On 8 February 1867, Mr. Gathorne Hardy introduced his Metropolitan Poor Bill. In broad terms, its purpose was to extend the 1834 Poor Law Amendment Act, so far as the metropolis was concerned, by providing for the separate management of certain categories of the non-able-bodied poor, for whom the deterrent principle was inappropriate. A system of medical care was to be inaugurated by the creation of hospitals and dispensaries; and for this purpose the unit of administration and finance was to be extended beyond the existing parishes and unions. In order to implement its new policy, the Poor Law Board asked for wider and more specific powers of control.
This proposed legislation amounted to an explicit acknowledgment of the State’s responsibility for the destitute sick as a class, entirely separate from the able-bodied poor; and, as such, it introduced a fundamental variant of traditional poor law practice. For Gathorne Hardy, head of an impermanent ministry and member of a party without a straight majority, this was not an easy measure to steer through the House of Commons. While his own right wing might curb advances it considered revolutionary, the radical opposition would insist that he was insufficiently progressive. The Bill was skilfully drafted for Gathorne Hardy’s immediate purposes, even though later developments were to disclose technical flaws concerning its implementation.2 It provided a flexible framework in which a smaller or larger number of projects could be initiated, on a lesser or greater scale, with varying degrees of local participation and central control.
Gathorne Hardy began his introductory speech with a dispassionate account of the evils which the measure was designed to eradicate. He reported the unpalatable facts with disarming frankness, and submitted his solution with impressive sincerity and confidence. Sedulously, he abstained from attributing blame. The office of a guardian is one of great difficulty and delicacy’, he observed, speaking with first-hand experience as an ex officio member of a Kentish board of guardians. It was expedient for Gathorne Hardy to respect the sensitivity of the parochial mind on the subject of local self-government. It was also necessary to win the confidence of the radical opposition, particularly that of his predecessor in office, Mr. C. P. Villiers. Formerly, medical men and the Poor Law Board itself believed that there was much less necessity for greater space, paid nurses and other appliances than is now thought requisite’, Gathorne Hardy asserted. ‘We can only act up to the lights we have’. He could not refrain, however, from expressing surprise that, as recently as 1864, the House of Commons Committee on Poor Relief had recorded its satisfaction with the medical treatment of the poor generally. Nevertheless, he applauded the Chairman of that Committee (Mr. Villiers) for recommending that the authority of the Poor Law Board should be confirmed and strengthened, and, in particular, that more powers should be given for the purpose of effecting a better classification in workhouses.’
Gathorne Hardy’s measure provided for such additional powers and for a new basis of classification. With dramatic emphasis, he defined his new policy and the use to be made of the authority for which he asked:
“There is one thing [he declared] which we must peremptorily insist on—namely, the treatment of the sick in the infirmaries being conducted on an entirely separate system; because the evils complained of have mainly arisen from the workhouse management, which must to a great degree be of a deterrent character, having been applied to the sick, who are not proper objects of such a system. That is one thing which I should insist upon as an absolute condition. I propose, therefore, that power shall be given to combine such districts as the Poor Law Board may think proper—whether parishes and parishes, unions and unions, or unions and parishes—under a more complete system of inspection and control.”
His main object, he continued, was to classify the inmates of workhouses, as the Poor Law Inquiry Commissioners had apparently intended when they reported in 1834 that the Central Board
“. . . should be empowered to cause any number of parishes to be incorporated for the purpose of workhouse management, and for providing new workhouses where necessary and to assign to those workhouses separate classes of the poor. . . . Each class might thus receive appropriate treatment; the old might enjoy their indulgences without torment from the boisterous, the children be educated, and the able-bodied subjected to such courses of labour as will repel the indolent and vicious.”
`In carrying out their intention’, Gathorne Hardy went on, they seem to have come to a different conclusion, for, so far as I can see, no step was taken in this direction.’
