The number of children to be placed in any one home was at first limited to two—or four, if all were brothers and sisters,—but it was soon found that further restrictions were necessary for the prevention of overcrowding. Accordingly, it is ruled that not more than one child may be placed in a home where a child is boarded by any other agency and none where there ismore than one such child; no child is to be boarded in a home where, with him, there would be more than five children resident. The clothing provided for a boarded-out child is to be of a good, ordinary character, with no suggestion of a workhouse uniform. The highly expensive but most advantageous service of dentistry may be paid for by the guardians. The Central Authority strongly disapproved of a proposal made to it, under which a child was to be sent out to work, and earn wages, while the full allowance was still being paid by the guardians. "If a boarded-out child is eligible under the Education and Factory Acts for employment, the boarding-out committee should report the case to the guardians, who should obtain the consent of the Local Government Board to any proposal to relieve the child whilst in receipt of regular wages. A foster-parent should not be permitted to allow a child to go to work for wages unless the guardians, with the assent of the Board, have previously assented thereto."[637]
Prior to 1877 the Central Authority held that children boarded out within the union, being merely cases of outdoor relief, did not require these precautions. From 1877 onward similar precautions were required in their cases. Such children became thus differentiated from other children on outdoor relief, on whose behalf no such requirements are insisted on. For the boarded-out children a payment was approved of 4s. a week each (afterwards raised to 5s.), a sum to be contrasted with the 1s. or 1s. 6d. for each child which is the usual sum allowed for each child on ordinary outdoor relief.[638]
In equally marked contrast with its attitude with regard to the other children on outdoor relief, the Central Authority has been vigilant to secure for the boarded-out children systematic inspection. Mr. Chaplin said in Parliament: "I approve of, and warmly sympathise with boarding-out, subject to one condition, which is of surpassing importance, namely, that the inspection of the children boarded out shall be adequate and effective. I cannot conceive a position of greater misery and hardship than that of some poor unfortunate little child boarded out to some one who takes care of it, not for love of the child, but simply for the purpose of making a gain and a profit out of it.... So far as it is possible to promote that adequate inspection ... and wherever it is possible to board out on these conditions, the Board gives its assistance."[639]
The children boarded within the union are to visited by the medical officer quarterly, whether or not they are reported ill, and by the relieving officer—who pays the foster-parents at their residence,—ordinarily weekly, and may also be visited by the guardians or any other person appointed for the purpose by the guardians or the Local Government Board. If there is a boarding-out committee (which is permissive under the 1889 Boarding-out in Unions Order) a member thereof must visit every six weeks; the inspection by the medical officer may then be dispensed with, and the system becomes more nearly like that for boarding outside the union. Under the latter, the responsibility is thrown on the committee, and unless they fail the guardians are not allowed themselves to inspect. The Local Government Board also sends an inspector from time to time, with the object of discovering how the committees do their work, for it is on the efficiency of the committees that the whole system of boarding-out depends.[640]
When the children are thus thoroughly supervised by the committees, and the committees are kept up to their work by the general inspectors, the Board do not favour anyfurther inspection by the guardians. "One of the main objects of the boarding-out system is that pauper children should become merged in the general population; but if a child boarded out is to be examined regularly by a medical man, supervised by a committee of the guardians, and inspected by a Government inspector, it would appear to imply that no confidence whatever is to be placed in the boarding-out committees under whom the children are placed, although for any success attending the boarding-out system it is on these committees that we must rely."[641]Besides, "where children are boarded out by guardians at a long distance from their own union or parish, it may often be inconvenient, except in the case of many children being placed in the same neighbourhood, for the guardians to arrange for the visitation of the children by their own officer as frequently as the Board deem indispensable, when inspection by members of the committee has ceased. It follows, therefore, that if the voluntary boarding-out committees should allow their vigilance or their interest to flag, the guardians will, in all probability, seldom have any alternative but to take back the children."[642]
The boarded-out children, thus elaborately inspected and expensively provided for, had, by 1st January 1906, slowly risen to 8,781;[643]but they were even then only one-seventh of those in institutions, and only one-twentieth of those on ordinary outdoor relief.
