish
Councillors, and yet they were powerless to retain my services for want of a residence. So tyrannical was the business from the very beginning that the form of engagement was with his Lordship and not with the Parish Council. I then went to Durness, Sutherland, and I met with similar treatment at the hands of a large farmer. There they had heard that Lord Middleton had dismissed me in Applecross, and apparently that partly induced them in Durness to do the same to me. There, also, they dealt similarly with my successor in about two years’ time, but he took the Parish Council to the Court of Session, and they had to replace him in his office. Lastly, I was dismissed in Uig, Skye, from North Snizort, fully three years ago. At the time of my appointment I was doctor for it as well as for the parish of Kilmuir, but a Skye man left money for building an hospital in Uig and willed it for the most part to the sick poor of Kilmuir. The trustees of the hospital, however, and the Parish Council of Snizort agreed that I should not be doctor for the hospital, and both parties got me dismissed although the hospital belonged chieffiy to Kilmuir, of which I was doctor till I left of my own will. Evidently the Parish Council inffiuenced the Trustees against me.

10,867. (Lady Tullibardine.) I see you don't like the principle of club practice ?

10,868. And what are your reasons ?
—The people will be better attended by paying for their visits. A doctor is more liable to neglect a club patient, as far as my observation goes. I may be that way myself ; I might scarcely be so attentive to club patients.

10,869. Would that be partly because they sent for you unnecessarily ?

10,870. You said to the Chairman you would like the idea of a check fee in this district ?

10,871. And the check would be desirable, not only to safeguard the doctor, but it would make him more ready to go ?

10,872. That seems perhaps about the best solution of the difficulty ?

10,873. Now, do you think the check fee should be extended beyond the-first visit ?
—Yes, I think the fee should be for every visit, because otherwise they would send continually.

10,874. That, really, is in order to keep up the interest of the doctor ?
—And the people too—not the interest of the doctor altogether. It would be good for them to pay something for the visits of a doctor. It is not good for them to have nothing to pay for visits.

10,875. They would be paying the club subscription, in the first place, and we have had the suggestion that there should be a check fee for the first visit in an illness, because that would prevent the people sending for the doctor unnecessarily, and if, when the doctor went, he saw it was a case of real illness, then there would be no fee for further visits ?
—Then they would be sending continually.

10,876. You think a check fee for the first visit would not be sufficient ?

10,877. Would you give us some idea of the fee you think the people here could pay for an annual club subscription per family. Or would you say what the people could pay at Kilmuir for the whole family, seeing you have not been so long here ?
—10s. a year.

10,878. You think that they could pay that—even the small crofters ?
—In North Uist they were paying 5s. and they worried me there.

10,879. What do you mean ?
—They called me too often

10,880. You did not have a check fee in North Uist?

10,881. In Kilmuir, do you think they could have paid 10s. a year ?
—It would have been heavy on some of them, but still the doctor could get that for his visits.

10,882. But the point is, what could the people afford to pay ?
—They could not afford to pay anything at all, many of them. They are poor.

10,883. Do you think they could manage 5s. a year?

10,884. And a check fee of 1s. a visit ?
—Yes, ls. or whatever it is.

10,885. Do you think a shilling would get over the difficulty, so far as the doctor is concerned ?
—I don’t know that it would meet the difiiculty, but it would be a help.

10,886. Are you afraid. of the doctor losing interest in his work if too Inuch of his income were guaranteed ?
—Yes I am rather inclined to believe he would get very careless that way.

10,887. You would like to feel that there was a margin of private practice to keep up an incentive in his work

10,888. I notice that you think that under a club practice a doctor is regarded much as a servant of the general public. Do you think if he had an appeal to the Local Government Board against dismissal by the Parish Council, or he were under a larger body than the Parish Council, that that would prevent other people feeling that he was in the position of being a servant ?
—Yes, that would help.

10,889. Therefore, if you introduce a club practice, it is desirable to give the doctor some fresh status, or the public may be inclined to take a little advantage of him ?
—Yes, I don’t like the club practice anyway ; because it is not good for the patient or the doctor.

10,890. Not even with check fees ?
—Only with .poor people it seems to be the best remedy.