The aged, the sick and the infirm, he explained, had become the main occupants of workhouses since the time when they were originally designed for the purpose of deterring the able-bodied. Of nearly 27,000 inmates in the London institutions, less than 900 men and about 2,000 women were classed as able-bodied. Except for some 3,000 children, the remainder—about 21,000—were all sick, old or disabled. Of these, about 2,000 were classed as imbeciles or lunatics.’ Gathorne Hardy proposed to legislate in accordance with the recommendations of his expert advisers, who had urged the necessity for greater space in the workhouses. In order to obtain this, he proposed, first, to remove the lunatics and imbeciles and to place them in new, separate establishments. This category would comprise the inoffensive cases who required ‘none of the restraints nor the luxuries and advantages which were available for the other and more dangerous class in county asylums ‘. Secondly, he would provide separate accommodation for seven to eight hundred needy persons suffering from fever and smallpox. Prophetically, Gathorne Hardy expressed the hope that
“the time will come when by proper attention to the use of those remedies which science has discovered—vaccination on the one hand, and good sanitary arrangements on the other—we may be able to dispense with these hospitals almost entirely. We cannot, however, do so at present [he continued] and it is a most material thing for the people themselves, and for others in the workhouse, that, to avoid risk of spreading the disease, they should be removed.”
Hitherto, some of these cases had been treated in the charity-supported institutions of London, but, Gathorne Hardy urged, it was a matter of real necessity to build some entirely under poor law management. In the proposed new hospitals, he hoped to ensure resident medical officers, independent matrons and paid nurses, as well as to provide for medical instruction.
Further, as ‘half the pauperism of the country originated in sickness’, it was proposed to erect dispensaries in different parts of the metropolis in order to prevent so many people coming into the hospitals. District medical officers would attend the outdoor poor at specified hours and would be obliged to keep written records of the drugs dispensed. This requirement was aimed to remedy the loose system of prescribing which was known to exist in the poor law medical service. (Mr. Gathorne Hardy cited instances where poor law patients sent a relative, sometimes a child, to the district medical officer. Medicine was dispensed on the basis of the second-hand description of the symptoms, sometimes with fatal results. He also referred to the practice in some workhouses of providing what was called ‘house medicine’, which was dispensed by pauper nurses to whoever applied for it.) Gathorne Hardy explained that, although this might be considered a cumbersome procedure, it was carried out effectively in Paris and in Ireland. The dispensary system would help to prevent the spread of disease by providing early treatment.
It was estimated that the new schemes would cost about £6o,000 a year to operate, a sum which could be met by a metropolitan poor rate of one penny in the pound. Capital costs would be in the region of £400,000. This would include £100,000 for institutions for the insane; £50,000 to £70,000 for isolation hospitals; a similar sum for additional school buildings; and £120,000 for other sick paupers. These estimates were based on a rate of £50 per head for children and lunatics and £60 per head for the acute sick. An additional metropolitan rate of two-thirds of a penny in the pound would cover loan charges for the capital outlay.’
As the author of the Bill unfolded his plans, the additional degree of central control involved in each innovation appeared reasonable and not unduly excessive. The total effect, nevertheless, represented an appreciable diminution in parochial autonomy. The Poor Law Board was to be empowered to combine existing parishes and unions into Asylum Districts. The institutions for these new areas would be administered by boards of management composed partly of elected guardians and partly of Poor Law Board nominees, but the number of appointed members would not exceed one-third the number of guardians. Nominees of the PLB were originally to be chosen from citizens rated at not less than £100 p.a., but Mr. Gathorne Hardy made it clear that he would be more than gratified if this figure were deleted and the choice were left to the PLB. (In the Act, as passed, the qualification was reduced to £40 p.a., the same as for elected guardians.) The object, Gathorne Hardy explained, was to make some persons responsible who might be volunteers and who would be removed if they did not discharge the duty which they had undertaken. It was not intended that they should come into collision with the elected members’. In effect, the inclusion of nominated members would be little different from the presence of Justices of the Peaces as ex officio guardians on existing boards, Gathorne Hardy explained, as he sought to allay fears of central interference in the local management of the projected hospitals. (Before 1834, local administration of the poor law in the counties had been in the hands of the Justices of the Peace. There was then little, if any, control by a central administrative authority. Since the 1834 Act, Justices of the Peace had been ex officio members of all boards of guardians.)
