Haphazard development of institutions in London .sx It would hardly be untrue to say of every single one of the Poor Law institutions which came into the possession of the Council in 1930 that it owed its existence to the chance influence of a pushful individual ; or to the political doctrine of a group , carried into power by two or three dozen votes at an election of which not ten per cent .sx of the electorate was aware !sx From 1834 till 1930 , as we have just said , the County contained ( with slight changes ) twenty-five Boards of Guardians .sx Each of them sent some of its patients and beneficiaries to a huge variety of voluntary institutions , viz .sx : hospitals , homes , schools , orphanages , convalescent homes , etc. One fine day a member would get up and propose " Schools of our own , " " A Home for the Aged , of our " " A Convalescent Home of our own , " an " additional block to the infirmary , " and so on .sx The building would be erected and perhaps found far in excess of requirements .sx Cases would be received from other Authorities and often under other Acts of Parliament .sx Then came the Metropolitan Asylums Board upon which all the 25 Boards combined to own institutions and to provide services hitherto obtained by some of them in voluntary institutions , and by others supplied in their own .sx In these , again , patients were received from outside authorities , who paid for them there precisely as they paid for them in voluntary institutions .sx For a number of years prior to 1929 the great group of Institutions managed for the London Boards of Guardians by the Metropolitan Asylums Board were under the control of a genius , Sir Allan Powell , and were extremely well run .sx This was a very fortunate circumstance for the London County Council , which was compelled in that year to take over the 24,000 beds they contained !sx but it affords no sort of proof that voluntary institutions could not have rendered the required services and rendered them in a satisfactory manner .sx A remarkable illustration of the argument of this chapter is afforded by the history of the London County Council .sx From its inauguration in 1888 down to the election of 1906 , the London County Council actively and eagerly developed its functions and showed no hesitation about incurring liabilities .sx It committed itself to a directly owned and operated tramway system ( 1,660 cars , 150 miles of line 1930 figures ) , and under the Education Act of 1902 , accepted the ownership and administration , among other things , of elementary schools containing 550,000 school places .sx By 1906 it owned lunatic asylums containing 17,000 beds , in addition to the 7,000 beds in the mental hospitals , then belonging to the Metropolitan Asylums Board , but now transferred to itself .sx The burdens , liabilities and consequent danger of all this public ownership had now become painfully familiar and a group of public spirited citizens , probably without rival in capacity and application , came into office in that year determined to arrest the growth of an incubus that threatened to crush the vitality of the greatest city in the world .sx They embarked upon a policy which is at once an example and an illumination .sx New policy applied to medical treatment of school-children , tuberculosis , etc. .sx The policy was soon to be tested .sx In 1907 was passed the Education ( Administrative Provisions ) Act , under which all children attending elementary schools are medically examined .sx It immediately became necessary to produce returns of ailments treated after detection at these examinations .sx Instead of yielding to the temptation of an attractive scheme for the direct provision of treatment clinics accounts of which would have looked charming in the " shop window , " the group in power constituted the whole of the new service an opportunity for voluntary philanthropy , and so it remains to-day .sx In the year 1931 , 306,724 school-children were treated at voluntary institutions under the Council's scheme for .sx defects and ailments notified at school medical inspections .sx The scheme includes arrangements with 15 hospitals and 72 treatment centres , while of the 457 doctors , surgeons , etc. , who carried out these inspections and treatments , only 23 were full-time officers , 434 being employed only for part of their time .sx In most instances the Council does not even directly engage these part-time services , but leaves it to groups of local practitioners to detail certain of their members for the service required .sx It is impossible to exaggerate the advantage to the community of putting through this enormous mass of community service without calling into existence an army of professional people withdrawn from the life of the community , and with a huge aggregate claim against that community .sx Bearing in mind the vastly enhanced administrative convenience of operating services in directly owned premises by directly employed staff , this must be regarded as a real object lesson of far-sighted wisdom .sx One might almost think the County Council foresaw in 1907 at least the possibility of the " Crisis " of 1931 !sx It is no secret that at first distinguished officers of the Council , more interested in their own administrative duties than in public finance , opposed the Council's self-denying ordinance with all their might .sx There is nothing surprising in this , but it brings home the debt of gratitude the public owes to that resolute and far-seeing group of councillors .sx Besides the treatment of school-children the Council contracts out to voluntary institutions the whole of its venereal disease service and most of its tuberculosis service .sx The grants involved ( in the three services ) amount to about 160,000 annually .sx Rather , however , than saddle itself with directly owned and staffed institutions , the Council also makes capital grants to aid in the erection of new buildings as well as grants for maintenance .sx Policy reversed again in 1929 how it came about .sx 1906-1929 was the period of the greatest development of public medical services the period in which it is not too much to say that the centre of gravity in medical service passed over from the family doctor , the friendly society , the Provident dispensary and the voluntary hospital , to the salaried or subsidised servants