(vi.)Apprenticeship
We may note a tendency to enlarge the responsibilities, powers and duties of the guardians for successfully launching the children in the world—an enlargement which plainly loses sight altogether of the principle of "less eligibility." We see the Central Authority making elaborate suggestions for the care of children apprenticed or in service, and issuing an Order enabling the guardians to provide outfits when children were sent out, without previously asking for sanction,which had before been necessary under some of the Orders. When the Central Authority had been asked for such sanction it had taken the opportunity of objecting to a child being sent to service without money wages, or to an inn or public-house (unless in exceptional circumstances), or to any place where the conditions of service seemed unsatisfactory, and of requiring to be satisfied that the child was qualified for employment as required by the Education Acts. By allowing guardians to obtain outfits without obtaining express sanction the Central Authority relinquished this opportunity of control over the conditions of service. It therefore referred to these points in the Circular on the Order, and expressed its confidence that the guardians would see that all was satisfactory in these respects.[644]It did not approve of the Poor Law children being engaged as servants to officers of Poor Law establishments—situations which, like those in public-houses, etc., were left to be filled by the less carefully protected children of independent parents or those on outdoor relief—considering it desirable that the children should be severed from all connection with pauper surroundings as soon as possible after attaining an age at which they can secure employment.[645]
When children are first apprenticed they receive very low wages or more often none at all, and there is frequently a difficulty in providing for their maintenance. We have already referred to the doubt of the Central Authority as to how to treat the experiment of the Norwich Guardians on this point. Though these Guardians kept their homes this doubt apparently continued. The Keighley Guardians wished to use one of their cottage homes as a residence for working boys from the workhouse, but the Central Authority refused its assent, stating that it had no power to render such a course legal. Nevertheless it allowed a lad who received no wages, but was entirely engaged in learning his trade, to reside in the workhouse during the term of his apprenticeship,[646]and to children earning low wages insufficient to support them outdoor relief may be given. "In such cases the Board have required to be furnished with an assurance that the guardians had satisfied themselvesthat the amount allowed by them would, with the weekly wages paid by the master, be adequate to provide for the maintenance and clothing of the apprentice, either alone or in association with other boys. They also required a statement of the weekly wages ordinarily paid in the locality to apprentices in the particular trade, and to be informed (a) of the amount of weekly relief the guardians proposed to grant; (b) the period during which such relief should continue; and (c) whether, as the apprentice's wages increased, the relief would be correspondingly reduced."[647]
In 1904 the Central Authority was prepared to acquiesce, subject to the details of the scheme proving satisfactory, in a proposal to establish a home for boys over whom the guardians had acquired parental rights, the boys receiving board and lodging therein for so long in each case, as the wages were insufficient to enable them to obtain suitable accommodation elsewhere.[648]
The Central Authority had, in 1873, been doubtful how far a relieving officer should interfere if he found, when visiting a servant or apprentice, that the master or mistress,instead of paying the stipulated wages, gave clothing, which might be old, useless, or valued at an exorbitant rate. It merely told the guardians that he should make a special inquiry, and report if the practice appeared to be actually injurious to the personal condition of the child, so as to amount to "cruel or illegal treatment in any respect."[649]
Apprenticeship to the sea service[650]had, previously to 1894, been left outside the scope of the orders regulating other apprenticeships, being subject to special provisions under the Merchant Shipping Acts, and also regulated by the Board of Trade. That Board made some alterations in the form of indenture in 1895, and the Local Government Board issued a circular to guardians calling attention to the changes. The master was required to pay to the superintendent any balance of spending money, share of salvage and other perquisites due to an apprentice after his daily or weekly allowance had been paid, and thesuperintendent was to apply such sums for the boy's benefit in the expenses of holidays, payment of fines, or other ways. This provision was considered by the Local Government Board to be of great importance, as it would "enable the magistrates in many cases to punish a boy for breaches of discipline, without committing him to prison." The new form of indenture also required the master to allow each apprentice a reasonable holiday in every year.
The same circular referred to recommendations made by Mr. Davy and Mr. Berrington, in a Report on the Fishing Apprenticeship System, as to the desirability of continued supervision by the guardians after the boys were apprenticed, and of arranging for reports to be made to the guardians in cases of absconding or other grave offence on the part of the boys, and also as to the expediency of giving future apprentices some preliminary instruction in cooking.[651]
So far as we can make out from the published documents, the use of the power of apprenticeship is—in the view of the guardians and the Central Authority alike—practically limited to the children maintained in Poor Law institutions (indoor paupers), numbering 50,669 on 1st January 1906, together with those outdoor pauper children who are either "boarded out" (in the technical sense), numbering 8,781, or maintained in certified schools, etc., numbering 9,364, making an aggregate total of 68,814 children to whom the Central Authority's policy of apprenticeship is assumed to be applicable.[652]We do not find any suggestion that any similar policy is applicable to the other 166,258 children on outdoor relief,[653]about the starting in life of whom we can find no documents.
(vii.)Adoption
From 1871 to 1889 the powers and responsibilities of Poor Law authorities with regard to children whose parents claimed the control of them were, as against the parents, extremely limited. The Central Authority clung to the principle of parental authority. In 1887, Mr.Ritchie said: "No doubt there are some instances in which the interests of children are prejudiced by their parents claiming them from the guardians, but I should not be prepared to propose legislation which would enable a board of guardians to withhold a child from its parent when claimed by him."[654]
