In the result the ad hoc poor-law authority did not absorb into it the newly created municipal and urban and rural sanitary administration, but continued on its separate path.
Simon, in 1868, had urged the inadvisability of continuing ad hoc authorities, and had urged that, at least, sanitary should be made coterminous in area of administration with poor-law districts. His advice was not adopted, and there followed years in which sanitary authorities were allowed to subdivide areas, until the total number became 1,807 instead of 635, the number of poor-law authorities; and in which they concerned themselves chiefly with nuisances and water supplies and with inadequate provision for the prevention and treatment of infectious diseases. With the creation of county councils and the more complete autonomy of the councils of county boroughs, the large centres of population developed and improved their sanitary administration more rapidly; and it became practicable to undertake every division of sanitary work on an efficient scale. Although much remains to be done, it can be claimed that in our larger towns, containing more than half of the total population of the country, the public health work in nearly all its branches is of a high order. It would have been still more efficient had the poor-law guardians been merged in the Town Council, and had the relationship between the school medical service and the other branches of the public health service been closer than has been the case.
What is now needed is that the defects just named should be made good; that more complete autonomy should be given to the authorities which come up to a required standard, and that especially they should have greater freedom in developing local possibilities of improved administration. Central grants in aid of local sanitary administration are steadily increasing. Already the Government pays one-half of local expenditure on a large program of maternity and child welfare work, one-half of the expense of local tuberculosis work, and three-fourths of the expense of local work for the diagnosis and treatment of venereal diseases, and for propaganda work concerning these. These grants should be the means of greatly increasing good local administration; but if,—this is improbable,—they curtail local experimentation and extension, and bring local public health administration into anything approaching the subservience of local poor-law administration, the value of these subventions will be doubtful.
Education Authorities and Health
The national system of compulsory elementary education inaugurated in 1870 has had valuable indirect influence in promoting the public health. Apart from the beneficent effect of education, the steadily increasing pressure on children to come to school in a cleanly condition and the stimulus of emulation in tidiness and cleanliness, have done much to improve the home conditions of the people. After the South African war much attention was drawn to the large number of recruits rejected owing to physical disabilities; and an inter-departmental committee reported inter alia in favour of a system of medical inspection of pupils in elementary schools, which had often been urged by hygienists. Observations made in Glasgow and Edinburgh by Leslie Mackenzie did much to draw attention to the physical defects in Scottish school children. In 1907 the Board of Education acquired power to make provision through the local education authorities for the medical inspection and treatment of school children. At first little more than inspection of pupils was undertaken, a large number of defects of sight, hearing, parasitic conditions, as well as malnutrition and actual disease being discovered. Gradually some items of treatment were undertaken at school clinics, or at hospitals or centres subsidized by the education authorities; though the amount of treatment is still small compared to the defects discovered and not otherwise treated.
But there now existed in every locality three authorities concerned in the treatment of disease:
1. Poor-law guardians, treating all forms of illness in paupers, at home and in institutions.
2. Public health authorities, undertaking preventive measures against disease, and treating fevers, tuberculosis, and occasionally other diseases in institutions; and more recently providing nurses at home for certain conditions.
3. Local education authorities, concerned in treating certain ailments in school children.
Centrally two government departments were supervising this work, and subsidizing it to some extent from government funds; and poor-law medical work and public health medical work were supervised by two divisions of the Local Government Board acting in almost complete isolation. More recently Parliament has permitted the Board of Education to give grants in aid of schools for mothers, and allied institutions for the care of children under school age; for which institutions, substantially, the Local Government Board in other instances was giving grants.