Further, the Poor Law Board was to have authority to make similar appointments to any board of guardians or any district school board, should it be deemed necessary. As a less expensive and more speedy remedy than a mandamus, the Poor Law Board would also be empowered to recruit nurses and other officers, if local boards neglected to make the requisite appointments. Such action would only be taken in the case of those authorities who were continually considering, putting off, hoping that something would turn up to save them the necessity of complying.
Next, Gathorne Hardy intended to abolish Local Acts. Hitherto, the majority of the large parishes in the metropolis had been able to defy the central authority because they were administered under Local Acts by independent governing bodies, which were responsible for the management of the poor, in addition to a variety of other functions. One such parish was that of St. Giles, Bloomsbury, where the pauper, Gibson, had died from neglect. These Local Acts had been among the greatest impediments with which the Poor Law Board had had to contend. Everything went wrong in consequence of this double government’, Gathorne Hardy explained. “I am willing to be responsible for the condition of the workhouses’, he declared emphatically, `if I have—and only if I have—power to enforce obedience to any orders I may issue.’ With the Local Acts out of the way, the whole of the metropolis would be under the administrative control of the Poor Law Board, as intended by the 1834 Act. The Board was, therefore, asking for authority to direct that any London workhouse should be used as an asylum for the sick or for any other class of the poor. By this means, it would be possible to extend the scheme of classification begun by the separation of the infectious and the insane. Thus, the central authority was to be empowered to intervene in the administration and management of every area of relief in the metropolis, either immediately or when deemed necessary. When the reactionary element in the House expressed concern at the apparent undermining of local responsibility, Gathorne Hardy calmed their fears of bureaucratic domination by declaring that ‘there was nothing in the Bill to abolish self-government: indeed under its provisions, local government would have the fullest scope for its exertions.’
The President of the Poor Law Board then outlined the financial concessions which he proposed to offer. The burden of poor relief was to be more evenly distributed among the parishes and unions of London by the creation of a Common Poor Fund. Each locality would be obliged to contribute on a proportional basis, and each would be eligible to claim repayment for certain items of relief expenditure. These would include the cost of drugs, and the salaries of all officers, both medical and lay, employed by boards of guardians, managers of poor law schools, the new asylum boards and dispensary committees. The fund would also bear the cost of maintaining infectious and insane patients in the new hospitals. Gathorne-Hardy said little concerning the operation of the fund and nothing about its possible use as an instrument of coercion. The Bill, however, made it plain that it was to be under the control of the Poor Law Board, which would appoint a Receiver to administer it, and assess, on the basis of rateable value, each locality’s contribution to the revenue of the fund. Claims were also to be subject to Poor Law Board orders. The threat of central authority intervention in cases of non-compliance could be inferred from references to compensation payable from the fund to poor law officers whose contracts might be varied through the operation of the Act.
The principle of collective responsibility for the support of the needy had been applied in the past within relatively limited areas. As early as the mid-sixteenth century, statutory collections had been made from the inhabitants of the more affluent neighbourhoods of cities and corporate towns for the purpose of relieving destitution in the poorer districts. In 1555, it was decreed (2&3 P&M c. 5) that in cities and corporate towns not co-terminous with a single parish, the mayors and other head officers were to `consider the estate and ability of every parish’, and if they found that the parishioners of any one parish were of such wealth and haviour that they have no poverty amongst them, or be able sufficiently to relieve the poverty of the parish where they inhabit and dwell and also to help and succour poverty elsewhere further’, they might then `with the assent of two of the most honest and substantial inhabitants of every such wealthy parish’ consider the needs of all the inhabitants of the town and move, induce or persuade the parishioners of the wealthy parish charitably to contribute somewhat according to their ability towards the weekly relief of the poor in the other parishes. When provision for the poor in this semi-voluntary manner proved inadequate, compulsion by magistrates was introduced by an Act of 1563 (5 Eliz. c. 3).