Two years later Parliament over-rode this contention of official irresponsibility, and passed the first of a series of Acts under which guardians might themselves assume parental responsibilities and unsuitable parents might be deprived of the custody of their children; and the guardians of the poor might becomein loco parentis, even up to eighteen years of age. By the Act of 1889, "where a child is maintained by the guardians of any union and was deserted by its parent," or if the "parent is imprisoned under a sentence of penal servitude or imprisonment in respect of an offence committed against a child," "the guardians may at any time resolve that such child shall be under the control of the guardians until it reaches the age, if a boy, of sixteen, and, if a girl, of eighteen years"; such a resolution of the guardians is not irrevocable; they may rescind it, or, without rescinding it, "permit such child to be either permanently or temporarily under the control of such parent, or of any other relative or of any friend." If the parent is aggrieved by the resolution, he may appeal to a Court of Summary Jurisdiction, and the Court, if satisfied "that the child has not been maintained by the guardians, or was not deserted by such parent, or that it is for the benefit of the child that it should be either permanently or temporarily under the control of such parent, or that the resolution of the guardians should be determined, may make an Order accordingly, and any such Order shall be complied with by the guardians, and if the Order determines the resolution, the resolution shall be thereby determined." The "powers and rights" of a parent which the guardians may assume are subject to one limitation, in that no resolution can authorise them to have the child educated in any religious creed otherthan that in which the child would otherwise have been educated,i.e.that of its parents.[655]
The Central Authority duly commended the Act among other legislation of the session to the notice of the boards of guardians in an official circular.[656]
Such was the original form of this law; but the experiences of the Central Authority and the guardians as to its working led them to get passed successive measures developing its details in various respects. The Court's power of determining the resolution of the guardians was limited by the Act of 1890, which provides that: "where a parent has (a) abandoned or deserted his child; or (b) allowed his child to be brought up by another person at that person's expense, or by the guardians of a Poor Law union, for such a length of time and under such circumstances as to satisfy the Court that the parent was unmindful of his parental duties, the Court shall not make an order for the delivery of the child to the parent unless the parent has satisfied the Court that, having regard to the welfare of the child, he is a fit person to have the custody of the child." Under this law, therefore, not only the Poor Law guardians, but any other person who has brought up the child at his own expense may acquire the right of custody in the place of the parent. This Act is not to "affect the power of the Court to consult the wishes of the child ... or diminish the right which any child now possesses to the exercise of its own free choice." The Court was also given the power to make such order as it may think fit, "to secure that the child be brought up in the religion in which the parent has a legal right to require that the child should be brought up."[657]
The class of children to which the law applies was, at the instance of the Central Authority, considerably enlarged in 1899, and it is worth considering how extensive it now is. "Where a child is maintained by the guardians of a Poor Law union, and: (i.) the child has been deserted by its parent; or (ii.) the guardians are of opinion that by reason of mental deficiency, or of vicious habits, or mode of life, a parent of the child is unfit to have the control of it; or (iii.) a parent isunable to perform his or her parental duties by reason of being under sentence of penal servitude or of being detained under the Inebriates Act 1898; or (iv.) a parent of the child has been sentenced to imprisonment in respect of any offence against any of his or her children; or (v.) a parent of the child is permanently bedridden or disabled, and is the inmate of a workhouse, and consents to the resolution hereinafter mentioned; or (vi.) both the parents (or in the case of an illegitimate child, the mother of the child) are (or is) dead; the guardians may, at any time, resolve that until the child reaches the age of eighteen years, all the rights and powers of such parent as aforesaid, or, if both parents are dead, of the parents, in respect of the child shall, subject as in this Act mentioned, vest in the guardians." Penalties were also enacted against any person who shall knowingly assist or induce any child adopted by the guardians to leave their control. If any child maintained by the guardians is, with their consent, adopted by some other person, their responsibility for the child does not at once cease, for they are required, during three years after the date of the adoption, to cause the child to be visited at least twice a year, by some person appointed by them for the purpose; and they have the power, if they see fit, to revoke their consent to the adoption, and reassume custody of the child.[658]
Some boards of guardians—often on the suggestion of the inspectorate—promptly made use of their new powers. On 1st June 1902, the number of children already adopted up to that date was no fewer than 7724, of whom 1503 were then over fifteen.[659]It is to be noted that, though the powers are applicable to all pauper children, the Central Authority has not suggested their use except in respect of the children in Poor Law institutions (including, however, the "ins and outs"),[660]together with those technically "boarded out," or in certified schools; and we do not find that they have ever been made use of for any of the children maintained by the guardians on outdoor relief, however disastrous is their upbringing.
E.—The Sick
We broke off the description of the policy of the Central Authority with regard to the sick with the suggestive quotation from the Annual Report of the Poor Law Board in 1870, over Mr. Goschen's signature. "The economical and social advantages," said the last President of the Poor Law Board, "of free medicine to the poorer classes generally as distinguished from actual paupers, and perfect accessibility to medical advice at all times under thorough organisation, may be considered as so important in themselves as to render it necessary to weigh with the greatest care all the reasons which may be adduced in their favour."[661]
(i.)Domiciliary Treatment
So far as published documents go, we cannot find that any inquiry was made by the Local Government Board (at any rate on its Poor Law side) as to the advantage and feasibility of this suggestion of providing free medical assistance, under thorough organisation, to the poorer classes generally. There was no breach of continuity in the policy, begun in 1865, of transforming the provision for the sick paupers in the workhouse, into elaborately equipped, adequately staffed, and separately administered general hospitals, which were called Poor Law infirmaries. But in the general crusade against outdoor relief, initiated by the able and zealous inspectorate in 1871, there was no exception made for outdoor medical relief.[662]There was accordingly (just as we have shown to be the case in regard to widows and the aged) no limitation, corresponding to the express exceptions of the General Orders in favour of the sick, in the phrases condemnatory of outdoor relief generally, which are to be found in the Annual Reports and Circulars of these years. The inspectors, it is clear, made no distinction, in theirpersistent pressure against "outdoor relief," between medical and other relief, between hygienic advice and money doles. Mr. Longley, indeed, went so far as to condemn, expressly because it provided medical relief otherwise than in the workhouse, the whole system of Poor Law dispensaries which the Central Authority had itself just initiated and practically forced on the Metropolitan Boards of Guardians.[663]This report of Mr. Longley's was honoured by notice in the annual volume, and commended by the Local Government Board for "careful consideration."[664]There is, therefore, some warrant for the inference that the Local Government Board, under Mr. Stansfeld and Mr. Sclater-Booth, had not only put aside the suggestion of providing free medical attendance for the poorer classes generally, but also that it had now become the policy of the Central Authority—so far as we can discover, for the first time since 1834—to restrict, as far as possible, even such domiciliary medical attendance as was being given under the Poor Law to the sick poor.