of the State and a great array of public institutions .sx Till 1929 this dangerous period had been safely tided over for the citizens of London , through the wisdom of their rulers , without the enormous commitments for salaries and buildings , which might so easily have happened .sx Mean time , by the system of grants , voluntary services and institutions were strengthened , financially at least , if not morally !sx This great feat should be clearly grasped before we face the astonishing reversal of their self-denying ordinance suddenly thrust upon the Council in 1929 .sx Under the Local Government Act of that year the London County Council suddenly found itself the proprietor of 52 institutions containing 24,707 beds transferred from the Metropolitan Asylums Board , 29 Hospitals containing 17,072 beds , 25 Institutions containing 22,000 beds , and 23 schools and homes ( 7,700 children ) transferred from the 25 Metropolitan Boards of Guardians .sx Curiously , 41 district dispensaries , the type of institution they had refrained from setting up direct under the school-children's treatment scheme , also came into their hands !sx In regard to pay , emoluments and pensions , they became at the same time the direct employers of 26,000 additional officers .sx Of all the reasons we have enumerated which induce a public body to make itself liable for institutions , which was the one that , in one fell swoop , destroyed a wise constructive policy based upon a self-denying ordinance in regard to any such liability , which had triumphed during a quarter of a century ?sx The Answer must be , " the eternal enigma of the Poor Law .sx " For it was under the Poor Law that this enormous commitment of public liability had been piled up .sx We do not know the secrets of the County Council or the Ministry of Health .sx No break in any Poor Law service was possible .sx Every part of it had to be just as much in being on the morning of .sx April 1st , 1930 , as at midnight on March 31st , 1930 .sx The end is not yet .sx There are many ways , familiar to the London County Council , of passing on the direct ownership of many of these institutions to voluntary bodies .sx It was announced at the time that the new arrangements would take five years to complete .sx Ten years is thought more likely now .sx If part of this terrific mortgage upon London business life can be passed to institutions or foundations outside the reach of politics , a second object-lesson in municipal wisdom will be given to the world .sx No one will be more grateful than the housewife and her friends , amongst whom we so proudly count ourselves .sx A public institution as a means of transferring wealth to another class .sx The unequal distribution of wealth in human society is the principal subject matter of politics .sx The forcible transfer of part of one man's income to another man attracts some minds but not others .sx As a device for achieving this transference a public institution has many advantages .sx It puts the presumably poorer man in direct enjoyment of services for which the richer man pays a considerable price .sx The history of benefaction contains far more examples of indirect transfer of wealth through the medium of serviceable institutions than by way of cash payments .sx In the occupation and excitement of building , equipping and running the institution , the sacrifice of cash is lost sight of , or at least a quid pro quo enjoyed .sx It is a method which appeals to the British public .sx Most of them far prefer supporting charity through the medium of lotteries , sweepstakes , bazaars , concerts , whist drives and the like , to subscribing cash .sx When it is analysed , however , the provision of a hospital or a school out of money forcibly raised by taxation , is a very different thing from its voluntary provision by philanthropists .sx Analysis is a rare process , and the average politican gets as much enjoyment from transferring other people's wealth by the method of setting up a public institution as the benevolent donor does .sx Unfortunately for the public , and especially the housewife , this method of equalising wealth is fraught with danger because of the lasting character of the liability incurred .sx The construction of public institutions is a fruitful source of unemployment .sx The burden imposed upon the housewife by public institutions , both in cost of current upkeep and in future liability , is of staggering dimensions .sx Compared to hers , the task of Sisyphus was a rest cure .sx Besides the rates , which are added to her rent , she is hit in five other ways , and hit cruelly , because she is most exposed to the penalties of economic irregularity and discontinuity , and least able to bear them ( cf .sx Chapters I and II) .sx 1 .sx The construction of public buildings is not subject to the steady operation of supply and demand .sx Upon each occasion the order is an arbitrary one due to the initiative of some elected person .sx Being lucrative , capital and labour are deflected to it from ordinary channels .sx When the building is completed , all this equipment and labour suddenly competes again in the market .sx Thus , orders for public buildings cause economic dislocation .sx z. This evil is aggravated by the fact that such buildings or extensions are frequently ordered in response to pressure behind the scenes by some section of the building trade which is redundant to market requirements .sx The order of the public building perpetuates and intensifies this redundancy .sx " Public works contracting " comes high on the list of industrial groups when arranged in the order of their unemployment and in the order in which they drain the Unemployment Insurance Fund .sx The withdrawal from the give and take of ordinary life of the institutional staffs , entrenched against economic fluctuations , aggravates the pressure of bad times upon .sx the housewife , the last and weakest link in the chain of those who have to support them ( cf .sx Chapter II) .sx 5 .sx The temptation of putting in hand the construction of public buildings in bad times as a means of " evening out the demand for labour " has proved a disastrous one for this country , and that on a gigantic scale .sx The Prime Minister ( Mr. J. Ramsay Macdonald ) has found it necessary to emphasize this finding repeatedly even in the autumn of 1932 .sx