During the nineteenth century, the unit of relief was extended beyond the parish of Elizabethan legislation. The Poor Law Amendment Act of 1834 empowered parishes to combine into unions for the provision of workhouses; the Poor Law Amendment Act of 1844 permitted poor law localities in London and other large towns to combine into districts for the relief of the itinerant poor, and for the care of destitute children; while, under Mr. Villiers’ Metropolitan Houseless Poor Act of 1864, all London parishes and unions were obliged to contribute to a common fund for the upkeep of casual wards for vagrants. (Under the Metropolitan Houseless Poor Act of 1864 (27 & 28 Vict. c. 116) the metropolitan unions contributed uniformly at the rate of one-eighth of a penny in the pound. The fund was administered by the Metropolitan Board of Works.) This system was to be extended for the purpose of financing Mr. Gathorne Hardy’s medical reforms. Both Dr. Hart of the Lancet Commission and Miss Nightingale had advocated a general poor rate for maintaining the destitute sick of the metropolis. This had been one of the salient features of the scheme which she had submitted to Gathorne Hardy and which he had declined to discuss with her.
The author of the Bill might escape Miss Nightingale in person, but her ABC pursued him into the House. She campaigned furiously between the first and second readings of the Bill, particularly for the inclusion of provisions which would ensure improved nursing for the poor. In the course of an eloquent, if defensive, speech, Charles Villiers recited Miss Nightingale’s hospital creed, and emphasized, in particular, the need ‘for properly trained nurses to attend upon the sick’, since this was ‘almost more important than the attendance of doctors or the administration of medicine’. He urged that the proposed hospitals should be superintended by persons whose education and interests qualified them for the post’, since experience had shown the inappropriateness of the guardians superintending establishments for the sick’. Public hostility, he explained, had hitherto made it impossible for the Poor Law Board to obtain the necessary powers to act. Only now, when events had shown that the paupers required central protection from their local oppressors, was the moment opportune for such powers to be sought.
It had been anticipated that Villiers would display considerable hostility towards Gathorne Hardy and his Bill. During the latter’s early days at the Poor Law Board, he had made his predecessor frantically angry by asserting in the House of Commons that fresh poor law legislation was quite unnecessary, provided the existing Acts were properly understood and applied. Villiers had confided to Florence Nightingale that ‘he was not going to sit down under this kind of thing’ and that ‘something more was needed to solve the poor law administration problem than a touch of Gathorne Hardy’s magic wand’.’ When the Bill was introduced, he had described it privately as ‘a seven months child born in the Whitehall Workhouse’. (Gathorne Hardy had been at the Poor Law Board seven months, while Villiers had served there for as many years.) But, so skilful and conciliatory was Gathorne Hardy’s presentation of the Bill that Villiers declared his full support for the new policy, and criticized it only on the ground that it did not go far enough. ‘The charge for the poor is as much a national charge as the interest on the National Debt’, he declared, `and it is only fair, when we can safely do so, to place it on the whole property of the country.’
Miss Nightingale had mobilized another willing mouthpiece in the House, her devoted brother-in-law, Sir Harry Verney, Liberal Member for Buckinghamshire. He advocated ‘one board for the uniform management of the sick poor of London . . . just as the general drainage of London was placed under the Metropolitan Board of Works.’ His object was `the cure of all the sick poor of the metropolis’ who, he urged, ‘should be placed under the care of trained nurses in a sufficient number of duly regulated hospitals’. The proposed Common Fund should be applied, he suggested, not only to the maintenance of the hospitals, but also to the cost of instructing the nurses. One of the few amendments made to the Bill in committee was Miss Nightingale’s recommendation, as presented by Sir Harry Verney, that the new hospitals should be used for the training of nurses as well as for medical instruction.
