Apart from this severe discouragement of apprenticeship we can discover no indication of the policy of the Central Authority as to starting the children in life. No advice was given to the local authorities on the subject.
We have seen that neither the Report nor the Act of 1834 laid down any policy for the sick—suggesting, in fact, no change in the existing practice under which they were both maintained and medically attended in their homes. During the whole of the period, 1834-47, there is nothing in the Orders laying down any other policy so far as the maintenance of the sick is concerned. Both the two streams of regulations, the Outdoor Labour Test Orders (culminating in the Outdoor Relief Regulation Order of 1852) and the Outdoor Relief Prohibitory Order of 1844, expressly excepted, from all their prohibitions or restrictions on the grant of outdoor relief, cases of "sickness, accident, or bodily or mental infirmity." In all these cases the policy of the Central Authority was to leave the local authorities the same absolutely unfettered discretion with regard to the grant of outdoor relief that they had before possessed. In the Instructional Letter of 1836 as to medical attendance the practice of granting outdoor relief to the sick in "food or clothing" is mentioned, without criticism. [161] So much was this the accepted policy that, when the Central Authority referred to the sick, in the comprehensive defence of its action in 1839, it only mentioned the steps that it had in view with regard to the better organisation of medical attendance, which did not seem to call "for any immediate general change"—without even alluding to the almost universal practice under which the sick received also outdoor relief in money.[162] In a Minute of 1840 it is pointed out that members of friendly societies in receipt of a money allowance whilst sick were only to be granted such amount of outdoor relief as, together with their allowances, would make up the sums which the local authority would have granted if they had had nothing. It is not even hinted that the grant of outdoor relief at all was against the policy of the Central Authority, although it is suggested that in these cases it should be granted on loan.[163]
The first suggestion that we have found of this policy not being wholly satisfactory occurs in 1840, in the Central Authority's comments on the case of a boy who had died, it was asserted, from privation whilst his father was actually in receipt of outdoor relief. No blame was imputed to the local authority, which, it was said, had been "acting under a recognised mode of relief"; but it was suggested that the case showed the dangers of "partial relief"; that illness was likely to be more quickly cured "with the advantages of the superior cleanliness and the better regulated warmth and ventilation of the appropriate rooms or a sick ward" of the workhouse together with the superior nursing, dietary, and doctoring there possible; and that, especially where there was likelihood of the outdoor relief or other family income being unwisely applied, it was better to relieve by admission to the workhouse.[164] But this first suggestion of an alternative policy stands alone; and it was not embodied in any Order.
What the Central Authority was concerned about, with regard to the sick poor, was not their outdoor relief, but the extent to which they took advantage of the services of the parish doctor. Already in 1836 it was laid down by an Instructional Letter (which expressed no criticism on the practice of granting relief "in food or clothing") that medical attendance could be allowed only in cases of destitution. As, however, sickness quickly involved destitution, it was suggested that provident sick clubs should be promoted, to provide for medical attendance when needed.[165] Four years later it is pointed out that members of friendly societies, entitled as such to medical attendance, must not be allowed the services of the parish doctor.[166] This was repeated in 1844.[167] "Medical extras," such as "meat, milk, wine, and porter," could not be ordered by the doctor, but could be granted, on his recommendation, by the local authority; and it is to be noted that the Central Authority adds no words in any way discouraging such grant.[168] The Central Authority became even more concerned about the organisation of the medical attendance, the area of each medical officer's district, the method of selecting him, his qualification, and above all the mode of his remuneration, so that he might not be tempted to increase the number of cases.[169] Its views on this subject were embodied in the General Medical Order of 12th March 1842, and explained in the accompanying letter of the same date.[170] We omit this, along with other administrative questions; but it must be noted that the whole policy of the Central Authority in the matter rested on the assumption, on which no criticism was expressed, that the sick would, as a matter of fact, be relieved in their homes.
When the sick entered the workhouse they were dealt with as a class by themselves, in the general establishment which alone was then in existence. We shall deal with the policy with regard to them in a subsequent section.
It may be noted that in 1840 the Central Authority supported the proposal of the Government Bill of that year for the establishment of district infirmaries, but these were not for the sick, but for the infirm.[171] The proposal was never proceeded with. In 1842 the local authorities are incidentally reminded that they have power to send sick persons to hospitals outside the union.[172]
A separation of lunatics from the other inmates of the workhouses had been suggested in the Report of 1834. But it was in the course of this period 1834-47 that persons of unsound mind became recognised as a distinct class. It was, however, long before any settled term was used. We read of "idiots" (1), dangerous (2), or not dangerous (3), curable (4), or not curable; "the insane" (5), "persons of weak intellect" (6), or suffering from "mental infirmity" (7), or from "mental imbecility" (8), or from "disease of mind" (9), or merely "persons of unsound mind" (10).[173]
Persons suffering from "mental infirmity" (explained to mean "insane") were repeatedly excepted from the prohibition of the grant of outdoor relief.[174] In the Outdoor Labour Test Order a similar exception allows outdoor relief, without work, and even if the applicant is in employment, on account of the mental infirmity of a member of his family.[175] Finally, a similar exception was definitely incorporated in the Outdoor Relief Prohibitory Order of 1844 (still in force) and the Outdoor Relief Regulation Order of 1852 (still in force).