It is, however, fair to say that this policy of restricting outdoor medical relief was not expressed in any alteration of the GeneralOrders, nor, explicitly, in any published minute or circular of the Central Authority itself. In the 1871 Circular, discouraging outdoor relief generally, it is, for instance, merely suggested that all paupers receiving relief on account of temporary sickness—among whom there were at that date apparently some 119,000 sick persons[665]—should be visited at least fortnightly by the relieving officer.[666]The Central Authority clung to the general disqualification of paupers, even those in receipt of medical relief only, though the Parliamentary Secretary had to admit that: "No doubt the Legislature had made an exception in the cases of vaccination and of education, and it might be that the exception should be extended to infectious diseases."[667]But when it was pressed to impose a limit of one month to each grant of outdoor relief, the request was, on the cautious advice of the permanent advisers, definitely refused, lest hardship should be caused in cases of sickness; though it was said that the guardians themselves might put such a limit, "where such ... may properly be imposed."[668]
The Central Authority was willing to consider any proposal to amend the law, so as to allow of the compulsory removal to the workhouse of sick persons who had no proper lodging accommodation.[669]But even to a person who had refused to enter the workhouse, the guardians were not to denyoutdoor medical relief if sick,[670]and in no case were the sick to be removed from their homes unless certified by the medical officer as physically able to endure the journey.[671]There was thus, even between 1871 and 1885, no explicit reversal, on grounds of Poor Law principle, of the old policy which, it will be remembered, had not been condemned by the 1834 Report of outdoor relief to the sick. If a "destitute young husband or wife were sick," Mr. Sclater-Booth, speaking as President of the Local Government Board, told the House of Commons in 1876, "they would not be taken into the workhouse, but would receive outdoor relief."[672]Two years later the Central Authority actually declared itself in favour of supplying to the sick poor who were under domiciliary treatment, not only medical attendance and maintenance, but also skilled professional nursing. There was, it said in reply to influential medical pressure, "nothing to prevent the guardians supplying such assistance," and the Central Authority was even "desirous of encouraging this arrangement as much as possible," though the insufficient supply of qualified nurses was likely to "render impracticable for some time to come any general application of the system of paid nurses in the treatment of the poor at their own homes."[673]
(ii.)Institutional Treatment
Meanwhile, however, the substitution of indoor for outdoor relief in the case of the sick[674]was being supported on grounds, not of Poor Law principle, but of medical efficiency. The transformation of the workhouses into what the Poor Law inspectors themselves began to call "State hospitals" made more striking than ever the contrast between the light, clean, and airy newly-built infirmary ward, with trained nurses, a resident doctor, complete equipment, and a scientifically determined dietary, on the one hand; and the insanitary and overcrowded hovel or slum tenement, on the other, in which the sick pauper had no other food than was provided by the pittance of outdoor relief, no further nursing than his family could supply, and no better medical attendance than the grudgingly accorded order on the district medical officer could command. Quite irrespective of "Poor Law principles," the case for institutional rather than domiciliary treatment of nearly every sick case became, to the medical experts who now advised the Central Authority, simply overwhelming. "The treatment which in sickness the poor receive in workhouses constitutes," said the Central Authority in 1878, "one of the most valuable forms of medical relief.With a considerable portion of the population, indeed, it is the only mode in which, when overtaken by sickness, their medical needs can be adequately met."[675]This policy led not only to an incessant pressure on boards of guardians to providethe "State hospitals" which had, from 1865 onwards, been expected from the guardians of all populous unions,[676]but also to a positive encouragement of sick persons, whether or not actually destitute in the technical sense of the term, to take advantage of them. We see this first with regard to infectious diseases. The hospitals of the Metropolitan Asylums Board, maintained out of the Poor Rate exclusively for paupers, and technically only workhouses like any others, soon came to be used, free of charge, by smallpox and fever patients who were not paupers.[677]It became the official policy, well understood by the Central Authority, to get removed to these Poor Law institutions every patient, whether destitute or not, who could not be adequately isolated at home.[678]Already in 1875 the Central Authority expressly authorised the medical superintendent to admit without an order any smallpox or fever patient presenting himself, if refusal to admit might involve danger,[679]and in 1887 it expressly permitted even non-urgent casesto be admitted on the certificate of any medical practitioner.[680]Nevertheless, in 1877 the Central Authority was still taking the line that "the hospitals ... of ... the Metropolitan Asylums Board are essentially intended to meet the requirements of the destitute class, and that the admission ... of persons not in need of poor relief is altogether exceptional."[681]Two years later, however, by a statute promoted by the Central Authority itself, the Metropolitan Asylums Board were expressly empowered to receive non-pauper patients, though only under contracts with the local public health authorities, by which they were to be paid for.[682]We cannot discover which vestries and district boards, if any, entered into such contracts. Not until 1883, when these fever and smallpox hospitals had been a dozen years in use by non-paupers, was the position temporarily legalised by the Diseases Prevention Act of 1883[683]—a measure also carried by the Central Authority itself—which, whilst leaving these hospitals as Poor Law institutions, administered by a Poor Law authority, and kept up out of the poor rate, declared that admission, treatment, and maintenance therein should—whether the patients were or were not otherwise paupers—not be deemed parochial relief, or carry with it any disqualification whatever.[684]Since that day we have the remarkable spectacle of the Poor Law Authorities, Central and Local, annually congratulating themselves on the fact that, year after year, they were managing to attract into these expensive Poor Law institutions, for gratuitous maintenance and treatment, a larger and larger percentage of the total number of cases notified.[685]