10,891. It is only for people below a certain income that we are proposing this club system : it is not for people who are well off, but just for the people who find it very

difficult to pay the doctor’s fees ?
—Yes, but many of them call the doctor unnecessarily if they get that. I don’t like club practice in any form if it can be avoided.

10,892. Do you not prefer it to bad debts ?
—I have had bad debts with club practice.

10,893. If there were a compulsory club system there would be no bad debts ?
—There would be bad debts with the club system, too.

10,894. Did the doctor collect the club subscriptions in the club you were talking of ?
—Yes, he sent a man to collect them.

10,895. But if they were collected by the public authority, that would ensure payment ?
—Yes, to some extent only.

10,896. (Dr Miller.) With regard to your remarks about the Local Government Board, you are quite aware that the Local Government Board under the existing conditions has really no power to interfere between a doctor and the Parish council in regard to tenure of office ?
—I am aware of that, but the Local Government Board had to do with matters like that; they got an appeal for the Inspector of Poor long ago. And another thing, the last place I was in, Skye, it was Within the power of the Local Government Board to step in ; I was dismissed from North Snizort, and I was also medical officer of Kilmuir. Another doctor was got for North Snizort. That was an additional doctor for Skye.

10,897. What happened at North Snizort? There was an hospital built ?

10,898. And you could quite well have attended that hospital?

10,899. Who was the other doctor?
—He was a Dr Macdonald, appointed by the trustees of the hospital.

10,900. Where did he hail from ?
—Tobermory originally.

10,901. Didn’t he come from Klondyke (Canada) ?

10,902. Was that a reason why he should take the bread out of your month ?
—No. He was quite ready to apply for the appointment. I don’t blame him at all; I blame the Local Government Board for sanctioning his appointment. It was always the arrangement that the Parish of North Snizort should be attached to Kilmuir. It was within the power of the Local Government Board to have withheld their sanction there.

10,903. I am afraid that the Local Government Board had not the power. I suppose I am not unravelling a secret when I say that you were approached by a very distinguished gentleman who has been much in the public notice of late to go under his service—-a Dr Knight of Portobello?
—I applied for that place.

10,904. What happened?
—I did not take it.

10,905. Were the conditions not attractive enough ?
—I did not care for them.

10,906. Your opinion was that the man ought to have been put down ?
—I did not know anything about the man.

10,907. With regard to lunacy fees, your parish gives you £2, 10s. per annum ?

10,908. And have you got to attend any resident lunatics for that ?
—Yes, I have to visit them every quarter, and also I have to give lunacy certificates. I don’t think I get justice there.

10,909. How many resident lunatic paupers have you ?
—I am not sure of the number ; I think it is about eight or nine.

10,910. Are many of them situated at Tolsta ?
—Yes ; there are three patients there.

10,911. And you have got to pay four visits per annum to each of these cases ?

10,912. And of your nine patients, you have got to pay sixteen visits to the lunatic patients at Tolsta, in addition to the others, and you get £2, 10s. Do you think that fair remuneration ?
—No, and besides that, I give lunacy certificates for the £2, 10s. That is what I complain about. I don’t complain about the £2, 10s. ; I look upon it as fair. In other places I used to be paid for these lunacy certificates ; I used to get a guinea for every lunacy certificate besides the £2, 10s.

10,913. Does not it sound a little oppressive of a Parish Council in cases like that which involve serious and moral responsibility?
—I don’t think they think about it.

10,914. What have you to say about vaccinations?
—I would prefer that the people should meet me. I have to go to the houses, and I have a difficulty in doing them.

10,915. You don’t find that the number of vaccinations is becoming less ?

10,916. Do you think it ought to be free ; do you think it ought to be connected with the Public Health administration ?
—I don’t think it should be free.

10,917. It should be free, as far as poor people are concerned ?
—They pay 2s. 6d. for a vaccination.

10,918. (Dr Mackenzie.) You are aware that under the Public Health Act, the District Committee can pay the fees for vaccination if they like ?
—It is better that they should pay, I think.

10,919. (Mr Lindsay.) I was struck by the remark you have made in your statement, that Parish Councils occasionally dismiss a doctor “for sport” ?
—“ And spite,” I added also.

10,920. That is an extraordinary thing ?
—They often do it.