To his radical critics, Gathorne Hardy explained that, as it was not possible in principle to distinguish between the outdoor sick and the indoor sick, he had thought it advisable to take only those classes of disease which could clearly be separated from the rest and which affected the health of the whole metropolis—fever and smallpox. ‘These are not things, the relief of which can be traded in’, he explained. ‘Nobody will go into a smallpox or fever hospital who has not one of those diseases. Patients such as these endanger the health of the whole population. . .’ As for the lunatics, it could not be contended that they belonged more to one part of the metropolis than to another. ‘It is one of those items which cannot be jobbed: you cannot make lunatics for the purpose.’ To justify further the limitation of his scheme to certain classes of the sick, Gathorne Hardy explained that a sufficient number of new hospitals for all the sick poor of London would be extremely costly and render useless existing workhouses. Moreover, the vast institutions required would be susceptible to hospital diseases. ‘In the smaller establishments, with all their defects, gangrene, erysipelas and puerperal fever did not intrude’. In this way, Gathorne Hardy sought to suggest that immediate reforms of a more revolutionary nature were inadvisable. His real and concealed reasons were, doubtless, associated with the vast number of the sick poor in the London institutions, relative to the number of the able-bodied. To remove 21,000 sick and infirm from the workhouses and place them in hospitals would leave the guardians with only about 11 per cent of their total indoor pauper population. If the 3,000 children were also removed, as Gathorne Hardy contemplated, and the thirty-nine boards of guardians were left with only 3,000 able-bodied inmates scattered in forty-three large institutions, the existing structure of poor law administration in London would disintegrate completely. The principle of local self-government, being as deeply ingrained as it was, the Bill would have risked defeat at the prospect of the vast majority of the London poor being re-housed at great expense and removed from the jurisdiction of the elected guardians to that of indirectly elected and centrally nominated hospital managers. It seemed more expedient to Gathorne Hardy to manoeuvre for new powers in the first instance, and to use these for consolidating his experimental scheme as and when the temper of local susceptibilities permitted.
Gathorne Hardy was diverted from defending his policy by objections to terminology. In the Bill, the new establishments were referred to as asylums but throughout the debate Gathorne Hardy had spoken of ‘hospitals’. Both Charles Villiers and Sir Harry Verney, among others, urged him to use this term in the Bill. Exception was taken to the word ‘asylum’, not on account of its association with the county institutions for `lunatics’, but because, as one Tory member explained, there were asylums for the blind, the deaf and dumb, for indigent gentlemen and decayed merchants. If the word were applied to receptacles for paupers, it might bring discredit on the others’. Gathorne Hardy remained unmoved and the term ‘asylum’ was retained in the Bill to denote the establishments for the sick as well as for the insane.
The district hospital scheme, as expounded by Gathorne Hardy, left the House wondering what size the districts were intended to be. On occasion, he had mentioned one central board, but the context of such references suggested that he had in mind, not so much the management of the hospitals, as the administration of the Common Fund. When directly asked to specify the number of different boards which would be created under the Bill, Gathorne Hardy admitted that ‘this has been one of the difficulties that have dwelt in my own mind’. Miss Nightingale’s emissaries suspected that Gathorne Hardy’s mind was not irrevocably made up on this point, and they continued to urge—as she herself had done in her ‘ABC’—that ‘the entire medical relief of London should be under one central management’. John Stuart Mill, Member for Westminster, who also had been briefed in similar vein, made a persuasive and logical plea for a unitary authority. ‘Why’, he asked, ‘had the Bill . . . preserved so much of the fractional character of the old system?’ Its principles of administration seemed to him true and just’, but the Bill was far from carrying them out to the extent which, he was persuaded, the House and the country would come in time to think desirable.