A similar enlargement of the sphere of the Poor Law institution has, of late years, been going on in other than infectious cases. "The poorer classes generally," to use Mr. Goschen's words, "as distinguished from actual paupers," came more and more to appreciate the practical distinction between the workhouse and the Poor Law infirmary; and, especially in the Metropolis and the large towns, the latter became more and more freely used as a general hospital.[686]This tendency was facilitated in London by the operation of the Metropolitan Common Poor Fund established by the Central Authority itself, which, from 1870 onward, bore the bulk of the cost of maintenance of the Poor Law infirmaries, as of the hospitals of the Metropolitan Asylums Board.[687]The Central Authority saw with approval the increasing attractiveness of these institutions, not only in London but throughout the country. In an official memorandum communicated to all boards of guardians in 1892, it observed that: "The sick poor can usually be better tended and nursed by skilled nurses in well-equipped sick wards than in their own homes; andthe regularity, neatness, and order of the wardstend to diminish the repugnance to entering the workhouse, which is often evinced by the sick poor of the better class when reduced to want by failing health."[688]It did not refuse to permit them to be made use of by paying patients, where—as is usually the case in rural districts—no "non-pauper institution" was available. "If," writes the Central Authority in 1902, there is "a sick person who is in receipt of an allowance from a benefit club or similar society," and who "is unable to obtain in a non-pauper institution such treatment as the illness from which he suffers requires," the Central Authority will "offer no objection to his admission to the workhouse infirmary."[689]
To those boards of guardians who clung to the policy of "deterring" the sick poor from obtaining medical relief—which, as we have shown, Mr. Gathorne Hardy had, on behalf of the Central Authority, in 1867 expressly repudiated[690]—all this official encouragement to enter Poor Law institutions seemed revolutionary. The fact that the sick poor came more and more to draw a distinction between the workhouse on the one hand, and the Poor Law infirmary or isolation hospital on the other, appeared seriously objectionable. When it was noticed that the Central Authority officially styled the separate institution for the sick "an asylum for the sick poor,"[691]or "the hospital," or simply the "infirmary,"[692]the Manchester guardians revolted, and definitely instructed their medical and relieving officers "to avoid using the word 'hospital' or 'infirmary,' and simply to use the word 'workhouse.'"[693]Other boards, we believe, insisted—although "the infirmary" was an entirely distinct institution—that it should be entered only through the workhouse itself. Against this lingering objection on grounds ofPoor Law policy to get the sick cured in the most efficient way, we see the inspectorate in the later years more and more explicitly protesting. "I wish it were possible," said Mr. Preston-Thomas in 1899, "to get rid of the name of workhouse (which, by the way, has become singularly inappropriate), for I believe that it is to the associations of the name rather than to the institution itself that prejudice attaches. The disinclination of the independent poor to enter the hospitals of the Metropolitan Asylums Board, which was considerable at first, has now practically vanished, and I do not see why there should not be the same change of feeling with regard to Poor Law infirmaries in the country."[694]
In the same spirit we see the Central Authority in these three decades persistently pressing Boards of Guardians to build new workhouse infirmaries.[695]The report becomes current in the Poor Law world that Local Government Board officers, in interviews, went so far as to say that a certain board of guardians was morally guilty of manslaughter in refusing to embark on extensive new building operations. The official architect's criticisms on the Poor Law infirmary plans submitted to him are all on the lines of making these into up-to-date general hospitals. The proposals sanctioned by the Central Authority go up to a capital outlay of £350 per bed. The Central Authority even sanctions special hospitals established by the guardians at the expense of the poor rate, for particular classes of patients, such as the "West Derby, Liverpooland Toxteth Park Hospital, ... for the reception of persons suffering from tuberculosis," many of whom are so little destitute that they pay the cost of their treatment and maintenance;[696]or, as at Croydon, Kingston, and Richmond, "for the reception of epileptic and feeble-minded persons," who cannot be certified as of unsound mind.[697]Persons in receipt of medical relief only are no longer disqualified as paupers from being registered as Parliamentary and Municipal electors, and it has even been held that admission to a Poor Law hospital, sick asylum, or infirmary because of ill-health, and for the purpose of being medically treated, amounts to medical relief only, even though it incidentally involves also maintenance at the expense of the poor rate.[698]By 1903 we have the Central Authority laying it down in general terms, "that it is the guardians' duty to provide for their sick poor, and no sanction ... is necessary to sending such cases to institutions for curative treatment ... and ... paying reasonable expenses involved in so doing."[699]The Central Authority seems, indeed, to exhaust official ingenuity in securing the best possibletreatment and also the comfort of the patients in the sick wards.[700]Any reasonable fee may be paid for calling in consultants whenever the medical officer thinks it "necessary or desirable," without any special sanction being requisite.[701]We need not recite the constant struggle to get more nurses and better. As early as 1879 a president could (perhaps with some ministerial optimism) declare that: "in the new infirmaries I have succeeded in abolishing pauper help almost entirely."[702]
The guardians are reminded that the epileptics are especially to be incessantly accompanied by trained nurses, lest they should be suffocated in their fits.[703]The sick men in the workhouse may be allowed tobacco and snuff, the sick women tea, in addition to that prescribed in the dietary table.[704]The doctor is expressly reminded that it is his duty to "order such food as he may consider requisite."[705]When a complaint was made that beer was supplied in a Norfolk workhouse, the Central Authority refused to interfere with a "beer allowance" to sick paupers, given and renewed from week to week by direction of the medical officer.[706]The guardians are even reminded of the importance of providing illustrated books and newspapers for the sick.[707]
Meanwhile the standard of equipment, of resident medical attendance, and especially of trained nursing[708]required by theCentral Authority in the Poor Law institutions is constantly rising, in correspondence with the progress of hospital science. We see all this reflected in the advice and criticisms pressed by the inspectorate on the boards of guardians. "The workhouses of a past and bygone age," says Mr. Hervey in 1903, "are no longer refuges for able-bodied, but are becoming every day more of the nature of State hospitals for the aged, sick, and infirm.As such, they should be furnished with the very best nursing procurable."[709]
(iii.)The Municipal Medical Service