10,921. Do you mean to say they rob him of his livelihood just for sport ?
—Yes, they do. They did it to me.

10,922. Do you charge a Highland Parish Council with dismissing a doctor just for sport ?
—Yes, I do.

Provost MACKENZIE, called and examined.

10,923. (Chairman) You are Provost of the Burgh of Stornoway, and you know the conditions of the country and the district very well indeed ?

10,924. The main sources of livelihood are crofting and fishing?

10,925. A considerable sum comes to the island from other services ?

10,926. We were very interested to hear that practically all the men on the island are trained in some form of military or naval drill ?

10,927. Compulsory service would make very little difference to the island of Lewis?
—Yes, so far as that goes.

10,928. Can you give me any estimate of the amount that comes into the island from these services ?
—I would say it would be a matter of £30,000 from the army, navy, and militia.

10,929. Can you tell us what the fisher-women bring in from the gutting and curing of fish ?
—I would put that down at £50,000. I include the hired men and women in that £50,000. I think that would be about the amount they bring into the island.

10,930. The sources of income from the land in addition to that is what they can make from their crofts, which, after all, does not amount to much ready money, but it gives them a home and a living ; they get their food and a house and fire, and so on ?

10,931. Is there much money comes into the island of Lewis from home industries ?
—I should say for the past two years there would be about another £50,000 from home industries. I should also say that the value of the fish caught by the fishermen on the island will amount to about £110,000.

10,932 Do you say that most of it was caught by the fishermen of the island alone ?
—The great bulk of it, possibly £60,000.

10,933. Are there any other sources you can mention ?

10,934. This £110,000 is distributed among the population of 30,000 ?
—Except what the stranger fishermen who come here to fish get.

10,935. So that the people are really not able to adequate fee to a doctor if he is going to give the attendance they need ?
—That is so.

10,936. The distance from the doctor is so great that a fee to adequately compensate him for visiting the patient cannot be got ?
—Yes. Sometimes when a doctor should go to a place they defer sending for him owing to the fee that is charged on account of the distance.

10,937. And sometimes a doctor is not called in at all ?
—That is so. I might supplement that by giving you the number of deaths. As far as the Stornoway landward parish is concerned, I would say that the total number of deaths was 138, and the number uncertified was 37, or 26 per cent. In the burgh we had 41 deaths, and 5 were uncertified, which represents 12 per cent. Coming now to Lewis landward, there were 380 deaths, and the number of uncertified deaths was 130, or 34 per cent.

10,938. Lewis landward is Lewis outside the burgh ?
—Yes, exactly.

10,939. Of course that is a very high percentage, and the reason is, as you have stated, that the people have some hesitation in sending for the doctor on account of the difficulty they have of getting at him, and, secondly, on account of the bill they are likely to incur ?
—Yes. I may say at this stage that to supplement what I sent to Mr Beaton I wrote down a few notes, and I have them here. I will read them. The insanitary condition of the houses is the cause of a great deal of disease, particularly phthisis, among the sick poor. I give you this simply as the and knowing how we are burdened with regard to this question. Phthisis has now been made a notifiable disease, and owing to the ravages made by this disease in Lewis a sanatorium in Lewis is much required. The great difficulty, however, to be overcome is the provision of sanitary dwellings in the rural districts and the getting of the people to call in a doctor at the early stage of illness. This delay on their part tends to spread infection, particularly in the black houses, before treatment of the patient commences. That is just what I was saying with regard to sending for the doctor for these houses. They only send for the doctor when he ought to have been there before. In that way the disease takes a firm hold. The other subject I was going to draw your attention to was the under-feeding of children. It is much to be regretted that in the rural, as Well as the country districts, the proper feeding of the children is neglected by parents. There is far too much tea and loaf bread used. Porridge in the morning is very seldom given, and the consequence is that the children are not so robust as they were a generation or two back when more wholesome, plain food was the rule. The periodical lectures by the medical officer of health, Dr Murray, will no doubt help to educate the parents in this matter. Another thing I was going to draw your attention to was the district nursing. Point district in the parish of Stornoway has a population of 5789, and the Back district has a population of 3840. Each of those districts has a nurse, for which the Parish Council pay £12, 10s. towards the Point nurse’s salary and £5 towards the Back nurse’s salary. While Parish Councils get back a portion of the medical officer’s salary from the Medical Relief Grant they get no portion of the district nurses’ salaries. The salaries of our medical officers for the parish are Dr Mackenzie, Point district, £66, he also gets for the burgh £67 ; and Dr Murchison gets £67 for the Back district; making a salary of £200 for the two doctors who have charge of the whole parish. The charge for medicines, prior to Dr Mackenzie being appointed——when the appointment rested with Dr Macrae and Dr Miller—two gentlemen we had who were doctors—was just a slump sum; it was a salary that included medicines and everything else. Now it is different. The salary is separate from the medicines.