“. . . It was a sound rule [he continued] that the administration of the same kind of things ought to be . . . on a large scale and under the same management. A central board would be under the eye of the public who would know and think more about it than about local boards. It would act under a much greater sense of responsibility. It was probable that a considerable number of powers now reserved to the Poor Law Board might safely be exercised by such a central board, which would to that extent preserve the principle of administration of the local affairs of the people by their own representatives. With a view to future legislation, it would be well worth considering whether the administration of relief of the sick for the whole of London should not be placed under central, instead of local, management. . . . The value of a central board to superintend the application of the resources of the whole Metropolis to the immediate exigencies of the distressed districts is obvious.”
Defender of individual liberty, John Stuart Mill was fundamentally opposed to social reform by the enlargement of State powers, but he did not wish to weaken the authority of the Poor Law Board, since the destitute were not a local but a national concern. Addressing the critics who had feared the creation of an intermediate board as a step towards centralization, he said that the denial of it would be a far greater step towards centralization. The powers which such a body was best qualified to exercise had become indispensable, and, in the absence of a central board, they would necessarily be assumed by a purely government board—the Poor Law Board. Charles Villiers, supporting John Stuart Mill’s advocacy of a single hospital board, said that he had failed to find any provision in the Bill calculated to have that effect. Replying to John Stuart Mill, Gathorne Hardy declared that `an experiment would be made by the Bill, which to a certain extent would effect the object which the honourable Member had in view. . .’ Either he had been converted by the exponents of a central board, or he had discovered unexpected support for his concealed intentions. For the first time during the debate, Gathorne Hardy made it clear that ‘it was not proposed to have a board of management for each separate hospital, but one for each district; so that, if the metropolis were made one district, a central board would be created. . .’
One of the most difficult clauses which Gathorne Hardy had to defend was that which decreed that ‘any order of the Poor Law Board under this Act shall not be deemed a General Order . . ‘ General Orders’ within the operation of the Poor Law Acts required the signatures of at least three Cabinet Ministers, members of the Poor Law Board, whereas ‘ Common Orders’, which also had the force of law, were signed only by the President and countersigned by the Permanent Secretary. (General Orders’ issued by the central poor law authority under the 1834 Poor Law Amendment Act were required to be communicated to the Home Secretary and formally laid before both Houses of Parliament.) The system of Orders’ was the principal means by which the central poor law department exercised its authority over local boards of guardians. The new measure would confer very great powers on the Poor Law Board—to take over buildings, buy land, sell property, grant compensation, alter poor law boundaries, administer a common fund, nominate hospital governors, and, if considered necessary, intervene in institutional management. Many such acts were to be executed by simple orders signed by the President of the Board. These would be statutory instruments, although they would lack the safeguards of Parliamentary sanction or shared responsibility: by this time the Poor Law Board had ceased to meet as a body. Gathorne Hardy confidently rode out the storm, and closed the discussion by declaring that ‘it did not carry the matter further if the papers were sent round in a box for the signature of the President’s colleagues. As soon as they saw his signature there, they added theirs as a matter of course, and there was an end of the matter.’ He, as President of the Poor Law Board, was ‘responsible for everything done ‘. Assessed in their entirety, Gathorne Hardy’s demands of Parliament appeared audaciously ambitious,. In effect, he was seeking to extend the operations of the `administrative State’, introduced by the 1834 Act, and to endow the head of a central department with wide discretionary powers to devise the detailed means for implementing policies broadly defined in legislation. But, so sagacious was his judgment and conciliatory his manner, that he dispelled with relative ease the fears of despotic centralization which threatened to obstruct the passage of his Bill.
Gathorne Hardy had been persuaded that a pilot scheme for London was the logical approach to poor law medical reform. The capital, home of one-quarter of the total urban population of England and Wales, was provided with the barest minimum of isolation accommodation. About one-sixth of the rate-aided poor of the country was the responsibility of the metropolitan poor law authorities, and the ten largest of these had displayed an intractable degree of defiance to central direction on account of Local Acts. Further, by reason of the varying states of affluence and poverty of its constituent localities, London was particularly suited to a collective system of responsibility for its poor. A national scheme, as Villiers had intimated, was not yet feasible. Describing his Bill as ‘a sketch which may hereafter be filled up ‘, Gathorne Hardy doubtless envisaged the completion of his reforms by subsequent legislation applicable to the provinces after the new measures had been adopted successfully in the capital. The Poor Law Amendment Act of 1868 (31 & 32 Vict. c. 122 s. 8) empowered provincial poor law authorities to provide separate infirmaries, but it was a whole generation before even a dozen unions in the larger towns got their separate infirmaries and dispensaries. They had no financial stimulus such as the Common Poor Fund.