It may be that it is on the Public Health side, which was in 1871 added to the Poor Law work of the Central Authority, that we may trace the influence of the suggestion that was under discussion at the Poor Law Board under Mr. Goschen's presidency, just prior to its merging in the Local Government Board. The idea of "free medicine to the poorer classes generally, as distinguished from actual paupers, and perfect accessibility to medical advice at all times under thorough organisation"—which the new permanent secretary, Sir John Lambert, may have brought back from his official visit to Ireland—finds a certain expression in the Public Health Act of 1872, re-enacted with additions in 1875, which created "one local authority for all public health purposes in every place, so that no area should be without such an authority, or have more than one." In the rural districts the board of guardians became this authority. As such they came under a series of responsibilities based upon ideas diametrically opposed to those of the Poor Law. Instead of confining their actionto actual applicants for help, they had to search out cases of nuisance or dangerous disease. Instead of restricting their administration to those who were willing and anxious for it, they were charged with compelling to be done all that was required. Instead of being limited in purview to a small class specially stigmatised as paupers, the guardians had to consider the whole population as needing their attention without distinction of class or subjection to stigma. They were expressly authorised, not merely to repress nuisances, but to provide hospitals "for the use of the inhabitants," without any limitation to infectious or any other diseases.[710]They were even empowered, with the consent of the Central Authority, to "provide or contract with any person to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their district."[711]The Central Authority eagerly pressed on the local authorities the policy of the new Act.[712]We see the Poor Law inspectors—who were "in possession of the views of the (Local Government) Board on the subject"—explaining to boards of guardians in unions having rural districts their new duties; the future work of their new Public Health staff of medical officer of health and sanitary inspectors; and their responsibility for maintaining and improving the health, not of paupers only, but of the whole community.[713]We are not here concerned with the progress of public health administration, in which the boards of guardians cannot be said to have been apt or willing disciples. It is not to the boards of guardians, in 1907 still the sanitary authorities in non-urban districts, that we owe the elaborate medical organisation of an up-to-date Public Health Department, with its peripatetic health visitors and diagnosing doctors, its milk depots and campaign against infantile mortality, its gratuitous supply of anti-toxins and diarrhœa medicine, its gratuitous hospitals and sanatoria no longer confined to smallpox and fever. We need only notice here the gradualappreciation, by the Central Authority and the Poor Law inspectors, of the intimate connection between shortcomings in the public health service and an excess of pauperism. Even from the narrowest standpoint of Poor Law principles, the causal connection between disease and pauperism could no longer be ignored. "The effect of bad house accommodation on the health of the poor," writes Mr. Bagenal in 1902, "has often been demonstrated by experts in public health. Not only are serious illnesses more frequent, but damp and draughty dwellings lower vitality to such an extent that the bodily vigour and activity, as well as the spirits, are affected, and the system becomes unable to withstand actual disease. Families are often pauperised on account of sickness produced by living in unhealthy conditions. Labourers also often become permanently disabled, and fall upon the rates, owing to premature old age brought on by insanitary houses. To prevent sickness and to prolong the working term of a labourer's life must be a gain to the ratepayers, as well as to all classes of the community."[714]To take only one specific instance, in the Redruth Union the reason for a high average of pauperism in 1906 was found in the large amount of destitution produced by "miner's phthisis," and the great number of widows and orphans which it caused, "the total number of persons pauperised owing to this special cause being ... 333," besides other cases of infirmity of the miners themselves. "A substantial proportion of the excessive pauperism in the Redruth Union is thus accounted for."[715]
F.—Persons of Unsound Mind
It does not seem necessary to trace the slight changes in the law relating to pauper lunatics, or in the orders and circulars of the Central Authority. There appears to have been no alteration in the relation of the Central Authority to the Lunacy Commissioners, practically no steps being taken to initiate policy except upon the suggestion of the latter, whose standard of accommodation and treatment continues steadily to rise for pauper as for non-pauper lunatics.
The only point of interest is the continuance, virtually unchanged, of the three methods of treatment, viz. maintenance in the workhouse, treatment in a lunatic asylum, or grant of outdoor relief.
The number of persons of unsound mind in the workhouse continued practically undiminished, without any steps being taken to prevent their retention among the aged, the sick, and the children, who came more and more to make up the workhouse population.[716]There were, in fact, three classes of cases in which a lunatic might be detained in a workhouse. Firstly, there is the old provision, under which "the visitors of any asylum may, with the consent of the Local Government Board and the Commissioners, and subject to such regulations as they respectively prescribe, make arrangements with the guardians of any union for the reception into the workhouse of any chronic lunatics, not being dangerous, who are in the asylum, and have been selected and certified by the manager of the asylum as proper to be removed to the workhouse."[717]Secondly, "where a pauper lunatic is discharged from an institution for lunatics, and the medical officer of the institution is of opinion that the lunatic has not recovered, and is a proper person to be kept in a workhouse as a lunatic, the medical officer shall certify such opinion, and the lunatic may thereupon be received and detained against his will in a workhouse without further order, if the medical officer of the workhouse certifies in writing that the accommodation in the workhouse is sufficient."[718]Thirdly, if it is necessary for the welfare of a lunatic, or for the public safety, that he should immediately be placed under care and control, pending regular proceedings for his removal, he may be taken to a workhouse (if there is proper accommodation therein) by a constable, relieving officer, or overseer, and may be detained there for three days, during which time the proceedings are to be taken; and in any case in which a summary reception order has been or might be made, he may be further detained on a justice's order till he can be removed, provided that the period doesnot exceed fourteen days.[719]Moreover, any other lunatic might be "allowed to remain in a workhouse as a lunatic" if "the medical officer of the workhouse certifies in writing: (a) that such a person is a lunatic, with the grounds for the opinion; and (b) that he is a proper person to be allowed to remain in a workhouse as a lunatic; and (c) that the accommodation in the workhouse is sufficient for his proper care and treatment, separate from the inmates of the workhouse not lunatics, unless the medical officer certifies that the lunatic's condition is such that it is not necessary for the convenience of the lunatic or of the other inmates that he should be kept separate." Such a certificate signed by the medical officer is sufficient authority for detaining the lunatic in a workhouse for fourteen days, but no longer, unless within that time a justice signs an order for his detention. Failing such a certificate, or, after fourteen days, such an order, or if at any time the lunatic ceases to be "a proper person to be allowed to remain in a workhouse," he becomes "a proper person to be sent to an asylum," and proceedings are to be taken accordingly.[720]
Meanwhile the Central Authority continued to permit the grant of outdoor relief in cases of lunacy; and about 5000 were always so maintained.