10,940. (Dr Mackenzie.) How much do they get for medicines ?
—Last year Dr Mackenzie got for the Point district, £20, 4s. 6d., and for the burgh, £26, 1s. 9d.

10,941. That is beyond the £200 ?

10,942. (Chairman.) Have you ever any complaints about the doctors from the patients there
—There was just one complaint that came before us as a Parish Council lately, but when we investigated it, it was found to be utterly unfounded. This complaint did not come from a pauper, but from a private individual.

10,943. Is there a druggist in Stornoway ?
—Yes, two of them.

10,944. You have not any contract practice with them for the provision of drugs. It is generally through the doctors ?
—Yes. For the most part it is done through the chemists when supplied to the Poorhouse, but the doctor is really the party who is responsible to us. The medical officer for the Back district got £14, 6s. 6d. for medicines. The salaries amounted to £200, and the medicines amounted to £60, 12s. 9d. That was for last year. We, at the same time, give an annual donation of £10 to the Lewis Hospital, and three guineas to the Eye Infirmary, Glasgow. We benefit for that three guineas to a very great extent, because if we have any person suffering from cataract or anything like that, we send them to Glasgow to be operated on there.

10,945. (Dr Mackenzie.) As a matter of fact, have you sent any ?

10,946. Free of charge ?

10,947. You pay their fare ?
—Yes. .

10,948. They are not paupers ?
—Paupers and non-paupers.

10,949. It is purely medical relief ?
—Yes. The other points to which I might draw your attention are, that in the Parish of Stornoway we have about 700 people whom We call squatters, who pay no rates or taxes here at all. That, of course, makes the burden upon us as ratepayers heavier than it would otherwise be.

10,950. (Chairman) Are they fairly well off ?
—Yes, in fact they are better off than some of the crofters.

10,951. Have you any rough idea as to what difference it would make if these 700 squatters were added to the ratepayers ?
—I think it would reduce the parish rate by 2s. 6d. Here we are schooling them, and doing everything for them, and they are sitting quite free there. The parish rates for 1910—1911 on the owner—the poor rate—was 2s. 5d. ; registration ½d., cemetery ½d. ; and the school rate was 10½d. The total of that is 3s. 4½d. On the occupier, the poor rate was 2s. 9¾d ; registration ½d; cemetery ½d. ; and the school rate was 1s. 1d. That was a total 3s. 11¾d. The two added together come to 7s. 4d. This year we are going to be 5d. less—-2½d. on each. Our burgh
rates again, or the year 1910-11, were 9d. on owners, 1s. 8d. on occupiers, making a total of 2s. 5d. I suppose we are the lowest. There may be perhaps two other burghs in Scotland that are lower, but we are as low as any of them. Our water rate is 3d.

10,952. Do you mean to tell me that you charge for your water rate 3d. on owners and 3d. on occupiers ?
—-Yes. The population of Stornoway parish at the last census for for the Point district was 5789; for the Back district 3840; and for the burgh 3806; the total being 13,435. The Tolsta district—the people in which are the furthest away from any medical men in Stornoway—has a population of 853. The population of Portnagouran, Aird, and Portvoller was 1222.

10,953. How far are they away from a doctor ?
—Fourteen miles: Going into the average rental of the parish of Stornoway, I calculated that it is about £9 per family compared with Scotland where it is £31 per family.

10,954. You have an hospital. Have you anything to say about that ?
—The Lewis Hospital.

10,955. Yes. Does it satisfy the needs of the locality?
—Well, it should.

