[669] Ibid. p. 54.
[670] Local Government Board decision, in Local Government Chronicle, 11th June 1904, p. 635.
[671] Circular of 23rd May 1879, in Ninth Annual Report, 1879-80, p. 92.
[672] Hansard, 13th June 1876, vol. 229, p. 1780 (in Committee on Poor Law Amendment Bill).
[673] Local Government Board to Dr. Mortimer Glanville (Lancet Memorial on Poor Law Medical Relief Reform), 12th November 1878; in Eighth Annual Report, 1878-9, pp. 91-2. In spite of this official answer, we may infer a certain internal conflict of policy with regard to these salaried outdoor Poor Law nurses. Though the Central Authority expressed itself as "desirous of encouraging" the experiment, we cannot find that it issued the Order, without which no board of guardians could create a new salaried office, for nearly fourteen years. The District Nurses Order, which was merely permissive, and which, therefore, could not have been delayed merely because there were, in 1878, not enough trained nurses to supply every union in the Kingdom, was not issued until 27th January 1892 (Twenty-second Annual Report, 1892-3, pp. 12-13). We cannot find that any "paid nurses in the treatment of the poor at their own homes" were sanctioned before that date. Moreover, even then, it is difficult to feel sure that the Central Authority was still, to use its words of 1878, "desirous of encouraging this arrangement as much as possible." In sending the Order to boards of guardians, it accompanied it by a circular, which can scarcely be deemed encouraging. It was of opinion that "it can only be under exceptional circumstances that a sick pauper, whose illness is of such a character as to require that the services of a nurse should be provided by the guardians, can, with propriety, be relieved at home. At the same time it appears ... that where circumstances render it desirable the nurses employed in such attendance should be duly appointed officers of the guardians, having recognised qualifications for the position, and being subject in the performance of their duties to the control of the guardians, and the Board have consequently decided to empower boards of guardians to appoint such officers" (Circular of 1st February 1892; in Twenty-second Annual Report, 1892-3, p. 9). Fifteen more years have elapsed; but we do not gather that the experiment, which the Central Authority in 1878 was desirous of encouraging, has been very strenuously pressed by the inspectors, or the power made publicly known. The result is that we cannot find that it has yet taken shape even to the extent of as many as a dozen salaried Poor Law nurses for the outdoor sick from one end of the Kingdom to the other.
[674] "The sick" were held to include not only acute cases, but also cases of "chronic disease requiring regular medical treatment and trained nursing" (and also venereal and skin diseases, including the itch). (Local Government Board to Poplar Union, October 1871; MS. Minutes, Poplar Board of Guardians, 6th October 1871).
[675] Local Government Board to Dr. Mortimer Glanville (Lancet Memorial on Poor Law Medical Relief Reform), 12th November 1878; in Eighth Annual Report, 1878-9, p. 91.
[676] The more old-fashioned guardians failed to keep pace with the Central Authority in its ignoring of the principle of "less eligibility" with regard to the sick; see, for instance, The New Pauper Infirmaries and Casual Wards, by a Lambeth Guardian, 1875, in which the elaborate hospital requirements are objected to as being far too good for paupers. Where the guardians persisted in refusing to provide the elaborate and expensive new infirmary accommodation considered necessary, the Central Authority at last issued a peremptory Order requiring them to submit plans within a month, under penalty of having plans "prepared at the expense of the union" and of being deprived of "the benefit of participation in the Common Poor Fund" (Local Government Board to St. Olave's Union, June 1873; see Local Government Chronicle, 5th July 1873, p. 379).
[677] For unions out of London we have to note an extraordinary provision of 1879, proposed by the Central Authority itself. Boards of guardians in rural districts were empowered to transfer any of their buildings (into which only destitute persons could legally be received) from themselves as Poor Law authorities to themselves as public health authorities (in which case the buildings became available, without the stigma of pauperism, for all classes of the population) (Poor Law Act 1879 (42 & 43 Vic. c. 54, sec. 14)). We cannot discover in which cases, if any, this provision was acted upon, and the necessary confirmatory Order issued by the Central Authority; or what difference it made to the buildings.
[678] This was, in effect, to hold that inability to secure isolation, when isolation was required, amounted to destitution, so far as this kind of medical relief was concerned, just as a man requiring an expensive surgical operation was legally within the definition of destitute for the purpose of the operation if he could not pay the market price of it, even if he had ample food, clothing, and shelter. We cannot discover, however, that this explanation was actually given in an official document. Under it, not merely "a considerable portion of the population," but practically five-sixths of it would, in cases of infectious disease, have to be deemed destitute.