Regulations for the boarding-out of pauper lunatics first appear in the Act of 1889. "Where application is made to the committee of visitors of an asylum by any relative or friend of a pauper lunatic confined therein that he may be delivered over to the custody of such relative or friend, the committee may, upon being satisfied that the application has been approved by the guardians of the union to which the lunatic is chargeable, and, in case the proposed residence is outside the limits of the said union, then also by a justice having jurisdiction in the place where the relative or friend resides, and that the lunatic will be properly taken care of, order the lunatic to be delivered over accordingly." The authority liable for such a lunatic's maintenance is to pay an allowance for his support to the person who undertakes his care; the medical officer of the district is to visit him and report tothe visiting committee every quarter, and two visitors may at any time order the lunatic to be removed to the asylum.[721]Any two Commissioners have also the right to visit any pauper lunatic or alleged lunatic not in an institution for lunatics or in a workhouse, and call in a medical practitioner; if the latter signs a certificate, and they think fit, the Lord Chancellor may direct that the lunatic be received into an institution.[722]
For the paupers of unsound mind in the Metropolis there was even a fourth alternative, namely, the "district asylums" of the Metropolitan Asylum Board. On the opening of the Darenth Asylum, the Central Authority quoted, without disapproval, the following remarks of the Lunacy Commissioners: "The withdrawal, for proper care, of helpless children of this kind [idiots] from the households of many of the industrious and deserving poor is a frequent means ofwarding off pauperism in the parents."[723]We do not find, however, any more explicit statement on this point. What the Central Authority continued to press on the Boards of Guardians was, not so much the importance of relieving the struggling poor from the burden of their insane or idiotic dependants, nor yet the freeing of the workhouses from the presence of persons of unsound mind; but rather of appropriate discrimination. "It is of great importance not merely to exclude from the [district] asylums those who, by reason of violence or irritability, are proper subjects for the county asylum, but also those who, from old age or disease, are unfit for the journey to the asylum, or who, from the slight degree to which their mind is affected, might more properly remain in the workhouse."[724]"The removal of helpless, bedridden persons, whose mental weakness is, in many cases, the result of old age, to asylums situated a considerable distance from the Metropolis, is calculated, on the one hand, to be injurious to the persons thus removed, and, on the other, to occupy the district asylums with a different class of persons from that for which they were constructed."[725]Imbecile children are to be kept in the workhouse till they are five years old, and may thenbe sent to the asylum at Darenth.[726]Outside the Metropolis there is no specialised Poor Law provision for idiots, who, if not received into the county asylum, must either be placed in non-Poor-Law institutions at considerable expense, or detained in the workhouse. In 1885 the Central Authority even suggested that harmless and aged lunatics had, on grounds of economy, better be retained in the workhouse, rather than removed to an asylum.[727]We hear incidentally of a Special Order in 1900 under which certain chronic lunatics were actually transferred from the Suffolk County Asylum to the workhouse of the Mildenhall Union.[728]As late as 1905 we find the Central Authority expressing regret that so many cases of senile imbecility were removed from the workhouses to asylums.[729]
Under this policy the number of paupers of unsound mind receiving outdoor relief diminished very slightly, being 4736 on 1st January 1906; those in the asylums of the Metropolitan Asylums Board and in county and borough lunatic asylums rose to no fewer than 92,409; whilst those in workhouses nevertheless did not fall off from the total of thirty-five years previously, being, in fact, on 1st January 1906, 11,484, or an average of nineteen in each workhouse.[730]
Towards the latter part of the time we begin to find the inspectors, somewhat in disaccord with the suggestions of the Central Authority itself, protesting against the presence in the workhouses even of the chronic lunatic, the harmless idiot, or the senile imbecile, on the new ground that their presence caused annoyance to the sane inmates—annoyance which had, for seventy years, been apparently either unnoticed or not considered. "I am sorry to say," reported Mr. Preston-Thomas in 1901, "that in all but six of the workhouses in my district imbeciles mix freely with the other workhouse inmates. Many of them are mischievous, noisy, or physically offensive.