10,956. Does it ?
—Not particularly at present I am sorry to say.

10,957. It is managed by governors elected by the subscribers, just the same as the ordinary hospitals ?

10,958. And are the people not satisfied with it ?
—They are complaining, of course, at the present, at any rate.

10,959. Are there many of the subscribers in the town in the neighbourhood of Stornoway?
—Yes, a good number of them.

10,960. They have never had sufficient agitation to make them change their management ?

10,961. They have the power ?
—Yes. In fact the hospital was carried on under the local committee in former years but in the past year it has come under a new constitution it is worked under the trustees, governors, and managers

10,962. Could we have a report of the constitution and so on ?
—Yes, I think so.

10,963. (Dr Mackenzie.) Do you think the hospital is fulfilling its full possibilities as a medical institution?
—Not at present.

10,964. What is the real reason? Is it a mere money matter or is it a management matter ?
—It is perhaps both to a certain extent.
10,965. Can you tell us anything about the telephone or telegraph service in the island ?
—The telegraph service is very good indeed.

10,966. You have no telephone outside the burgh ?
—No, not outside the burgh.

10,967. Have you any views as to the desirability of extending that ?
—Well, I would say that the telephone would be, perhaps, cheaper for them to use than the telegraph.

10,968. You have thought of it as to its application to medical service ?
—It would be very handy in that respect,I suppose there are some people in the country who are
loth to spend 6d. on a telegram who might, perhaps, go to the telephone to ask for medical service.

10,969. (Lady Tullibardine.) I should just like to ask you one question with regard to the men who go for training in the naval reserve or the militia. Do you think it affects their physique at all ?
—I think they are all the better for it.

10,970. Has the number been increasing ?

10,971. Do they like it ?

10,972. It is quite popular ?

10,973. (Dr Miller.) Would you think that a club system could be initiated for the remuneration of the medical men in the outlying districts, among the rural population ?
—I am not prepared to say anything with regard to that.

10,974. You don’t think that it would be a good method of furnishing the people with efficient medical service?
—I would say that with regard to the Tolsta district and and the Portnagouran district, I think they are just a little bit far away from the medical men in the town, and I think that a qualified nurse in both of these places would be of great advantage to them.

10,975. But don’t you think it would be desirable to devise some scheme for remunerating the doctor better for his services when called out to the country districts?
—Yes, I think so.

10,976. The people at present are not able to pay an adequate fee ?
—No. I think if there was some system of that kind arranged, or if some help were given to the doctors who visit these places, it would really be of service to the people furthest away from the doctor.

10,977. (Mr Lindsay.) You are chairman of the Parish Council?

10,978. You never had any difficulty with your Parish Medical Officer ?

10,979. Dr Mackenzie, whom we had here to-day, has been there for twenty-eight years ?

10,980. You have never had any difficulty with him ?

10,981. (Mr Orrock.) You mentioned the receipts from the home industries amounted to £50,000 during the last two years. Do you think that the tweed industry is at the present moment in a flourishing state ?
—No, I think it is going down. They have spoilt it themselves, in my opinion.

10,982. It has been going on for how long ?
—For the past twelve months.

10,983. You say that the Parish Council of Stornoway paid so much towards the Point nurse and so much towards the Back nurse ?

10,984. That was a proportion of their salaries, and the District Committee and the Ladies’ Association contributed the remainder?

10,985. Between the Parish Council and the District Committee they contribute to the extent of 50 per cent. ?

10,986. With regard to your contribution to the Eye Infirmary in Glasgow—three guineas—are you aware that the estate for many years, up to within the last twelve years were subscribers to the same Infirmary, and in this way secured admission to those requiring treatment ?

10,987. (Chairman.) Take these crofters who are far away from the doctor ; it is a little unfair that they should have to pay about £1 a visit for the doctor. Manifestly they cannot have a sufficient number —of visits at long distances ?

10,988. It cannot be paid by them ; it must be paid by the doctors ?

