MAB , Metropolitan Asylums Board x Metropolitan Asylums Board

The Metropolitan Asylums Board was established by an Order of the Poor Law Board, 15 May 1867. This Order combined the London unions and parishes in to one 'Metropolitan Asylum District' to comply with the stipulations of the Metropolitan Poor Act of 29 March 1867 (30 and 31 Vict c 6). This Act provided for "the Establishment in the Metropolis of Asylums for the Sick, Insane, and other Classes of the Poor and of Dispensaries; and for the Distribution over the Metropolis of Portions of the Charge for Poor Relief; and for other Purposes relating to Poor Relief". The Metropolitan Asylum District was responsible for "the reception and relief of poor persons infected with or suffering from fever or the disease of smallpox or who may be insane".

The first Metropolitan Asylums Board consisted of 60 members, 45 represented the parishes and unions of London and 15 were nominated by the Poor Law Board (afterwards by the Local Government Board and latterly by the Ministry of Health). The number was subsequently increased to 73 members.

Fever and smallpox epidemics had revealed deficiencies in Poor Law provision in the Metropolitan area. In most unions patients suffering from all diseases were crowded together in the workhouse infirmaries. The Boards first task was to devise ways of isolating patients with infectious diseases. The main difficulties confronting the Board were the spasmodic nature of the demands for hospital accommodation during the first 30 years of its existence (the worst outbreaks of smallpox occurred in the years 1870-2, 1884-5, 1893-4 and 1901-2), the objections of local residents to the establishment of hospitals in their neighbourhoods and the statutory limitation of patients to persons within the scope of the Poor Law.

MAB was delegated responsibility for accommodating and treating different diseases during the course of its life (taken from Ayers, 1971, pp 269-270):

Physical disorders:

Infectious and contagious diseases

1867 Scarlet fever; typhoid fever; typhus, smallpox. Poor law cases only before 1883

1883; 1893; 1894 Asiatic cholera. Accommodation available in case of need.

1888 Diphtheria. Poor law and non-pauper cases admitted from 1888. Free treatment after 1891

1905 Plague. Accommodation available in case of need.

1907 Cerebro-spinal meningitis

1911 (Feb) (Poor law)

1911 (May) Measles (non-pauper)

1911 Whooping-cough (poor law)

1912 Whooping-cough (non-pauper)

1912; 1926 Puerperal fever and puerperal pyrexia

1919 Trench fever; malaria; dysentery

1924 Certain contagious conditions of the eye (children received through the LCC)

1924 Zymotic enteritis

Tuberculosis

1897 Poor law children

1911 Insured persons under the National Insurance Act, 1911

1913 - 1921 Non-insured persons

Venereal disease

1916 Parturient women

1917 Infants suffering from ophthalmia neonatorum

1919 Other women and girls

Children's diseases

1897 Ophthalmia and ringworm (children)

1924 Interstitial keratitis and infantile paralysis

1925 Marasmus

1925 - 1929 Encephalitis lethargica (cases suffering from after-effects)

1926 Rheumatic fever; acute endocarditis, chorea

Carcinoma

1928 Women suffering from carcinoma of the uterus

Mental disorders and epilepsy

1867 Harmless poor law 'imbeciles' (adults and children, capable of improvement and non-improvable)

1891 Suitable cases certified under the Lunacy Acts transferred form the London County 'lunatic asylums'

1897 Feeble-minded poor law children (uncertified)

1916 - 1917 Sane epileptics (poor law)

1918 Cases certifies under the 1913 Mental Deficiency Act (poor law and non-pauper)

1924 Mentally infirm persons over 70 years of age (poor law) who had not previously been certified

Healthy classes

1875 Poor law boys training for sea service (non-poor law boys were later received through the LCC be private arrangement

1902 - 1910 Juvenile offenders (MAB remand homes were transferred to the LCC in 1910)

1912 Homeless poor

1914-1919 Destitute enemy aliens and war refuges

Throughout its history the Board was kept under strict control by the central authority and approval had to be obtained from the Poor Law Board (later the Local Government Board) for all appointments of staff, purchases and allocation of property, etc. Some extra duties were placed upon the Board solely by Orders issued by the Local Government Board, e.g., the care of children suffering from opthalmia and from contagious diseases of the skin and scalp or because of some physical or mental defect, in need of special schooling (1896); and the control and management of London casual wards (1911). The most important statutes affecting the work of the Board were:-

The Diseases Prevention (London) Act, 1883 (46 and 47 Vic c.35, which removed the civil disabilities which had previously been attached to admission to the Board's hospitals)

The Public Health (London) Act, 1891 (54 and 55 Vic c.76, sanctioning the treatment of fever patients who were not paupers)

The Public Health (Prevention and Treatment of Disease) Act, 1913 (3 and 4 Geo.V c.23, sanctioning the treatment of tuberculosis patients by the Board)

The Youthful Offenders Act, 1901 (1 Edw.VII c.20 under which the Board established remand homes)

The Mental Deficiency Act, 1913 (3 and 4 Geo.V c.28 as a result of which the Board undertook the care of uncertified mental cases)

The Local Authorities (Emergency Provisions) Act, 1928 (18 and 19 Geo.V c.9 under which the Board was given co-ordinating powers over the London Poor Law Unions in respect of the Metropolitan Common Poor Fund)

Under the Local Government Act, 1929 the powers and duties of the Board were transferred to the London County Council.

An explanation of terminology: At the time of the Metropolitan Asylums Board there was no distinction between learning difficulties and mental disorders. The Mental Deficiency Act, 1927 uses the following terms:

(1) The following classes of persons who are mentally defective shall be deemed to be defective within the meaning of this Act:-
(a) Idiots, that is to say, persons in whose case there exists mental defectives of such a degree that they are unable to guard themselves against common physical dangers:

(b) Imbeciles, that is to say, persons in whose case there exists mental defectiveness which, though not amounting to idiocy, is yet so pronounces that they are incapable of managing themselves or their affairs or, in the case of children, of being taught to do so:

(c) Feeble-minded persons, that is to say, persons in whose cases there exists mental defectiveness which, though not amounting to imbecility, is yet so pronounced that they require care, supervision and control for their own protection or for the protection of others or, in the case of children, that they appear to be permanently incapable by reason of such defectiveness of receiving proper benefit from the instruction in ordinary schools:

(d) Moral defectives, that is to say, persons in whose case there exists mental defectiveness couple with strongly vicious or criminal propensities and who require care, supervision and control for the protection of others.

(2) For the purposes of this section, 'mental defectiveness' means a condition of arrested or incomplete development of mind existing before the age of eighteen years, whether arising from inherent causes or induced by disease or injury.
Note: the 1913 Act said that mental deficiency had to exist from birth or from an early age.