The legend of nineteenth-century laissez faire was losing ground. While Hansard records the animated and constructive debates on the Bill, Gathorne Hardy’s personal diary best defines the climate in which the founding of England’s first State hospitals was sanctioned.
February 9: My Bill came on yesterday. . . . I got a most attentive hearing, and so far as talking went, universal approval . . .
February 24: On Thursday night . . . my Poor Law Bill came on for second reading. . . . It was duly puffed by every speaker, and even Villiers had but small criticisms to make. March io: On Friday evening, after long waiting, I at last got my Bill on, and the Committee carried me through 3o clauses with steady and earnest support. Indeed, I never saw anything like it.
March 12: Last night I got through Committee with my Bill almost unchanged and ended amid loud cheers. Resistance to it was hopeless.
On 14 March 1867, the Metropolitan Poor Bill was passed amid further enthusiasm and acclaim. Disraeli wrote exuberantly to the Queen describing the extraordinarily favourable impression made by Mr. Gathorne Hardy and his new poor law legislation ‘. For the author of the Bill, it was a political triumph; for the reformers, the new measure was a victory, even if it fell short of all they had hoped. Miss Nightingale was angry, nevertheless, because Gathorne Hardy had not consulted her about the new hospitals and had failed to make direct provision for the improvement of workhouse nursing. Giving vent to her disappointment, she scribbled on a draft copy of the Bill: ‘Humbug ‘ No principles’, `Beastly!’. In calmer mood, she was able, later, to appreciate the advances which would be assured by the operation of the Act. ‘ This is a beginning. We shall get more in time’, she wrote confidently to a friend.
On 29 March 1867, the Bill received the Royal Assent. Six weeks later, Gathorne Hardy decreed that all the unions and parishes of the metropolis should be combined for the reception and relief of the London rate-aided poor suffering from smallpox, fever or insanity, and that, for this new hospital region—to be known as the Metropolitan Asylum District—a Board of Management should be constituted. The Metropolitan Asylums Board was thus given statutory existence. Without disrupting the structure of London’s poor law administration, Gathorne Hardy had instituted a central hospital system which would confer preventive benefits upon all constituent localities, and a Common Poor Fund which would equalize their relief burdens. Immediately after signing the birth certificate of England’s first regional hospital board, the President left the Poor Law Board to take up his new appointment as Home Secretary.
During the following year, the implementation of the Metropolitan Poor Act was carried a stage further. Six ‘Sick Asylum Districts’ were formed. Each comprised four or five unions, which were ordered to erect a joint asylum’ for the general sick poor. Owing to the high cost of building, only two survived. The constituent unions of the disbanded `sick asylum districts’ were re-grouped with a view to one of the existing workhouses in each of the new areas being allocated exclusively to the sick. The remaining localities were instructed to ‘provide infirmaries on sites detached from the workhouses’. As a result, some twenty separate poor law infirmaries, with 10,000 beds, were established in London during the next decade. For the outdoor sick, the guardians were urged to set up dispensaries under the Act; and during the same period all but three of the metropolitan unions and parishes successfully adopted this form of medical relief. By 188o, twenty-seven of the thirty metropolitan unions had established forty-seven dispensaries. Some of them were set up only because the guardians feared the PLB would use its power over the Common Poor Fund under the 1867 Act.
State hospital services for the London poor were thus inaugurated. `Gathorne Hardy’s Act ‘—as it came to be known—proved to be the most important poor law measure for London between 1834 and 1929 and a significant step towards the socialization of medical care in this country.