10,989. Would it commend itself to you that it should be in some way equalised, and that the crofter who never needs a doctor and the crofter who is near the doctor should help to bear the expense of keeping an efficient doctor who might attend these people who needed him, and to accomplish that by having a system, a modification of the club system, whereby each family should be asked to contribute compulsorily a certain sum every year, and that this sum should go to a fund to remunerate the doctor. That fund would need to be helped in other ways, either by the Government or through the rates. Do you think it would be unworkable ?
—No. We had it up before us in the Parish Council, that something in that line should be adopted.

10,990. There would be a fund constituted, contributed to in that form by the club system, and the other by contributions through the rates, and by many other offices that the doctor should hold, and by a Government subvention. You don’t think there is anything impossible in that?
—I don’t think so.

10,991. What sum do you think you could afford to pay towards a fund of that kind?
—I think that these two districts could easily afford £100 each.

10,992. What do you think the ordinary family could pay? There are some who could not pay at all, and they would we need to be relieved, as they are of the rates. Do you think 3d. a week is too much ?
—We were putting it on the basis of 4d. a week.

10,993. That would be a great deal for some families ?
—Yes. Of course they would look upon it as a large sum to pay.

10,994. Would they be able to pay 5s. a family ?
—Yes, I think so.

10,995. You would not put it as high as 13s. a family?

10,996. (Dr M‘Vail.) 4d. a week is more than 13s.; it is 16s.?

10,997. (Chairman) Are there any voluntary insurers in this district ?
—I don’t know. There are very few.

10,998. (Dr Mackenzie.) Any club system, such as suggested, you think, should be compulsory?

10,999. (Chairman) Could this contribution be collected along with the poor rate ?
—It is the only way it could be collected.

11,000. (Dr M‘ Vail.) Could a poor crofter’s family at a distance afford to pay at the rate of 4d. a week—about 16s. a year—for medical attendance? We were lookin at it in this way, that they would not be able to pay it; that there is just a certain number that could pay. If they all had to pay do you think they could pay so much ?
—No, I don’t think so.

11,001. What could they pay ?
—Perhaps about half of it.

11,002. Would you have a little fee in addition to the club subscription to prevent frivolous calls? Could the pay that as well as the subscription?
—Some of them would. I was always pointing out to Dr Mackenzie with regard to his visits down to these places that if he could combine in his visit a number of visits his charge could be divided over a number of houses. They don’t work amicably together ; that is the difficulty.

11,003. (Chairman.) There is a difficulty working in a place like Stornoway where there are several doctors, and where different doctors go to the same district. I don’t know how that could be arranged ?
—People in certain districts want a certain doctor. For instance, down in Point district, not only does Dr Mackenzie go down there —although he is the parish doctor still—but others go down there too.

11,004. (Lady Tullibardine.) Do you find the people change their doctors sometimes for rather small reasons ?
—Not with us. They very often stick to the one doctor. If they have any faith in the doctor at all they will stick to him.

11,005. (Mr Grierson.) You don't give any meals to the children at school ?

11,006. (Lady Tullibardine.) In the event of a club system being set up, would it be possible to ask for a smaller contribution among unmarried men or women who are earning their own livelihood?
—I think that the girls and young men would be‘quite willing to contribute to anything like that, because really it is from them that the whole of the money comes. It is the young men and young women who bring the money into the island; in fact, their old people depend mainly on them.

11,007. Do you think the old people would be able to pay 5s. per family, supposing the grown-up sons and daughters were paying for themselves?
—They might just bring forward the point that it is the young people who give them the 5s. that they have to pay. They look at things in a peculiar way at times.

11,008. Are there many householders who are not married in the island ?
—A good number.

11,009. That is to say, living quite independently of anybody else ?

11,010. It would be desirable that these people should contribute to a club system ?

11,011. But it would be hardly fair to charge them the same ?
—Yes, only they could contribute something else.

11,012. Would you prefer to let the father’s subscription cover the grown-up sons and daughters in the house ?
—Yes, I think so.

11,013. You would not charge a single man or woman unless they happened to be a householder ?

11,014. (Mr Orrock.) Could you put any additional burdens on the rates ; could the rates stand it?
—I may say that our rates can hardly bear any addition.

11,015. That is the landward part ?

11,016. (Chairman.) There are some parishes where the rates are so much higher ?
—Yes. They get a good deal of help that we don’t get.

11,017. The burden of the rates falls mainly on the landlord here ?

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