In some instances, even if their bodily ailment is very slight, they sleep in the sick wards in order that they may come under the supervision of the nurses, and they frequently disturb other patients at night. By day they are a source of much irritation and annoyance, and in a small workhouse I have known the lives of a number of old men made seriously uncomfortable by a mischievous idiot for whom no place could be found in an asylum.... I am much afraid," prophetically continued Mr. Preston-Thomas, "that ... the question will be postponed indefinitely, and six or eight years hence the idiots will still be worrying the sane inmates of workhouses.... It is in the country workhouses, sometimes with only a dozen imbeciles or less, divided among the sexes, that the chief difficulty arises.... A good many are often found useful in the laundry and other domestic work of the institution, but I do not think this consideration ought to outweigh what may almost be characterised as the cruelty of requiring sane persons to associate, by day and by night, with gibbering idiots."[731]When the Select Committee on the Bill to establish Cottage Homes for the Aged Poor in 1900 strongly recommended the removal of all imbeciles from workhouses, the Central Authority, observing that the advisability of this step had been repeatedly brought to its notice by guardians and others, declared that the question must be deferred.[732]
G.—Defectives
For the first twenty years after 1871 there is no alteration of policy to record with regard to defectives. In fact, the Central Authority does not seem to have paid much attention to this class, whether mentally or physically defective, during this period. It enjoined no policy for the treatment of them till 1891. A Circular on "Blind and Deaf and Dumb inmates of Workhouses" then required the inspectors to "continue to give special attention" to children among this class, and urge their removal from the workhouse when desirable. It was held that the guardians might, if theychose, pay the whole of the maintenance of deaf and dumb children sent to appropriate institutions. No limit has been fixed, but in no case has more than £20 a year been sanctioned.[733]Adults also were to be given instruction in reading and writing, if able to profit thereby, and if such instruction could not be provided in the union, they might be sent, under contract, to the workhouse of some other union where teaching might be available, either in the workhouse or in the town. It is also suggested that arrangements might with advantage be made for reading aloud to the aged blind in the workhouse. But it was held to be illegal to pay for the technical instruction of blind workhouse inmates at a non-Poor-Law institution.[734]From 1903 onward, however, we have the almost dramatic extension of the scope of the Education Authority with regard to defective children of all kinds—a change which has already gone far to transfer responsibility for the treatment of the blind, the deaf and dumb, the crippled, the epileptic, and the mentally defective children up to sixteen from the Poor Law to the Education Authorities. The first step was the Act of 1893, which required the local Education Authority to provide education for blind and deaf children; but children sent to any institution from the workhouse, or boarded out by the guardians, were expressly excluded.[735]In 1899 similar provision was made for defective and epileptic children; and the guardians were authorised to arrange with the Education Authority to take over Poor Law cases on payment.[736]Under these Acts provision is more and more being made, especially in London, for the education, treatment, and even (where requisite) maintenance in educational institutions of these children up to sixteen.
In 1903 a Special Order provided for the transfer, from the Metropolitan workhouses to the special homes of the Metropolitan Asylums Board, of children who, without beingcertified as of unsound mind, were mentally defective; and for their retention in such homes until twenty-one years of age.[737]We do not find any corresponding provision with regard to the mentally defective children outside the Metropolis; or for the mentally defectives beyond sixteen years of age. In the rural workhouses, at any rate, which make up three-fourths of the whole, it would seem that in 1907, as it was officially reported in 1879, these mentally defectives, together with "the imbeciles, are more or less mixed up with the ordinary inmates of the class to which they belong."[738]
In recent years we see the Central Authority willingly sanctioning special provision for individual cases. Thus, special assistance may be given for starting in trade persons handicapped by their infirmities. In one case, the Board sanctioned the purchase of tools for a blind man who had been taught a trade.[739]In another case, "an adult having become incapacitated by reason of accident from again following his usual occupation, the guardians were desirous of paying a premium in consideration of his being taught a trade which the nature of his infirmity would not prevent his carrying on. On the proposal being submitted to the Local Government Board, the Board observed that as the person was too old to be bound as an apprentice, there was no authority for the payment of the premium, but they suggested whether the difficulty might not be overcome by out-relief being granted during the period of learning."[740]
A third instance is given as follows: "A boy, aged sixteen years, has been a pupil at an institution for the blind, the fees for his board and education having hitherto been paid by the said board [of guardians] under the Elementary Education (Blind and Deaf Children) Act 1893. The boy is desirous of competing for a scholarship of the value of £40 a year from the Institution for the Blind in London; total fees, £60 a year. The guardians wish to contribute £13 a year, the father, who earns on an average £2:2s. a week, being willingto pay the balance of £7, in addition to travelling expenses and outfit. The Board hold that the guardians can, assuming the boy is in need of relief, carry out their proposal under 30 and 31 Vic. c. 106, sec. 21."[741]An interesting feature of this case is the vagueness of the term "in need of relief," instead of "destitution."
H.—The Aged and Infirm
(i.)Outdoor Relief
The crusade of the inspectorate of 1871-85, in favour of the "workhouse system" of Poor Law relief, made no exception in favour of aged persons, whether deserving or undeserving, any more than it did in favour of widows with young children or the sick. On the contrary, Mr. Longley assumed, in every paragraph of his Report,[742]that the "workhouse principle" was universally applicable to "the disabled"—the term he used for the aged and infirm—as well as to the able-bodied. A rigid adherence to the policy of "offering the House" would, he argued, lead the poor to provide, or induce their relatives to provide, for old age as well as for sickness and widowhood.[743]Further, Mr. Longleystrongly deprecated any deviation in particular cases from what he euphemistically called "the offer of indoor relief." "That which an applicant does not know certainly that he will not get," he forcibly argued, "he readily persuades himself, if he wishes for it, that he will get; and the poor, to whom any inducement is held out to regard application for relief as a sort of gambling speculation, in which, though many fail, some will succeed, will, like other gamblers, reckon upon their own success."[744]For every "hard case" he relied on the springing up in every union of intelligently directed private charity. "It is, in fact, the very existence of charity"—assumed thus to be always at hand whenever required—"which strengthens the hands of the Poor Law administrator in adherence to rule."[745]Yet, with a certain want of logic, he desired this charitable provision to remain "precarious" and "intermittent;" something which it was possible to argue would always be there when a "hard case" occurred, and which, nevertheless, could not be counted upon by the poor themselves. In other words, he seemed to imply that charitable outdoor relief was superior to Poor Law outdoor relief for the very reason that though some applicants for it would succeed, others in like circumstances would fail to get it—thus inducing, one would have thought, exactly the spirit of "gambling speculation" on the part of the poor that he clearly perceived to arise from the adoption by boards of guardians of an intermittent and uncertain relief policy.